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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 76 out of 5,069

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VAERS ID: 1437049 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chills, Confusional state, Hyperhidrosis, Muscle spasms, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Dystonia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: 104.4 fever Chills Body aches Muscle cramps Confusion Sweats


VAERS ID: 1437051 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939676 / 3 LA / IM

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

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

Write-up: Error: Booster Given Too Early-


VAERS ID: 1437052 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EX0202 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Dizziness, Flushing, Hyperhidrosis, Hypotension, Nausea, Syncope, Tremor, Unresponsive to stimuli, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

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

Write-up: Systemic: Dizziness / Lightheadness-Severe, Systemic: Fainting / Unresponsive-Medium, Systemic: Flushed / Sweating-Severe, Systemic: Hypotension-Medium, Systemic: Nausea-Severe, Systemic: Shakiness-Medium, Systemic: Vomiting-Medium, Systemic: Weakness-Medium


VAERS ID: 1437055 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 1 LA / IM

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

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

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


VAERS ID: 1437058 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Confusional state, Dizziness, Dyspnoea, Fatigue, Flushing, Hyperhidrosis, Hypotension, Lethargy, Nausea, Syncope, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

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

Write-up: Systemic: Allergic: Difficulty Breathing-Medium, Systemic: Confusion-Medium, Systemic: Dizziness / Lightheadness-Severe, Systemic: Exhaustion / Lethargy-Severe, Systemic: Fainting / Unresponsive-Medium, Systemic: Flushed / Sweating-Severe, Systemic: Hypotension-Medium, Systemic: Nausea-Medium


VAERS ID: 1437060 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 2 LA / IM

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

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

Write-up: Error: Wrong Dose of Vaccine - Too High-


VAERS ID: 1437061 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 2 LA / IM

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

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

Write-up: Error: Wrong Dose of Vaccine - Too High-


VAERS ID: 1437226 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Hawaii  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009D21A / 2 LA / IM

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

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

Write-up: Error: Booster Given Too Early-


VAERS ID: 1437227 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1816022 / 1 RA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Presyncope, Syncope, Tremor
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Systemic: Dizziness / Lightheadness-Medium, Systemic: Fainting / Unresponsive-Medium, Systemic: Shakiness-Mild, Additional Details: patient had vasovagal episode @ 3 minutes after receiving Janssen vaccine. Has a history of vasovagal with blood draw and injection.


VAERS ID: 1437228 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-23
Onset:2021-06-29
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 049C21A / 1 LA / IM

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

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

Write-up: Site: Pain at Injection Site-Medium, Site: Redness at Injection Site-Medium, Site: Swelling at Injection Site-Medium, Additional Details: PATIENT SAYS RASH IS TRAVELING UP ARM AND IS NOW AT NECK. WILL UPDATE US IF GETS WORSE


VAERS ID: 1437231 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 1 LA / IM

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

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

Write-up: Systemic: Dizziness / Lightheadness-Mild, Additional Details: Patient felt overwhelemed due to fobia of needles


VAERS ID: 1437232 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009D21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Flushing, Hyperhidrosis, Seizure
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Systemic: Dizziness / Lightheadness-Medium, Systemic: Flushed / Sweating-Severe, Systemic: Seizure-Medium, Additional Details: Pt had a seizure about 3 minutes after receiving the second Moderna vaccine. He previously reported to adverseve reaction with 1st vaccine. Per mom who is a RN, pt first stated that he was lightheaded and she had him sit down. Then his eyes rolled back and he had a seizure. Mom shouted to me that he was having a reaction and she called 911 from her cell phone. A few minutes later he was able to talk to his as we waited for the paramedics.


VAERS ID: 1437234 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011D21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Confusional state, Dizziness, Dyspnoea, Fatigue, Flushing, Hyperhidrosis, Hypotension, Lethargy, Syncope, Tremor, Visual impairment
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (narrow), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Glaucoma (broad), Optic nerve disorders (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

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

Write-up: Systemic: Allergic: Difficulty Breathing-Medium, Systemic: Confusion-Severe, Systemic: Dizziness Lightheadedness-Severe, Systemic: Exhaustion/Lethargy-Severe, Systemic: Fainting/Unresponsive-Severe, Systemic: Flushed/Sweating-Severe, Systemic: Hypotension-Severe, Systemic: Shakiness-Mild, Systemic: Visual Changes/Disturbances-Severe, Systemic: Weakness-Severe. Additional Details: ER determined patient had a vasovagal syncope episode. At the time of the reaction, patient appeared to have trouble breathing (head back and making noises). I could not find a strong carotid pulse, so 1 dose of epinephrine was given.


VAERS ID: 1437246 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-06-25
Onset:2021-06-29
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0164 / 2 RA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Synthroid, calcium, vit d, vitc, magnesium, l-lysine/amino acid, bee pollen, collagen
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: n/a
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: 5 days later, woke up extremely dizzy and nauseated. Slightly sweaty. Temp was 97.3. Nausea left after 5 hours. Dizziness was reduced but still slightly present.


VAERS ID: 1437252 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-06-03
Onset:2021-06-29
   Days after vaccination:26
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0158 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Cardiac failure congestive, Condition aggravated, Dyspnoea, Oedema peripheral, SARS-CoV-2 test positive
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Angioedema (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 8 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: apixaban (ELIQUIS) 2.5 MG TABS tablet atorvastatin (LIPITOR) 20 MG tablet Blood Glucose Monitoring Suppl (BLOOD GLUCOSE MONITORING KIT GENERIC) kit calcium (OSCAL) 500 MG tablet clopidogrel (PLAVIX) 75 MG tablet Continuous Blood Gluc Sensor
Current Illness: Hospitalized due to complications of COVID-19 infection from 4/6/2021-4/17/2021 with subsequent admission to subacute rehab facility from 4/17/2021-5/3/2021.
Preexisting Conditions: Type 2 diabetes mellitus with stage 3 chronic kidney disease, with long-term current use of insulin (HCC) Hearing loss Psoriasis Mixed hyperlipidemia CKD (chronic kidney disease) stage 3, GFR 30-59 ml/min DJD (degenerative joint disease), ankle and foot B/L Secondary hyperparathyroidism of renal origin (HCC) HTN, goal below 130/80 Normocytic anemia related to CKD Diabetic neuropathy (HCC) S/P aortic valve replacement CAD (coronary artery disease) Body mass index 28.0-28.9, adult Continuous leakage of urine Mild persistent asthma without complication Benign prostatic hyperplasia with urinary frequency Thin blood (HCC) PAD (peripheral artery disease) (HCC) Pacemaker Polypharmacy COVID-19 Cellulitis of leg, right Cellulitis of leg, left Encephalopathy acute Bilateral lower extremity edema
Allergies: None known
Diagnostic Lab Data: COVID-19 test positive 4/9/2021 and 6/29/2021.
CDC Split Type:

Write-up: Patient presented to emergency department with complaints of worsened shortness of breath and lower extremity edema on 6/22/2021. He was admitted for further management of CHF exacerbation. During screening for placement to post acute rehab facility, patient was found to be COVID-19 positive on 6/29/2021. He was treated for COVID-19 infection in April of 2021. He is still admitted at time of writing.


VAERS ID: 1437253 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW01990 / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Diarrhoea
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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: sucralsate Donapill Pantoparcole
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data:
CDC Split Type:

Write-up: Dirahrra within 4 hours of the shot.


VAERS ID: 1437258 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-06-23
Onset:2021-06-29
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Spoke to my doctor over the phone. Will schedule a visit in approximately 2 weeks if this does not clear up.
CDC Split Type:

Write-up: Left armpit is swollen (lymph node the size of a small orange) and right armpit also swollen but not as severe as the right.


VAERS ID: 1437263 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-06-28
Onset:2021-06-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0153 / 2 LA / SYR

Administered by: School       Purchased by: ?
Symptoms: Chills, Feeling hot, Head discomfort, Pain, Photophobia, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious meningitis (narrow), Glaucoma (broad), Corneal disorders (broad), Retinal 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: Ashlyna
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Chills/full body aches/ heavy head/sensitivity to light/Fever 101.7/Feeling hot.


VAERS ID: 1437271 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Maine  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO191 / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Abdominal distension, Flatulence
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

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

Write-up: Gas and bloating


VAERS ID: 1437272 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 RA / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Flu shot 10 years or more ago
Other Medications: none
Current Illness: none
Preexisting Conditions: Thyroid condition
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Itchy hands, itching all over, broke out in rash, swollen face


VAERS ID: 1437279 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0202 / 2 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Incorrect dose administered
SMQs:, Medication errors (narrow)

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

Write-up: Gave .5 mls of the vaccine instead of the recommended .3mls


VAERS ID: 1437283 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0202 / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Incorrect dose administered
SMQs:, Medication errors (narrow)

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

Write-up: Patient was given .5mls instead of the recommended .3 mls.


VAERS ID: 1437295 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0202 / 2 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Incorrect dose administered
SMQs:, Medication errors (narrow)

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

Write-up: Patient was given .5ml instead of the recommended .3 mls


VAERS ID: 1437309 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0202 / 2 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Incorrect dose administered
SMQs:, Medication errors (narrow)

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

Write-up: Patient was given .5mls instead of the recommended .3mls.


VAERS ID: 1437311 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood glucose, Loss of consciousness, Oxygen saturation
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

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

Write-up: PATIENT CAME TO RECEIVE VACCINE AT THE PHARMACY, AFTER GETTING THE VACCINE PATIENT PASSED OUT WHITE SITTING ON THE CHAIR FOR OBSERVATION


VAERS ID: 1437313 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Headache, Joint contracture, Loss of consciousness, Nausea, Pyrexia, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: 2 mins after receiving the vaccine he became dizzy and nauseous. Then later loss conscious, hands were clenched and was unresponsive for 45 seconds. Fever and slight headache currently.


VAERS ID: 1437317 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026A21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Diarrhoea, Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: HCTZ, Synthroid, Doxepin, Fluticazone-Salmet inhaler
Current Illness: COPD, HTN, Depression, Chronic Laryngitis, vertigo, tinnitis
Preexisting Conditions: Tobacco User
Allergies: PCN, Morphine, Sulfa Drugs, Tizanidine, Meloxicam, Contrast
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt received 2nd dose of Moderna at 2pm on 6/29/2021, by 6pm same day started having symptoms of nausea/vomiting/diarrhea. At time of report on 6/30/2021, patient still having these symptoms. Pt states she has to go to work today. PCP was notified and the nurse spoke with pt and OTC meds were recommended. Pt to call back if symptoms persist.


VAERS ID: 1437328 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 2 - / 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? 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:

Write-up: Patient received Pfizer vaccine as dose 2 in series in place of Moderna [Dose #1 received 6/1/2021]


VAERS ID: 1437333 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 008C21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Mouth swelling, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: loratidine 10 mg
Current Illness: none
Preexisting Conditions: none
Allergies: citric acid
Diagnostic Lab Data: none
CDC Split Type:

Write-up: hives arms, chest, buttocks, mouth. Mouth swelling. treatment: claritin 10 mg po. symptoms resolved within 5 hours. still some mouth swelling the following day, advised cetirizine 10 mg po daily X 3 days, famotidine 20 mg po daily x 3 days.


VAERS ID: 1437341 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-06-27
Onset:2021-06-29
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Adderall, lamictal, Prozac, extra strength Tylenol
Current Illness: None
Preexisting Conditions: Major depressive disorder, attention deficit hyper disorder, bipolar type 2
Allergies: Latex, cats
Diagnostic Lab Data:
CDC Split Type:

Write-up: Swelling of skin between the eyes, starting with left eye. Lasting 2 days


VAERS ID: 1437352 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-02-28
Onset:2021-06-29
   Days after vaccination:121
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory failure, Aggression, Agitation, Ammonia increased, Arteriosclerosis, Blood culture negative, Blood lactic acid, Brain natriuretic peptide, COVID-19, COVID-19 pneumonia, Chest X-ray abnormal, Computerised tomogram abdomen abnormal, Computerised tomogram pelvis abnormal, Confusional state, Cough, Delirium, Electrocardiogram, Hepatic cirrhosis, Hepatic encephalopathy, Hepatic failure, Lactic acidosis, Lung hyperinflation, Lung opacity, Malaise, Neuropathy peripheral, Non-Hodgkin's lymphoma, Paracentesis, Portal hypertension, Portal hypertensive colopathy, Respiratory tract congestion, SARS-CoV-2 test positive, Scan with contrast abnormal, Sputum culture, Thrombocytopenia, Transaminases increased, Troponin
SMQs:, Liver related investigations, signs and symptoms (narrow), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Haematopoietic thrombocytopenia (narrow), Lactic acidosis (narrow), Peripheral neuropathy (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Dementia (broad), Malignancy related therapeutic and diagnostic procedures (narrow), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Hostility/aggression (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Malignant lymphomas (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Haematological malignant tumours (narrow), Infective pneumonia (narrow), Dehydration (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: past medical history of liver cirrhosis, esophageal and gastric varices, alcohol abuse, atrial fibrillation, CHF, coronary artery disease (last stent placed in 12/7/2012), type 2 diabetes, GERD, hyperlipidemia, hypertension, peripheral neuropathy, hypothyroidism, non-Hodgkin lymphoma and obstructive sleep apnea.
Allergies: atorvastatin hydroCHLOROthiazide lisinopril meloxicam propafenone
Diagnostic Lab Data: Pt. is a 67-year-old male with a past medical history of liver cirrhosis, esophageal and gastric varices, alcohol abuse, atrial fibrillation, CHF, coronary artery disease (last stent placed in 12/7/2012), type 2 diabetes, GERD, hyperlipidemia, hypertension, peripheral neuropathy, hypothyroidism, non-Hodgkin lymphoma and obstructive sleep apnea. Patient currently has been undergoing dexamethasone and remdesivir since 6/27. Patient has not yet received a dose of Tocilizumab. Patient has also been encephalopathic most likely due to liver failure. We will continue patient rifaximin. We will use Haldol for agitation and restraints. If patient continues to be agitated patient may need intubation to continue to maintain his saturations appropriately. Neuro/Psych Hepatic encephalopathy Agitation Delirium Peripheral neuropathy OSH Ammonia 72 Haldol 5 mg as needed for agitation Continue gabapentin 3 mg 3 times daily Continue rifaximin Pulmonary Acute hypoxic respiratory failure requiring MV 6/20-P COVID 19 pneumonia, non-vaccinated Chest x-ray at outside facility on 627 showed progressive pulmonary opacities suggestive of COVID-19, hyperinflated lungs and arthrosclerotic vascular disease process -dexamethasone 6mg IV daily 6/27-p -remdesivir 6/27-p -Patient does not seem to have received a dose of tocilizumab at outside facility Cardiovascular History of CHF History of CAD A.Fib BNP at OSH 155 EKG pending Troponin pending BNP pending Endocrine History of DM2 Hyperglycemia home regimen: Tresiba 75U BID, Reg insulin 50U TID AC and metformin Started insulin drip Renal Lactic acidosis Lactate at OSH was 6.2 Lactate upon arrival was 2.8 repeat 2hr later GI Liver cirrhosis Transaminitis ?CT of the abdomen and pelvis with contrast showed findings compatible with hepatic cirrhosis and portal hypertension, metallic density in the upper gastric body most likely due to surgical changes, high density material within the dependent portion of the body of the stomach that could represent gastric bleeding, thickening of the ascending and transverse colon likely represented a portal colopathy and lungs consistent with inflammatory process like Covid. ?Last paracentesis performed on 6/27/2021. Aspirated 5.2 L and was given 25 g of albumin IV Heme/oncology Thrombocytopenia Non-Hodgkin lymphoma We will continue to monitor We will hold DVT prophylaxis due to thrombocytopenia ID COVID 19 - tx as above ?Blood cultures 6/29?no growth to date ?Respiratory culture 6/29-Pending ?Vancomycin 6/27-p -zosyn 6/27-p - Azithromycin- 6/27-p Code: FULL okay with intubation Diet: NPO Lines/Tubes/Drains: DVT Prophylaxis: hold due to thrombocytopenia Patient staffed with attending Dr.
CDC Split Type:

Write-up: Patient presented to the outside hospital on 6/27 due to having congestion and feeling much worse. Patient symptoms started on Friday (6/25) with congestion and cough. This was not able to be remedied by Mucinex. Patient then went to an urgent care clinic on Saturday and after listening to his lungs was sent to the emergency room. While in the emergency patient received a CT scan of his abdomen and pelvis which showed signs of liver cirrhosis and Covid. Patient then had a rapid Covid test that came back positive. They then obtained a confirmatory test but that is still pending. Patient then had agitation while he was in the hospital to the point where he almost struck a nurse. Patient''s confusion got a little bit better but was found to have an elevated ammonia which was thought to be the cause of his delirium.


VAERS ID: 1437356 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-06-28
Onset:2021-06-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Asthenia, Chills, Fatigue, Headache, Pain, Pain in extremity
SMQs:, Guillain-Barre syndrome (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Achy body and joints, painful arm, fatigue, weakness, headache, chills


VAERS ID: 1437366 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Wyoming  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939676 / 2 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Chest discomfort, Chills, Fatigue, Headache, Pain, Pyrexia, Vomiting
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: Felt dizzy with the 1st shot
Other Medications: Tylenol, Excedrin extra strength
Current Illness: N/a
Preexisting Conditions: Ibs, irregular heartbeat
Allergies: Sulfa
Diagnostic Lab Data:
CDC Split Type:

Write-up: Puking, headache, body ache, fever and cold chills, tightness in chest, fatigue,


VAERS ID: 1437367 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-01-28
Onset:2021-06-29
   Days after vaccination:152
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Bioflavonoid Products (VITAMIN C PLUS) 1000 MG TABS Take by mouth. ? dextromethorphan-guaiFENesin (ROBITUSSIN-DM) 10-100 MG/5ML liquid Take 5 mLs by mouth every 12 (twelve) hours. ? Echinacea 450 MG CAPS daily . ? Fluticasone
Current Illness:
Preexisting Conditions: Anxiety ? Aortic regurgitation ? Benign essential tremor ? Mononucleosis ? Murmur ? Seasonal allergies
Allergies: AMOXICILLIN
Diagnostic Lab Data:
CDC Split Type:

Write-up: PATIENT BECAME POSITIVE AFTER BEING VACCINATED.


VAERS ID: 1437376 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-06-25
Onset:2021-06-29
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Blood creatine phosphokinase MB increased, Chest X-ray normal, Chest discomfort, Chest pain, Echocardiogram, Ejection fraction decreased, Electrocardiogram abnormal, Fatigue, Myocarditis, Nausea, Pain, Pain in extremity, Palpitations, Sensory disturbance, Sinus arrhythmia, Sinus bradycardia, Sleep disorder, Troponin increased, Ventricular hypokinesia, Vomiting
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (narrow), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Disorders of sinus node function (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Buspar
Current Illness: Anxiety and depression
Preexisting Conditions:
Allergies: Amoxicillin, Cephalexin
Diagnostic Lab Data: 6/29 - EKG showed sinus bradycardia with rate of 53 and sinus arrhythmia. Chest x-ray was clear. Troponin elevated at 10.7. Cardiology was consulted in the ED and ordered a TTE which showed decrease LVEF of 40%, mild left ventricular global hypokinesis, which is suggestive of myocarditis. Troponin was trended and continued to rise up to 19.5. CK-MB and CK were both elevated.
CDC Split Type:

Write-up: Patient is a 19 y.o. male with PMH significant for anxiety and ADHD who presents with chest pain and palpitations. He was woken up this morning by chest pain described as sharp, midsternal, 7/10, radiating down right arm, with no exacerbating or alleviating factors. He also reports chest pressure. During episode of chest pain he felt his heart was beating fast. He felt nauseous and vomited once. He received his 2nd Pfizer COVID vaccine 4 days ago. He states that he felt fatigue and aching for a day following the vaccine.


VAERS ID: 1437394 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-02-26
Onset:2021-06-29
   Days after vaccination:123
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Back pain, Haematuria, Renal cyst
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Retroperitoneal fibrosis (broad), Tubulointerstitial diseases (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: right side back pain, hematuria, cyst of kidney


VAERS ID: 1437407 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-06-28
Onset:2021-06-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 0178 / 1 LA / SC
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 2 LA / SC

Administered by: Pharmacy       Purchased by: ?
Symptoms: Bowel movement irregularity, Chills, Lymphadenopathy, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Synthroid, Lipitor
Current Illness: no
Preexisting Conditions: hypothyroidism, elevated LDL
Allergies: Penicillin, Iodine, wild mushrooms
Diagnostic Lab Data: CALLED DR, SHE SAID ITS A KNOWN SIDE EFFECT. DO NOT SCHEUDULE MAMMOGRAM FOR 6-8 WEEK TO AVOID FALSE POSITIVE
CDC Split Type:

Write-up: LEFT LYMPH NODE SWOLLEN FEVER CHILLS BOWEL MOVEMENT ISSUE


VAERS ID: 1437417 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006C21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chills, Diarrhoea, Dizziness, Gait disturbance, Headache, Joint range of motion decreased, Myalgia, Nausea, Pyrexia, Retching
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Arthritis (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Xanax, Furosemide, Lexapro, Albuterol, Metformin, Lisinopril, Amlodipine, Triamcinolone
Current Illness: none
Preexisting Conditions: Diabetes Mellitus type II, Anxiety, Hypertension
Allergies: Crestor, Hctz, Td toxoid, Talwin, Sulfa, Penicillins, Novocain, Norgesic Forte, Codeine
Diagnostic Lab Data: none at this time
CDC Split Type:

Write-up: Patient experienced chills and fever for hours, Nausea with dry heaves, Diarrhea, severe Headache, Dizziness , staggering gait, myalgia causing difficulty in raising her or moving left arm---patient advised that she could treat signs and symptoms, which started 11pm the night before and continued at time of her call to the office to report adverse reactions at 10 am on 6/30/21


VAERS ID: 1437436 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-02-23
Onset:2021-06-29
   Days after vaccination:126
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

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

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

Write-up: Patient with positive COVID 19 test after vaccination series complete (breakthrough). ASYMPTOMATIC, prescreening test prior to medical appointments


VAERS ID: 1437447 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-17
Onset:2021-06-29
   Days after vaccination:104
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

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

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

Write-up: Positive COVID 19 test result when prescreening done for orthopedic surgery. ASYMPTOMATIC


VAERS ID: 1437460 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8736 / 2 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Chills, Cold sweat, Lymphadenopathy, Nausea
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: No
Diagnostic Lab Data:
CDC Split Type:

Write-up: Clammy, chills, nausea, lymph node in left armpit enlarged to size of a line


VAERS ID: 1437465 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-28
Onset:2021-06-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Amlodipine, cymbalta, Allegra, Benadryl, aspirin, vit D, temazapan
Current Illness: Allergies, chronic lymphocytic leukemia, Ehlers Danlos Syndrome
Preexisting Conditions: Chronic lymphocytic leukemia, Ehlers Danlos syndrome
Allergies: Iodine, penicillins, avocados, bananas, melons, nuts, shellfish,
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Fever of 102.7 for 21 hours, starting at midnight on day of vaccine (14 hours later), headache, swollen lymph nodes in neck, armpits and groin, nausea , extreme fatigue. With the exception of fever, the other reactions are continuing throughout day three.


VAERS ID: 1437468 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / IM

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

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: Spironolactone 200mg, Women?s Multivitamin (One a Day)
Current Illness: n/a
Preexisting Conditions: Asthma
Allergies: n/a
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever (101? F), Chills, Body Aches, Chest Pain, Headache, Shortness of Breath


VAERS ID: 1437472 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: NO
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient received Moderna vaccine on 06/05/2021 and received Pfizer on 06/29/2021


VAERS ID: 1437474 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-04-29
Onset:2021-06-29
   Days after vaccination:61
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017C21A / 2 UN / UN

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Muscular weakness, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: leg weakness, Positive COVID 19 test


VAERS ID: 1437486 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-26
Onset:2021-06-29
   Days after vaccination:64
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7533 / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8736 / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: First trimester pregnancy, Haemorrhage in pregnancy, Vaginal haemorrhage
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Normal pregnancy conditions and outcomes (narrow)

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

Write-up: Vaginal bleeding in pregnancy, first trimester


VAERS ID: 1437501 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-01-29
Onset:2021-06-29
   Days after vaccination:151
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK4176 / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: COVID-19 RNA DETECTION BDMAX positive 06/29/2021
CDC Split Type:

Write-up: Pt currently has Covid 19


VAERS ID: 1437525 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 2 - / IM

Administered by: Other       Purchased by: ?
Symptoms: Chest pain, Electrocardiogram, Hyperhidrosis, Hypertension, Tachypnoea
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Hypertension (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Hypoglycaemia (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:
Other Medications:
Current Illness:
Preexisting Conditions: Denied, but family reported multiple illnesses as a small child.
Allergies:
Diagnostic Lab Data: Abnormal EKG
CDC Split Type:

Write-up: Client reported acute, sharp chest pain the moment the needle entered his arm. Chest pain was temporarily relieved by pressure, accompanied by diaphoresis, tachypnea and hypertension. EMS was called and initial EKG showed abnormal T waves. Client was transported to hospital for further care.


VAERS ID: 1437528 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 RA / IM

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

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

Write-up: Patient was given the Janssen Covid vaccine. He is only 16 years old so should not have received this vaccine. He should have received the Pfizer


VAERS ID: 1437544 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-28
Onset:2021-06-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Dizziness, Loss of consciousness, Migraine, Syncope, Tremor
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

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

Write-up: 13 hours after vaccine: extreme, violent shaking (chills) lasting about 12 hours 19 hours after vaccine: dizziness, then fainting (brief loss of consciousness) 20 hours after vaccine: intense migraine for 12 hours


VAERS ID: 1437550 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-06-11
Onset:2021-06-29
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 1 LA / -

Administered by: Private       Purchased by: ?
Symptoms: Angiogram cerebral, Arteriosclerosis, Atrophy, Brain oedema, Carotid artery disease, Carotid artery stenosis, Cerebral artery stenosis, Cerebral haemorrhage, Cerebral small vessel ischaemic disease, Cerebral venous thrombosis, Computerised tomogram abnormal, Condition aggravated, Meningioma, Nodule, Osteoma, Thyroid mass, Vertebral artery stenosis
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Hyponatraemia/SIADH (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? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: OMEPRAZOLE 20 mg hydroCHLOROthiazide 12.5 mg Tablet
Current Illness: N/A
Preexisting Conditions: HTN, carotid stenosis prior stroke without residual
Allergies: N/A
Diagnostic Lab Data: CT 6/29/2021 :1. Acute moderate sized parenchymal hemorrhage in left parietal region with associated edema. 2. Adjacent overlying hyperdense cortical vein suspicious for venous thrombosis. Associated smaller thrombosed vessel is also questioned. CT angiography of the brain is in progress. 3. Age-appropriate volume loss and changes of chronic microvascular ischemic disease CONCLUSION: 1. There is a somewhat diminutive appearance of the distal left posterior cerebral artery involving the P2 segment with areas of suspected high-grade stenosis. There is asymmetric appearance with hypoenhancement and decreased vascularity in the expected location P3 and P4 branches, occlusion or more proximal stenosis is not excluded. 2. There is additionally high-grade stenosis at the origin of the left P1 segment. 3. There is heavy calcified plaque in the intracranial carotid arteries, as well as vertebral arteries, limiting evaluation. There is suspected to be up to about moderate stenosis. 4. There is severe rather focal calcified and noncalcified plaque in the right proximal ICA with high-grade greater than 70% stenosis. 5. There is significant disease in the left carotid system with less than 50% stenosis in the proximal left ICA. 6. Additional atherosclerotic disease is noted in the visualized thorax, including calcified and noncalcified plaque in aortic arch, some which is likely ulcerated. This extends to multiple arch vessels. 7. Known left parenchymal hemorrhage. Suboptimal opacification of the venous system. The dense vein over the hemorrhage was present on noncontrast CT. Consider repeat CT venogram or MRI venogram, MRI venogram may be limited for evaluation of smaller cortical veins. 8. Small osteoma or meningioma in the right parietal region. 9. Atrophy and changes of chronic microvascular ischemic disease. 10. Large right thyroid nodule and smaller nodules present as well. Please correlate with any prior workup, otherwise thyroid ultrasound recommended, tissue sampling will likely be necessary as well.
CDC Split Type:

Write-up: left parietal ICH


VAERS ID: 1437558 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 2 LA / IM

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

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

Write-up: PATIENT WAS SCREENED FOR COVID-19 VACCINE DOSE #2. PATIENT WAS ADMINISTERED VACCINE AT 9:03 AM AND ABOUT A MINUTE AFTER RECEIVING VACCINATION THE PATIENT PASSED OUT (BLACKED OUT) FOR A BRIEF SECOND AND THEN CAME BACK. PATIENT WAS TALKING NORMALLY AND HAD NO SOB. 911 WAS NOT CALLED, PATIENT THEN STAYED IN OBSERVATION AREA FOR 20 MINTUES AND AT THAT TIME PATIENT STATED THEY WERE FEELING BETTER. BOTH MOTHER AND DAUGTHER LEFT PHARMACY AFTER THAT. I ADVISED TO SEEK MEDICAL ATTENTION IF SYMTPOMS CAME BACK.


VAERS ID: 1437563 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-06-25
Onset:2021-06-29
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 1 LA / SYR

Administered by: Private       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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Fish oil, Vitamin D and B
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: None
CDC Split Type:

Write-up: the day after the shot i have had a shin reaction and a rash on both arms and both legs. It itches really bad


VAERS ID: 1437564 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Maine  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 59676-0580-15 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hot flush, Hyperhidrosis, Immediate post-injection reaction, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Had immediate hot flash with lots of sweating and fainted. Unconscious for 1 minute and woke up feeling better and more cooled. Used ice packs and wet cloth to cool down. Took blood pressure and pulse - BP: 95/60 Pulse: 59; is on blood pressure meds and was told this was his normal by his wife.


VAERS ID: 1437568 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Maine  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hot flush
SMQs:

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

Write-up: Patient immediately got a bad hot flash. Drank some water and a few minutes later was fine.


VAERS ID: 1437592 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Palpitations
SMQs:, Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad)

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

Write-up: Patient stated he started to have heart palpitations in his car on the way home from the immunization and was still having some palpitations the following day. I instructed patient to call his physician.


VAERS ID: 1437625 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-04-16
Onset:2021-06-29
   Days after vaccination:74
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8729 / 2 LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8735 / 1 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Blood test, Chest X-ray, Chest discomfort, Chest pain, Electrocardiogram, Limb discomfort, Musculoskeletal discomfort
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: none
Preexisting Conditions: none
Allergies: Penicillin and Percocet
Diagnostic Lab Data: Ekg, chest x-rays, blood work
CDC Split Type:

Write-up: Right Chest discomfort, achy, and tightness. Goes into right shoulder. Right arm feels heavy


VAERS ID: 1437627 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-06-26
Onset:2021-06-29
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: On the night of 6/29/21, developed hives in random places on abdomen, back, legs, backs of arms. Applied calamine lotion and hives were gone in the morning.


VAERS ID: 1437630 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0165 / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Headache, Loss of consciousness, Pain
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

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

Write-up: 1:15PM-vaccine given and patient sent to waiting room for 15 minute waiting period. 1:25PM-patients wife alerted staff that he was "passing out". Staff assisted patient in waiting room, instructed to remain seated, patient had LOC for <10 seconds and then regained consciousness immediately after. Patient instructed to remain in the clinic until 1:50PM, provided apple juice, crackers and ice pack. 1:50PM patient left with his wife, said that a friend drove them to appointment so they would not be driving. 6/30/2021 2:00PM- call to patient for follow-up, he is feeling much better today, has slight headache and body aches but no other complaints.


VAERS ID: 1437672 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-26
Onset:2021-06-29
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / IM

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

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

Write-up: Pt noted with swollen axillary lymph node


VAERS ID: 1437687 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Nevada  
Vaccinated:2021-06-28
Onset:2021-06-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH SW0217 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Erythema, Headache, Pain of skin, Pyrexia, SARS-CoV-2 test, Skin burning sensation, Tremor
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), COVID-19 (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: Dietary supplements: Probiotics, Vitamin D-3, Collagen, organic fish oil, magnesium citrate and niacin
Current Illness: None
Preexisting Conditions: None
Allergies: Most perfumes and anti-perspirants/deodorants
Diagnostic Lab Data: They administered a Covid-19 test, still awaiting the results
CDC Split Type:

Write-up: About 26 hours after vaccine shot, my skin felt like it was burning and turned very red, had to put wet towels on skin to ease the pain, had slight fever (100.2) and a headache. Contacted Dr on call. Dr told me to go to urgent care or the ER and to take any allergy medication I happened to have. I took Claritin-D and waited for half hour. By then burning sensation was a lot better, but I started shaking and could not stop, even outside the house at a 100-degree heat. Went to the Urgent care clinic, I was given dexamethasone sodium phosphate and the doctor there told me to take benadryl every six hours as needed.


VAERS ID: 1437690 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Incorrect dose administered, Incorrect product formulation administered, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Medication errors (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: Tylenol was taken hours after vaccine administration
Current Illness: none
Preexisting Conditions: none
Allergies: nkda
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Patient was given 0.3 mL of undiluted Pfizer Vaccine by pharmacist on duty. It was suppose to be the patients second dose. Patient received 6 times the dose. Patient developed severe fatigue and body aches about 12 hours later. Patient visited the urgent care overnight due to fever. Patient is currently resting at home and being monitored 24 hours after the administration of the vaccine.


VAERS ID: 1437705 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Incorrect dose administered, Incorrect product formulation administered, No adverse event, Product preparation error
SMQs:, Medication errors (narrow)

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

Write-up: Patient received dose 1 of an undiluted Pfizer Vaccine. ( 6 times the dose). Patient reported no adverse effects after 24 hours


VAERS ID: 1437718 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 1 LA / IM

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

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

Write-up: Patient received an undiluted pfizer vaccine (6 times the dosage). Patient reported no adverse side effects after 24 hours


VAERS ID: 1437749 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-02-04
Onset:2021-06-29
   Days after vaccination:145
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Hospital 6/29/21


VAERS ID: 1437760 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: Delaware  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022B21A / 1 LA / IM

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

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

Write-up: Patient passed out while waiting the 15 minutes wait period after receiving his shot. He later reported that he passes out when nervous. Minutes after while under observation, he also vomited but then felt better and was able to leave with family member after approximately a 30 minute observation period.


VAERS ID: 1437778 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Montana  
Vaccinated:2021-01-18
Onset:2021-06-29
   Days after vaccination:162
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3246 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Positive for COVID by nasal swab on 6/29/2021
CDC Split Type:

Write-up: Tested positive for COVID after being fully immunized for COVID


VAERS ID: 1437786 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 1 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? 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 inadvertently given a vaccine that had expired the day before.


VAERS ID: 1437791 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: New York  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA LOT: 040B21A / 1 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (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: Reported an episode of syncope after Moderna second dose.


VAERS ID: 1437826 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-06-28
Onset:2021-06-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Went to the dentist for a cleaning, had flouride on teeth. May have taken a hydroxyzine to aid in sleep.
Current Illness: None
Preexisting Conditions: Injured ankle.
Allergies: Naproxen
Diagnostic Lab Data:
CDC Split Type:

Write-up: Terrible, excruciating pain in arm of injection, the entire arm but mostly lower. Terrible head and neckache. Worst pain in life besides childbirth, even worse than complete shattering of both ankle bones and heel after being hit by a car.


VAERS ID: 1437843 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-04-20
Onset:2021-06-29
   Days after vaccination:70
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0150 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 2 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Blood lactate dehydrogenase normal, C-reactive protein increased, COVID-19, Chest X-ray normal, Cough, Fibrin D dimer normal, Nasopharyngitis, Red blood cell sedimentation rate normal, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Insulin glargine, linsulin lispro
Current Illness:
Preexisting Conditions: Type 1 diabetes
Allergies: No known allergies
Diagnostic Lab Data: 6/29/2021, Normal chest Xray, normal ESR, D-Dimer, and LDH. Mild elevation in CRP.
CDC Split Type:

Write-up: Pt received both doses of the Pfizer COVID-19 vaccine, on 3/31/21 and 4/20/21. He then presented to the ER on 6/29/2021 for an unrelated reason (DKA) and was tested per protocol for COVID-19 prior to admission. This test on 6/29/2021 was positive. Pt reports having a mild cold about a week ago, with a mild cough on presentation to the ER. EMR also indicates that he had COVID 12/2020 (fatigue, loss of taste, cough).


VAERS ID: 1437846 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood glucose normal, Hyperhidrosis, Muscle spasms, Pallor, Seizure, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Dystonia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), 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: None
Diagnostic Lab Data: EMS tested heart - normal, Tested blood sugar - normal, BP tested - normal
CDC Split Type:

Write-up: Fainted and had a slight seizure. Left hand seized up. Lasted for about 45 seconds. Lost color in face and sweating all over.


VAERS ID: 1437897 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1816022 / 1 UN / SYR

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

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

Write-up: 12 yo female injected by NP provider against management advice and consent signed by NP instead of a parent/legal guardian. We were advised by a public health nurse to report this as the administration of COVID-19 Janssen vaccine to a 12 year old is considered as a medication error due to the patient being under an unauthorized age group.


VAERS ID: 1437923 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: New York  
Vaccinated:2021-06-28
Onset:2021-06-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / UNK RA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, Blood pressure normal, Confusional state, Dizziness, Inflammation, Injection site pain, Muscle twitching, Nausea, Neck pain, Pain in extremity, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Dyskinesia (broad), Dystonia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lamictal, Methylphenidate, Wellbutrin
Current Illness: None
Preexisting Conditions: None
Allergies: Sulfa, shellfish, Vyvanse, Adderall
Diagnostic Lab Data: Examined my own pulse and it was 93 and 87 bpm. Examined my own blood pressure and it was in the normal range (118, 77).
CDC Split Type:

Write-up: Pain at injection site, then twitching and pain in right leg, pain in left shoulder, pain in left side of neck. Pain feels like soreness and inflammation. Twitching in muscles of right leg, and twitching in other parts of my body. Nausea, dizziness, confusion, vomiting.


VAERS ID: 1437934 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dizziness
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE NOTED
Preexisting Conditions: Diabetes, High BP
Allergies:
Diagnostic Lab Data: 18:29 BP 130/ 80 HR 91 RR 16 BGL 253 O2SAT 91% ON RA. 18:31 BP 110/80 HR 80 RR 14 O2 SAT 97 % ON RA
CDC Split Type:

Write-up: Mild Dizziness. Patient takes Metformin and Lisinopril


VAERS ID: 1437951 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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 received one dose of Pfizer after already receiving one dose of Janssen in March 2021. The patient intentionally gave the wrong information to the pharmacy in hopes to boost their immunity.


VAERS ID: 1437954 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-06-27
Onset:2021-06-29
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 2 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Prenatal Euthyrox (50mcg)
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pain on the left shoulder from past 24 hours?.Doctor observed and told it?s lymph nodes swelling from the side effects cause by COVID vaccine.


VAERS ID: 1437966 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 1 LA / IM

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

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

Write-up: Patient received one dose of Pfizer after receiving one dose of Janssen in March 2021. The patient intentionally misled the pharmacy to receive this vaccine based on a study the patient read in order to boost his immunity,


VAERS ID: 1437990 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-28
Onset:2021-06-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Dyspnoea, Headache, Nausea, Orthostatic hypotension
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Dehydration (broad), Hypokalaemia (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: Sumatriptan 25mg Amitriptyline 10mg Metoclopramide HCL 5ml Ibuprofen 400mg Setraline HCL 25mg
Current Illness: NONE
Preexisting Conditions: Chronic Migraines
Allergies: NONE
Diagnostic Lab Data: Vital Signs @12:18 pm BP 110/62 Pulse Oximetry 98% Pulse 130 bpm (sitting) @ 12:19 pm BP 106/60 Pulse Oximetry 99% Pulse 110 bpm (laying) @12:39 pm BP 114/60 Pulse Oximetry 98% Pulse 130 bpm (standing)
CDC Split Type:

Write-up: Shortness of breath, weakness, headache ? Vaccine RXN Orthostatic Hypotension Nausea


VAERS ID: 1438005 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: New York  
Vaccinated:2021-06-28
Onset:2021-06-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 RA / IM

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

Write-up: 45 year old female presents with cc of left axillary pain and swelling since yesterday 6/29/2021 s/p J&J Covid19 Vaccine on 6/28/2021 to left deltoid. Pt reports pain is moderate, nonradiating, constant, minimally relieved despite use of tylenol and ibuprofen. Pt denies trauma to affected region. She denies fever, chills, cough, chest pain, SOB, palpitations, weakness, numbness, tingling, headaches, neck pain, back pain, rash, dizziness. Pt offers no other complaints.


VAERS ID: 1438019 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-03-01
Onset:2021-06-29
   Days after vaccination:120
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6202 / 2 - / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Coronavirus COVID-19~Coronavirus COVID-19 - 06/29/2021 Coronavirus COVID-19~Coronavirus COVID-19 - 06/30/2021
CDC Split Type:

Write-up: 11/09/2020 - Tested positive for COVID-19 02/08/2021 & 03/01/2021 - Received Pfizer COVID-19 vaccines 06/29/2021 - Tested positive for COVID-19 at Hospital 06/29/2021 - Admitted to Medical Center / Hospital 06/30/2021 - Tested negative for COVID-19 at Medical Center / Hospital 06/30/2021 - Discharged from Medical Center / Hospital


VAERS ID: 1438050 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-06-07
Onset:2021-06-29
   Days after vaccination:22
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / SYR

Administered by: Private       Purchased by: ?
Symptoms: Visual impairment
SMQs:, Anticholinergic syndrome (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: None
Preexisting Conditions: None
Allergies: Got Hives once when I was working with a firearm assuming it was from the ammos casing
Diagnostic Lab Data: None yet. I have been trying to get a hold of eye mart to set up an appointment to hopefully get some contacts to see if that helps.
CDC Split Type:

Write-up: I usually get very light headed from needles so I brought a coke and luckily didn?t pass out in the process. However, the following night I had severe stomach pains and felt like I could throw up all night. I also was freezing but had so many blankets and sweatshirts on I was sweating too. But what?s really concerning me is that I usually wear glasses to help me see and they worked up until yesterday. I cant see things close up anymore and my glasses only work for further away things.


VAERS ID: 1438231 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-05-26
Onset:2021-06-29
   Days after vaccination:34
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Eye haemorrhage
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Retinal 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: Escitalopram, Eliquis, propanol
Current Illness:
Preexisting Conditions: Arythmia, depressikn
Allergies:
Diagnostic Lab Data: None. Calling doctor tomorrow. Never had this before.
CDC Split Type:

Write-up: Blood vessels bursting in right eye. It is continuing to worsen on second day, today.


VAERS ID: 1438233 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-25
Onset:2021-06-29
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Acute medullary stroke. Patient admitted to the hospital for initiation of aspirin and stroke work-up.


VAERS ID: 1438237 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 027A21A / N/A LA / IM

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

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

Write-up: Pt. reports on this day that he wanted to receive a Pfizer vaccine in addition to his 03/12/2021 J&J vaccine R/T fear of Covid-19 variants and J&J effectiveness. He did not report the 03/12/2021 J&J vaccine to SLOPHD. Reports he is well and wanted to have the extra Covid vaccine to prevent illness. Pt. advised to not receive a 2nd dose of Pfizer. Pt. voices understanding.


VAERS ID: 1438245 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026D21A / 1 RA / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: No adverse events that we are aware of. We input the vaccine in our state registry, agency, last night. We discovered that the patient had already received a Janssen vaccine 03/06/2021 at a different facility when we saw his record in the agency. We gave the patient first dose of Moderna 06/29/2021.


VAERS ID: 1438428 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 LA / IM

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

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

Write-up: Patient request a first dose Janssen vaccine on 6/29/21. After giving the vaccine, pharmacy was later made aware that she had received the same vaccine from a different store on 6/26/21.


VAERS ID: 1438447 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-06-06
Onset:2021-06-29
   Days after vaccination:23
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 049C21A / 2 LA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Chest pain, Dizziness, Dyspnoea, Dysstasia, Gait disturbance, Headache
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

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

Write-up: Chest pain, trouble walking ,trouble Standing,headache ,dizzy,hard to breath


VAERS ID: 1438462 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: New York  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 1 LA / IM

Administered by: School       Purchased by: ?
Symptoms: Arthralgia, Ear pain, Joint range of motion decreased, Musculoskeletal discomfort
SMQs:, Rhabdomyolysis/myopathy (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: shoulder discomfort pain in left wrist, causing limited mobility in left wrist left ear pain


VAERS ID: 1438465 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-06-28
Onset:2021-06-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026D21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chills, Fatigue, Hot flush, Oropharyngeal pain, Pain, Rash
SMQs:, Anaphylactic reaction (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: See above and other report
Other Medications: One a day multi vitamin vitamin d trazadone zrytec
Current Illness: Ear infection
Preexisting Conditions: Bipolar Osteoarthritis
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fatigue sore all over chills hot flashes sore throat Feeling of prickly like insulation a red bumps notnclustered just random is on me mostly around the midsection of my body I got this reaction afterb14 days of the 1st shot and was told by Dr probably was related to vaccine but looking back i believe i had this the first time as well it just hasn''t gotten as bad yet. He did treat me with oral and topical steriods and antibiotics for ear infection.


VAERS ID: 1438567 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Chest discomfort, Fatigue, Feeling abnormal, Myalgia, Rash, Urticaria
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (narrow), Angioedema (narrow), Dementia (broad), Eosinophilic pneumonia (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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prozac, trazadone, prebiotic supplement.
Current Illness: Irritable bowel syndrome, possible polycystic ovarian syndrom.
Preexisting Conditions: Irritable bowel syndrome. Possible polycystic ovarian syndrome.
Allergies: Metronidazole, vicodin, citrus, metal.
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Full body hives spread out only about 10 in total lasting more then 24 hours. Red blotchy non bumpy rash on both arms lasting more then 24 hours. Heavy feeling in chest lasting more then 24 hours. Severe muscle and joint aches lasting more then 24 hours. Extreme tiredness lasting more then 24 hours. Brain fog lasted less then 24 hours.


VAERS ID: 1438801 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 1 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Cardiac flutter, Chest discomfort, Dyspepsia, Dyspnoea, Eye pruritus, Fatigue, Headache, Heart rate increased, Hiccups, Lacrimation increased, Nausea, Pain in extremity
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific dysfunction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Tachyarrhythmia terms, nonspecific (narrow), Lacrimal disorders (narrow), Tendinopathies and ligament disorders (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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: Nausea, headache, moderate arm pain, mild chest tightness, chest fluttering, increased heart rate, short of breath (mild), fatigue, itchy watery eyes, hiccups, indigestion.


VAERS ID: 1438804 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH E38733 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: No adverse event, Product reconstitution quality issue
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: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none applicable at this time
CDC Split Type:

Write-up: Incorrect reconstitution of vial. 0.8 mg of saline diluent to complete vial instead of 1.8 as directed. No symptoms, no adverse effects Patient received correct 0.3ml dose concentration of vaccine in dose is higher due to incorrect reconstitution. Parent notified and informed to contact the clinic directly if any symptoms occur. Also informed to go to ER if life threatening symptoms occur. None have occurred at this time.


VAERS ID: 1438943 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH E38733 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: No adverse event, Product preparation issue
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: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none at this time
CDC Split Type:

Write-up: No symptoms no adverse effects. Incorrect reconstitution of complete vial. Diluent applied to vial 0.8 of saline instead of recommended 1.8ml as directed Patient received correct dose of 0.3ml Parent instructed to contact clinic if symptoms arise and to go to ER if life threatening symptoms occur.


VAERS ID: 1438944 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-28
Onset:2021-06-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Blood test, Dizziness, Dyspnoea, Dysstasia, Feeling abnormal, Gait disturbance, Injection site induration, Injection site swelling, Loss of personal independence in daily activities, Migraine, Pain, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Probiotics and women?s multi vitamins
Current Illness: No
Preexisting Conditions: Fibromyalgia
Allergies: Dairy, and gluten
Diagnostic Lab Data: Blood work. No results because they were taking too long, and I had to pick up my child.
CDC Split Type:

Write-up: Hard to breath, right chest, raised, swollen, rock hard injection site (left arm), dizziness, fainting, all over body ache (feels like I?m being stabbed all over), severe migraines, can?t walk or stand or drive longer than 10 minutes.


VAERS ID: 1438953 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: New York  
Vaccinated:2021-06-28
Onset:2021-06-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 2 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Chest discomfort, Chest pain
SMQs:, Anaphylactic reaction (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? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Anxiety & Depression
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Light to moderate chest discomfort/pain.


VAERS ID: 1439576 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: New Mexico  
Vaccinated:0000-00-00
Onset:2021-06-29
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808986 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Abdominal pain upper, Body temperature, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Abstains from alcohol; Blood pressure high (Patient Takes medication.); Hormone replacement therapy; Non-smoker
Preexisting Conditions: Comments: Patient had No known allergies any allergies and no drug abuse or illicit drug usage.
Allergies:
Diagnostic Lab Data: Test Date: 20210629; Test Name: Body temperature; Result Unstructured Data: 99.6 F
CDC Split Type: USJNJFOC20210666560

Write-up: SHARP PAIN IN STOMACH; LOW GRADE FEVER; This spontaneous report received from a consumer concerned a 54 year old male. The patient''s height, and weight were not reported. The patient''s concurrent conditions included non alcoholic, non smoker, high blood pressure, and testosterone replacement, and other pre-existing medical conditions included patient had no known allergies any allergies and no drug abuse or illicit drug usage. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 1808986, and expiry: UNKNOWN) dose was not reported, administered on 25-JUN-2021 for prophylactic vaccination. No concomitant medications were reported. On 29-JUN-2021, the subject experienced sharp pain in stomach. On 29-JUN-2021, the subject experienced low grade fever. Laboratory data included: Body temperature (NR: not provided) 99.6 F. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient was recovering from low grade fever, and had not recovered from sharp pain in stomach. This report was non-serious.


VAERS ID: 1440228 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021B21A / 2 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Arthralgia, Chills, Dyspnoea, Fatigue, Headache, Pain
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Arthritis (broad)

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

Write-up: Severe Cold chills, headache, shortness of breath, joint an body aches an pain, fatigue. Used ibuprofen and albuterol, only lasted a day


VAERS ID: 1440251 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-06-27
Onset:2021-06-29
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Generalised tonic-clonic seizure, Vertigo
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (narrow), Generalised convulsive seizures following immunisation (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? No
Previous Vaccinations:
Other Medications: Keppra, Tylenol
Current Illness: N/A
Preexisting Conditions: Epilepsy
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Vertigo, Grand Maul Seizure


VAERS ID: 1440415 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Feeling hot, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), 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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: 6/29/21: BP: 110/71 Pulse: 101
CDC Split Type:

Write-up: Pt was given shot by immunizing technician. And then sat down by her parent in the waiting area. Immunizing tech came and got me since parent was worried. Pt briefly passed out. By the time I got out into the waiting area pt had already woken up. Pt felt hot got her water and checked blood pressure and pule all within normal range. Stayed with pt who after a few minutes said was feeling better. Did not call 911 due to quick recovery. Pt was kept for observation for an additional 20 minutes. Saw further improvement and pt continued to say she feels a lot better. Told pt and mother (mother did not speak English) that they should contact primary care provider about the event and further discuss if she should receive second dose or not. Due to quick recovery, believe patient most likely was nervous and worked herself up before getting the vaccination causing her to pass out.


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