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

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



Case Details (Reverse Sorted by Onset Date)

This is page 80 out of 8,010

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VAERS ID: 1751748 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:0000-00-00
Onset:2021-09-28
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210957271

Write-up: ADMINISTERED A DOSE OF EXPIRED VACCINE; This spontaneous report received from a health care professional concerned a 57 year old male. The patient''s weight was 85 kilograms, and height was not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, intramuscular, batch number: 201A21A, expiry: 21-SEP-2021) dose was not reported, administered on 28-SEP-2021 for prophylactic vaccination. No concomitant medications were reported. On 28-SEP-2021, the patient experienced administered a dose of expired vaccine. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of administered a dose of expired vaccine was not reported. This report was non-serious.


VAERS ID: 1751762 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Virginia  
Vaccinated:0000-00-00
Onset:2021-09-28
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210958348

Write-up: ADMINISTRATION OF AN EXPIRED VACCINE; This spontaneous report received from a health care professional concerned a 44 year old male. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 206A21A, and expiry: 21/SEP/2021) dose was not reported, administered on 28-SEP-2021 for prophylactic vaccination. No concomitant medications were reported. On 28-SEP-2021, the patient experienced administration of an expired vaccine. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of administration of an expired vaccine was not reported. This report was non-serious. This case, from the same reporter is linked to 20210958806 and 20210958405.


VAERS ID: 1751769 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Virginia  
Vaccinated:0000-00-00
Onset:2021-09-28
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210958405

Write-up: ADMINISTRATION OF AN EXPIRED VACCINE; This spontaneous report received from a pharmacist concerned a 32 year old male. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 206A21A, expiry: 21-SEP-2021) dose was not reported, administered on 28-SEP-2021 for prophylactic vaccination. No concomitant medications were reported. On 28-SEP-2021, the patient experienced administration of an expired vaccine. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of administration of an expired vaccine was not reported. This report was non-serious. This case, from the same reporter is linked to 20210958348, 20210958321, 20210958423, 20210958993 and 20210958806.


VAERS ID: 1751771 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Virginia  
Vaccinated:0000-00-00
Onset:2021-09-28
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210958423

Write-up: ADMINISTRATION OF AN EXPIRED VACCINE; This spontaneous report received from a pharmacist concerned a 54 year old female. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine (suspension for injection, route of admin not reported, batch number: 206A21A, and expiry: 21-SEP-2021) dose was not reported, administered on 28-SEP-2021 for prophylactic vaccination. No concomitant medications were reported. On 28-SEP-2021, the patient experienced administration of an expired vaccine. The action taken with covid-19 vaccine was not applicable. The outcome of administration of an expired vaccine was not reported. This report was non-serious. This case, from the same reporter is linked to 20210958249, 20210958321, 20210958892, 20210958366, 20210958993, 20210958405, 20210958502 and 20210933076. This case, from the Others is linked to 20210959351 and 20210958518.


VAERS ID: 1751776 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Virginia  
Vaccinated:0000-00-00
Onset:2021-09-28
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210958518

Write-up: ADMINISTRATION OF AN EXPIRED VACCINE; This spontaneous report received from a health care professional concerned a 40 year old female. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, and batch number: 206A21A expiry: 21-SEP-2021) dose was not reported, administered on 28-SEP-2021 for prophylactic vaccination. No concomitant medications were reported. On 28-SEP-2021, the patient experienced administration of an expired vaccine. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of administration of an expired vaccine was not reported. This report was non-serious. This case, from the same reporter is linked to 20210958566, 20210958806, 20210959351, 20210958321, 20210958348, 20210958371, 20210958425, 20210958977, 20210959620, 20210958525, 20210959581 and 20210959909.


VAERS ID: 1751791 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: Virginia  
Vaccinated:0000-00-00
Onset:2021-09-28
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210958806

Write-up: ADMINISTRATION OF AN EXPIRED VACCINE; This spontaneous report received from a health care professional concerned a 52 year old male. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine (suspension for injection, route of admin not reported, batch number: 206A21A expiry: 21-SEP-2021) dose was not reported, administered on 28-SEP-2021 for prophylactic vaccination. No concomitant medications were reported. On 28-SEP-2021, the patient experienced administration of an expired vaccine. The action taken with covid-19 vaccine was not applicable. The outcome of administration of an expired vaccine was not reported. This report was non-serious. This case, from the same reporter is linked to 20210958348, 20210958425, 20210958525, 20210958566, 20210958518, 20210959351, 20210959620, 20210958977, 20210959581, 20210958371 and 20210959909. This case, from the Others is linked to 20210958405.


VAERS ID: 1751798 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Virginia  
Vaccinated:0000-00-00
Onset:2021-09-28
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210959351

Write-up: EXPIRED VACCINE ADMINISTERED; This spontaneous report received from a health care professional concerned a 29 year old female. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 206A21A, expiry: 21-SEP-2021) dose was not reported, administered on 28-SEP-2021 for prophylactic vaccination. No concomitant medications were reported. On 28-SEP-2021, the patient experienced expired vaccine administered. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of expired vaccine administered was not reported. This report was non-serious. This case, from the same reporter is linked to 20210958348, 20210958371, 20210958425, 20210958518, 20210958566, 20210958806, 20210958321, 20210958525, 20210958977, 20210959581, 20210959620 and 20210959909. This case, from the Others is linked to 20210958423.


VAERS ID: 1753041 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-02-23
Onset:2021-09-28
   Days after vaccination:217
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024M20A / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: COVID + test result 9/29/*21
CDC Split Type:

Write-up: vaccine breakthrough event


VAERS ID: 1753251 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-09-28
Onset:2021-09-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 1 - / IM
HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. T008152 / 2 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. S039319 / 1 RA / SC
MNQ: MENINGOCOCCAL CONJUGATE (MENVEO) / NOVARTIS VACCINES AND DIAGNOSTICS AMVA57A / 1 LA / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS 3E52S / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Back pain, Chest X-ray, Chest pain, Costochondritis, Electrocardiogram abnormal, Feeling abnormal
SMQs:, Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

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

Write-up: Pateints mother called into our office (primary care) and reports the patient was given 5 vaccines at a local health dept the morning of 9/28/2021. Mother reports later that evening patient c/o chest pain and he was taken to a local ER. Mother reports her son had an abnormal EKG and also had a chest x-ray. The patient was dx with chest wall inflammation and sent home. Mother called our office on 9/30/2021 to schedule an ER f/u visit. She was concerned about her son still feeling abnormal and now has backpain. Advised his mother to take him back to the ER for reevaluation .


VAERS ID: 1753253 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-09-28
Onset:2021-09-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Eye pain, Hyperacusis, Listless, Mobility decreased, Night sweats, Pain in extremity, Tearfulness
SMQs:, Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Glaucoma (broad), Depression (excl suicide and self injury) (broad), Hearing impairment (narrow), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Oxcarbazepine, amlodipine, atorvastatin, Finisteride, Flomax
Current Illness: None
Preexisting Conditions: Back pain, pacemaker, arthritic thumb
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Chills, very sore L arm to point of uselessness, night sweat, tears, sore/painful eyes, listlessness, sound sensitivity.


VAERS ID: 1753269 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-09-10
Onset:2021-09-28
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Balance disorder, Dizziness, Feeling abnormal, Nausea, Neck pain, Palpitations, Vertigo, Vision blurred
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (narrow), Arthritis (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: levoceterizine montelukast qnasl
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: I will be seeing my primary care physician within the next few days.
CDC Split Type:

Write-up: off balance, light headed, dizzy, vertigo, brain fog, slight nausea, severe neck/shoulder pain, racing heart at times, blurry vision, joint pain in hands/fingers. I am afraid to take the 2nd dose which I am scheduled for today.


VAERS ID: 1753273 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-09-28
Onset:2021-09-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Atenalol, lisinopril, oxybutane, Taken at 2pm
Current Illness: None
Preexisting Conditions: Hyperactive thyroid, high blood pressure,
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient states she had a sudden onset of chills and severe quivering. Contacted 911 from fear of serious health issue. Temperature was 96.8 F, blood pressure was 100/100


VAERS ID: 1753300 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-04-27
Onset:2021-09-28
   Days after vaccination:154
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Insulin
Current Illness: Diabetes, lymphoma, melanoma
Preexisting Conditions: Diabetes, lymphoma, melanoma
Allergies: aspirin
Diagnostic Lab Data: rapid test
CDC Split Type:

Write-up: Positive for COVID


VAERS ID: 1753308 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-09-28
Onset:2021-09-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007C21A / 2 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Balance disorder, Chills, Dizziness, Feeling cold, Headache, Hot flush, Myalgia, Night sweats, Nightmare, Onychalgia, Pain, Pyrexia, Sleep disorder
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: 9/1/2021 first vaccination of Moderna.
Other Medications: TYLENOL
Current Illness: None
Preexisting Conditions: None
Allergies: Cherries, Pineapple, Lemons, Limes, Tomatoes, Gluten
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: On 9/28/2021 mild headache at 3:30pm, balance wobbly, extreme headache, muscle aches all over body at 7:30pm;, and fever at 11pm. On 9/29/2021 extreme body aches, 102 fever all night, hot flashes, night sweats then chills, and very cold. Bad headache and balance wobbly. Did not sleep much since my body ached so bad, even my toe nails hurt. On 9/30/2021 morning felt 95% better with just a touch of wobbly balance and light headedness, but continued to improve throughout the day. The night of 9/30 I had a horrible nightmare about losing my grandson. Hardly ever do I have nightmares.


VAERS ID: 1753347 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-22
Onset:2021-09-28
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Arthritis, Blood immunoglobulin M increased, Bone erosion, C-reactive protein increased, Dysstasia, Gait disturbance, Impaired driving ability, Insomnia, Pain in extremity, Red blood cell sedimentation rate increased, Rheumatoid arthritis, Rheumatoid factor increased, X-ray abnormal
SMQs:, Peripheral neuropathy (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypersensitivity (broad), Arthritis (narrow), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: esciltalopram mag supplement calcium supplement
Current Illness: spinal issues (compression fracture, cervical, etc.) sciatica
Preexisting Conditions: depression/anxiety hypertension h/o lung cancer (remission x 8 years) COPD
Allergies:
Diagnostic Lab Data: right wrist xray (9/29/21) - erosive changes to scaphoid bone consistent with inflammatory arthritis labs (9/29/21) - elevated CRP and ESR, and very high RF IgM.
CDC Split Type:

Write-up: 6-7 days after booster vaccine dose, patient developed severe b/l feet and ankle pain leading to taking hours to get out of bed in morning, difficulty walking, in the morning. Also severe right wrist pain. Symptoms resulted in inability to drive due to pain. Also difficulty sleeping due to pain. Evaluation by primary care office led to diagnosis of rheumatoid arthritis. Steroids started on 10/1/21 and referral to rheumatology made.


VAERS ID: 1753352 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-09-27
Onset:2021-09-28
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 3 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Ear discomfort, Headache, Hyperacusis, Hypoacusis, Insomnia, Tinnitus
SMQs:, Hearing impairment (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: over the counter prostate med for BPH
Current Illness: no
Preexisting Conditions: no
Allergies: no
Diagnostic Lab Data: no tests were given at the hospital, just temp and BP
CDC Split Type:

Write-up: Developed severe Tinnitus. Shot administered Monday at noon. By late evening started ringing in right ear, i am single sided deaf in left ear from birth. On Tuesday i thought maybe will just go away, hoping to wake up Wednesday morning and it would be gone. it was not. Sleeping was difficult, aside from ringing i was hearing swooshing sounds. Wednesday morning i noticed my hearing was deeply impaired. didnt hear my alarm clock, bathroom fan, car fob beep etc. called my local doctor, was not available but said to take tylenol, maybe he could perscribe steroid. Woke up thursday morning, everyting was much worse. since i only have one ear i got scared. went to Urgent Care, he told me to return to Location where i got the shot, go to the ER. so i did. by the time i got to the examination room after 2 or 3 hours i notice my ear popped back, my voice started sounding normal. this is 72 hrs after the shot. Dr prescribed steroid which i started taking thursday night and recommended i see an EMT. it''s friday morning, my hearing is back, feeling much better but still have a tiny buzz in head and a decent headache, loud sounds are not fun.


VAERS ID: 1753430 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-08-01
Onset:2021-09-28
   Days after vaccination:58
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Atrophy, Mitral valve incompetence, Pulmonary embolism
SMQs:, Embolic and thrombotic events, venous (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Atorvastin Loratadine Testosterone Simvastatin
Current Illness: None
Preexisting Conditions: High blood pressure High cholesterol
Allergies: None Just seasonal allergies
Diagnostic Lab Data: Atrophy to right portion of lung 9/28/2021 Mitral valve regurgitation
CDC Split Type:

Write-up: Multiple blood clots in right lung


VAERS ID: 1753545 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-09-27
Onset:2021-09-28
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026C21A / 1 - / -

Administered by: Private       Purchased by: ?
Symptoms: Herpes zoster, Injection site rash, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Opportunistic infections (broad)

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

Write-up: Rash under the boob same side of the injection site, rash began to spread, was diagnosed with Shingles by healthcare provider. Was prescribed Famciclovir and pain medication.


VAERS ID: 1753555 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-09-27
Onset:2021-09-28
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 019F21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Local reaction
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: No adverse event. A slight local reaction that has resolved. Pt was not eligible for 3rd dose.


VAERS ID: 1753580 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-28
Onset:2021-09-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 5 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood test, Dizziness, Exposure during pregnancy, Flushing, Laboratory test, Loss of consciousness, Syncope, Tunnel vision, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (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), Optic nerve disorders (broad), Cardiomyopathy (broad), Retinal disorders (narrow), Vestibular disorders (broad), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), 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: Baby Aspirin, Prenatal Vitamins, DHA-Fish Oil, Iron Supplements
Current Illness: Mild Anemia due to pregnancy
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Multiple blood work and lab test done
CDC Split Type:

Write-up: At 1636, received vaccine Pfizer 0.3ml IM in left deltoid. She was sitting in her chair holding her laptop, dropped laptop, staff checked on her. She had her head down, large amount of vomit on the floor, tapped her on the shoulder and was responsive. Asked if she was okay and responded, "Yes and apologetic for vomiting." At 1650, DSH-Napa''s dispatch/Fire Department was notified. Her vitals signs were taken T97.0-P92-R20-BP 121/78 O2 sat-97% RA. was unaware she vomited or dropped her laptop. reports, "sitting in observation area, became flush, lightheaded, then slight tunnel vision, so she closed her eyes and passed out". Fire department responded, ambulance took her to ER where she was Dx Vasovagal Syncope. She reports receiving IV fluids in ambulance, no further tx at. She reports Hx of near syncopal episode after having a blood drawn recently due to pregnancy. Patient is pregnant and her due date is 11/1/21.


VAERS ID: 1753611 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-02-06
Onset:2021-09-28
   Days after vaccination:234
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010A21A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: COMBIVENT RESP; OMEPRAZOLE; WIXELA INHALER
Current Illness: NONE
Preexisting Conditions: OBESITY; KNEE ISSUES
Allergies: NONE
Diagnostic Lab Data: COVID19 POS ON 9/30/21
CDC Split Type:

Write-up: BREAKTHROUGH COVID INFECTION.


VAERS ID: 1753612 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-01-27
Onset:2021-09-28
   Days after vaccination:244
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Covid-19 test
CDC Split Type:

Write-up: The patient tested positive for Covid-19 after being fully vaccinated


VAERS ID: 1753650 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-03-24
Onset:2021-09-28
   Days after vaccination:188
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Breakthrough case


VAERS ID: 1753654 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-09-28
Onset:2021-09-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Dizziness, Headache, Nausea, Presyncope
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: escitalopram, wellbutrin, linzess, pantoprazole, verapamil
Current Illness: no known illnesses at time
Preexisting Conditions: migraines, IBS, anxiety, depression
Allergies: no known allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Two hours after vaccination, started feeling dizzy, lightheaded and near syncope. This lasted for about 6 hours. For the following three days after vaccination had a horrible headache and nausea and episodes of lightheadedness.


VAERS ID: 1753669 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-09-27
Onset:2021-09-28
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 3 RA / IM
FLUA4: INFLUENZA (SEASONAL) (FLUAD QUADRIVALENT) / SEQIRUS, INC. 312830 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test, Brain contusion, Computerised tomogram, Echocardiogram, Loss of consciousness, Skull fracture, Ultrasound Doppler
SMQs:, Torsade de pointes/QT prolongation (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), 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? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Losartan, 50mg, Lansoprazole, Loratadine - 10mg, Atorvastatin - 10mg, Losartan Potassium - 50 mg, Loratadine - 10MG
Current Illness: None
Preexisting Conditions: hypertension
Allergies: Latex
Diagnostic Lab Data: Numerous blood draws, CT Scan, Ultrasounds on Heart and Arteries
CDC Split Type:

Write-up: Blacked out at store the day after the vaccines administered. Resulting in Bruise on front of Brain, and fracture of skull on back side of head


VAERS ID: 1753707 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-04-12
Onset:2021-09-28
   Days after vaccination:169
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036B21A / 2 UN / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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 RECEIVED MODERNA VACCINE ON 3/10/21 (LOT 048A21A)_ + 4/12/21 (LOT 036B21A). S/O BEGAN 9/21/21, TESTED + 9/28/21


VAERS ID: 1753743 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-28
Onset:2021-09-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034C21A / 2 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Fatigue, Injection site pain, Pain, Pyrexia, Rash, Rash pruritic, Somnolence, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Immediately after receiving the shot I was extremely fatigued. Couldn''t keep my eyes open. Got home and slept. Developed body aches, fever, stinging at injection site and a rash/welt on the right arm. I felt this way for 2 days. The third day, still had the body aches and fatigue and fever was intermittent. Rash still present and itchy. Applied anti itch cream to treat and used a lemon/chamomile spritz as well to help. The spritz helped more than the anti itch cream.


VAERS ID: 1753766 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-08-25
Onset:2021-09-28
   Days after vaccination:34
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032B21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Bradycardia, Chest pain, Computerised tomogram thorax, Dyspnoea, Echocardiogram normal, Electrocardiogram, Fibrin D dimer, Full blood count, Hypotension, Laryngospasm, Metabolic function test, Pericarditis, Troponin
SMQs:, Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Dystonia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Chronic kidney disease (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad), Hypokalaemia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Influenza about 4 years ago - left foot paresthesia
Other Medications: Vitamin D
Current Illness: 8/25/21 - 40 minutes after vaccination - dyspnea chest pain laryngeal spasms bradycardic and hypotensive
Preexisting Conditions: NO
Allergies: NKDA
Diagnostic Lab Data: EKG TROPONIN D DIMER CBC CMP CT chest ( ECHO was performed on 9/2/21 which was my first visit for chest pain that was normal )
CDC Split Type:

Write-up: 8/25/21 - already submitted severe reaction 9/28/21 - Was at ED for severe burning chest pain and dyspnea - Pericardial fluid noted on CT chest - diagnosed with pericarditis


VAERS ID: 1753789 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-04-13
Onset:2021-09-28
   Days after vaccination:168
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038B21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: albuterol 90mcg cholecalciferol 3000IU daily fexofenadine 180mg daily fluticasone nasal daily ibuprofen 800mg prn levothyroxine 112mcg daily magnesium oxide 500mg daily omeprazole 20mg daily oxybutynin 2.5mg daily rosuvastatin 10mg HS sertr
Current Illness: None documented
Preexisting Conditions: migraine, hypothyroidism, allergic rhinitis, TMJ, fibromyositis, anxiety, depression, GERD, asthma
Allergies: erythromycin - upset stomach
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient contracted COVID after being fully vaccinated Cough, Congestion, Sore throat


VAERS ID: 1753791 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-17
Onset:2021-09-28
   Days after vaccination:223
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Polymerase chain reaction
SMQs:, Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Cycle threshold 29.9 on admission.
CDC Split Type:

Write-up: Patient admitted to the hospital for COVID 19. Reporting per Moderna COVID vaccine EUA.


VAERS ID: 1753807 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-09-28
Onset:2021-09-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 1 AR / IM

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

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

Write-up: Site: Itching at Injection Site-Severe, Systemic: Allergic: Itch Generalized-Severe, Systemic: Allergic: Rash Generalized-Severe


VAERS ID: 1753857 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-04-02
Onset:2021-09-28
   Days after vaccination:179
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: Covid positive


VAERS ID: 1753876 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-18
Onset:2021-09-28
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Joint swelling, Peripheral swelling, Rash
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Swollen hands, feet, and joints. Initial rash over body has mostly resolved untreated. Swelling comes and goes but has not fully resolved.


VAERS ID: 1753888 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-27
Onset:2021-09-28
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / UNK LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Fatigue, Injection site pain, Pain
SMQs:, Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Vestibular disorders (broad)

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

Write-up: Pain at injection site with movement. Constant severe dizziness, lightheadedness, and fatigue.


VAERS ID: 1753898 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-09-27
Onset:2021-09-28
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / -

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

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

Write-up: Headache, fever, body aches.


VAERS ID: 1753906 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-09-26
Onset:2021-09-28
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Brain natriuretic peptide increased, Chest pain, Echocardiogram normal, Electrocardiogram ST segment abnormal, Fibrin D dimer increased, Myocarditis, Red blood cell sedimentation rate normal, Troponin increased
SMQs:, Cardiac failure (broad), Haemorrhage laboratory terms (broad), Myocardial infarction (narrow), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: 9/28: troponin I 30.2, BNP 1310, CRP 13, D-Dimer 902, EKG with nonspecific ST changes, ECHO nl function, ESR 11.
CDC Split Type:

Write-up: Myocarditis. Developed chest pain, without fever or other ill symptoms, 2 days after vaccine. Found to have elevated troponin, BNP, D dimer. Admitted to hospital for 3 days. Treated with 3 days of steroids in hospital, on ASA until f/u Cardiology.


VAERS ID: 1753980 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-28
Onset:2021-09-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dyspnoea, Heart rate increased, Injection site pain, Nausea, Pyrexia
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Metroprolol, Letrozole, Atorvastatin, calcium + vitamin D, Zyrtec, baby aspirin
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Nausea, fever, site soreness, shortness of breath, rapid heat beat


VAERS ID: 1753984 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-09-27
Onset:2021-09-28
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / 3 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9809 / 2 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3247 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Cough, Fatigue, Injection site pain, Nasal congestion, Pain, Pulmonary congestion, Pyrexia, Rhinorrhoea, SARS-CoV-2 test negative
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Amlodipine, Losartan, Metoprolol, Levothyroxine, Atorvastatin, Aspirin, Gapapentin
Current Illness: None
Preexisting Conditions: None
Allergies: Ciprofloxacin, Lisinopril
Diagnostic Lab Data: On 10/1/21 I went to testing and was found to be negative for Covid-10.
CDC Split Type:

Write-up: Took vaccine 1 on 1/30/21, vaccine 2 on 2/23/21 and booster vaccine 3 on 9/27/21. I experienced no adverse side effects from eith of the first two vaccines. Beginning 9/28/21 I experienced joint aches, nasal congestion with drainage, slight pain at injection site, mild fever, and overall fatigue. This continued for 2 days and progressed to my lungs with coughing with mild fever. I am still experience lung congestion and aches today on 10/1/21. I remain at home resting and recovering.


VAERS ID: 1753996 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-01-28
Onset:2021-09-28
   Days after vaccination:243
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Cough, Sneezing
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad)

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

Write-up: Patient complained of cough/sneezing


VAERS ID: 1754034 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-09-28
Onset:2021-09-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Incorrect route of product administration, Injection site pain, Joint range of motion decreased, X-ray normal
SMQs:, Drug abuse and dependence (broad), Extravasation events (injections, infusions and implants) (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Pepcid for GERD
Current Illness: None
Preexisting Conditions: Stage 2 CKD Dry macular degeneration
Allergies: Sulfa drugs Doxycycline
Diagnostic Lab Data: Xrays today, 10/01/2021, did not show damage. If I do not experience significant improvement wIthin 6 weeks, the dr wii order an MRI. ,
CDC Split Type:

Write-up: Injection was made into my shoulder capsule, not my arm. The injection itself was very painful. For 2.5 hours, I had no further pain. At approximately 2.5 hours after the injection, I experienced severe pain in my shoulder and upper arm. Now 3 days later, I have limited arm movement and continuing pain. My orthopedist believes that the injection was made directly into the rotator cuff. Treatment will entail anti-inflammatories, which I am not generally supposed to take because of CKD, physical therapy, and 6-8 weeks if I?m lucky.


VAERS ID: 1754055 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-28
Onset:2021-09-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / N/A AR / IM

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

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

Write-up: Vaccine affected by temperature excursion administered to the patient


VAERS ID: 1754057 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-09-28
Onset:2021-09-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Myocardial infarction
SMQs:, Myocardial infarction (narrow), Embolic and thrombotic events, arterial (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: Persugel Metoprolol Repatha atrovastatin ASA
Current Illness: Post MI
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Feel I suffered a Silent Heart attack 3 hours after my booster shot.


VAERS ID: 1754066 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-28
Onset:2021-09-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / N/A AR / IM

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

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

Write-up: Vaccine affected by temperature excursion administered to the patient


VAERS ID: 1754076 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-28
Onset:2021-09-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / N/A AR / IM

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

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

Write-up: Vaccine affected by temperature excursion administered to the patient.


VAERS ID: 1754084 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-28
Onset:2021-09-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / N/A AR / IM

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

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

Write-up: Vaccine affected by temperature excursion administered to the patient.


VAERS ID: 1754101 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: New York  
Vaccinated:2021-09-27
Onset:2021-09-28
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 3 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Electrocardiogram, Feeling hot, Nausea, Ventricular extrasystoles
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Ventricular tachyarrhythmias (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypokalaemia (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: VIAGRA; PRAVASTATIN; TAMSULOSIN; ASPIRIN 81 mg
Current Illness: None
Preexisting Conditions: Mitral Valve Disease, HLD
Allergies: NKDA
Diagnostic Lab Data: EKG: PVCs.
CDC Split Type:

Write-up: Feeling hot, nausea, and dizziness x 4 days.


VAERS ID: 1754122 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-22
Onset:2021-09-28
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

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

Write-up: Lightheadedness.


VAERS ID: 1754124 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-28
Onset:2021-09-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / N/A AR / IM

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

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

Write-up: Vaccine affected by temperature excursion administered to the patient


VAERS ID: 1754130 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-28
Onset:2021-09-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / N/A AR / IM

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

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

Write-up: Vaccine affected by temperature excursion administered to the patient


VAERS ID: 1754133 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-28
Onset:2021-09-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / 2 AR / IM

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

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

Write-up: Vaccine affected by temperature excursion administered to the patient


VAERS ID: 1754134 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-28
Onset:2021-09-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / N/A AR / IM

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

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

Write-up: Vaccine affected by temperature excursion administered to the patient


VAERS ID: 1754141 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-09-28
Onset:2021-09-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Fatigue, Headache, Neck pain, Pain, Pain in extremity, Pain in jaw, Pyrexia, Toothache
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Osteonecrosis (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Diltiazem, clopidogrel, apibaxan, losartan/hctz.
Current Illness: Slight cold one week prior
Preexisting Conditions: Heart disease
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Severe body aches, injection arm pain, jaw, neck and tooth pain. Fever 101. Chills. Headache. Symptoms began 20 hours post-vaccine. Resolved 20 hours after onset of symptoms, except for residual fatigue.


VAERS ID: 1754150 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Unknown  
Vaccinated:2020-12-23
Onset:2021-09-28
   Days after vaccination:279
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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

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

Write-up: PATIENT HAD PFIZER VACCINE, Dose 1 date: 12/23/2020, Dose 2 date: 01/13/2021, AND TESTED POSITIVE TO COVID.


VAERS ID: 1754180 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-28
Onset:2021-09-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 3 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Flushing, Hyperhidrosis
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Hypersensitivity (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: Medications: betamethasone 0.05% ointment Folic Acid 1mg PO Daily methotrexate 2.5mg PO Qwk secukinumab 300mg SubQ Q28days Triamcinolone 0.1% oint
Current Illness:
Preexisting Conditions: Pt w/ hx of Vision abnormalities, psoriasis, pericardial effusion, PDA, Heart Dz, H/o abnormal menstrual cycle, Down Syndrome, and CHL.
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: 14mins post vaccination pt c/o flushing/sweating. Vitals: BP 129/72, HR 85, RR 18, Temp 97.3F Symptoms resolved. Pt stable and released from the vaccination site.


VAERS ID: 1754186 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-09-21
Onset:2021-09-28
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 049C21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dyspnoea, Headache, Injection site induration, Injection site pruritus, Injection site reaction, Injection site warmth, Pyrexia, Rash erythematous, Rash pruritic, Rhinorrhoea, Tinnitus
SMQs:, Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Cardiomyopathy (broad), Hearing impairment (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: 2x previous Flu shots
Other Medications: 1. Alleritin, Makers Mark (generic Claritin) 10mg 2. Ibuprofin 800mg
Current Illness:
Preexisting Conditions: COPD
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: 1. Day after vaccine administered, Had headache 2. 2nd day after vaccine administered had headache and ears ringing 3. 7 days after vaccine administered in pm, a red raised patch appeared on arm around injection site. Felt hard and hot to the touch and became itchy. 4. 8th day after vaccine administered in am had slight fever, runny nose, breathing a bit impaired, a red raised itchy patch around injection site and an itchy rash in small patches on face, neck. and arms. 5. 9th day finally got the OK from doctor hat Benadryl was OK to take. Started Benadryl late PM 2 ea 25 mg tablets 6. 10th day after vaccine administered, Found itch relief, reduced swelling of red raised area, and small rash patches diminished. continued Benadryl at 1 ea 25 mg tab every 4 hours and will continue until small rashes are gone.


VAERS ID: 1754199 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-09-27
Onset:2021-09-28
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301458A / UNK LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: 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: Lisinopril, Atorvastatin, Women''s Centrum Silver multivitamin, Potassium, Calcium, Resveratrol, B Complex, B-12, Preservision, Vitamin D3, Vitamin A, Zinc, Iron, Fish oil, CoQ10, Vitamin E, Lactobacillus rhamnosis
Current Illness: None
Preexisting Conditions: High blood pressure, high blood cholesterol
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Facial swelling - below both eyes, right jawline, right cheek, right ear lobe


VAERS ID: 1754253 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-28
Onset:2021-09-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / 1 AR / IM

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

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

Write-up: Vaccine affected by temperature excursion administered to the patient


VAERS ID: 1754269 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-28
Onset:2021-09-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / N/A AR / IM

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

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

Write-up: Vaccine affected by temperature excursion administered to the patient


VAERS ID: 1754270 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-28
Onset:2021-09-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / N/A AR / IM

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

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

Write-up: Vaccine affected by temperature excursion administered to the patient


VAERS ID: 1754271 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-28
Onset:2021-09-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / N/A AR / IM

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

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

Write-up: Vaccine affected by temperature excursion administered to the patient.


VAERS ID: 1754289 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-02-22
Onset:2021-09-28
   Days after vaccination:218
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6203 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7534 / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Chills, Cough, Insomnia, Pain, Pyrexia
SMQs:, Anaphylactic reaction (broad), 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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Guanifenesin; Aspirin; Multivitamin; Metoprolol; Famotidine; Amlodipine; Atorvastatin
Current Illness: none
Preexisting Conditions: ASCVSD; mixed hyperlipidemia; GERD; primary osteoarthritis
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: fever 100.7, body aches, nonproductive cough, chills, not sleeping. starting on 9/29/21


VAERS ID: 1754327 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-03-31
Onset:2021-09-28
   Days after vaccination:181
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 041A21A / UNK LA / SC

Administered by: Other       Purchased by: ?
Symptoms: Bell's palsy, Facial paralysis
SMQs:, Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Hearing impairment (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Synthroid 125 mcg., Spironolactone 50 mg., Restasis 0.05% eml., daily vitamin, daily calcium tablet, daily probiotic
Current Illness: season allergies
Preexisting Conditions: hypothyroidism, dry eyes, rosacea, hormonal acne
Allergies: none
Diagnostic Lab Data: ER evaluation of stroke protocol.
CDC Split Type:

Write-up: On Sept. 28 in the morning, I started to show signs of mild facial paralysis on the left side, mainly the mouth. By the afternoon, I noticed my left eye looked "off". On Sept. 29, I went to the Emergency Room and was diagnosed with Bell''s Palsy.


VAERS ID: 1754355 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Rhode Island  
Vaccinated:2021-09-27
Onset:2021-09-28
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 2041321A / 1 RA / SYR

Administered by: School       Purchased by: ?
Symptoms: Chest pain, Loss of personal independence in daily activities
SMQs:, Dementia (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (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: Raynaud''s Phenomenon (primary), acid reflux - consult doctor for medical records
Allergies: Carbonated beverages (including alcohol), coconut, latex, mint (all), pepper (all)
Diagnostic Lab Data: None - did not go to the hospital.
CDC Split Type:

Write-up: Severe pain in sternum, 8.5/10 on pain scale It started on the morning after I received the injection; the pain was at a 2.5 when it came on. The pain worsened during an errand with family and caused me to halt my errand so that I could be transported home to rest. 8.5/10 was at its worst on late Tuesday night, and I kept hesitating to even go to the hospital in case it improved. Pain decreased to a slightly more comfortable 6/10 on Wednesday, so I went to work, but still had difficulty being comfortable. The pain finally subsided on its own on Thursday morning when I woke up at 6:30am.


VAERS ID: 1754531 (history)  
Form: Version 2.0  
Age: 97.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-09-27
Onset:2021-09-28
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Fatigue, Injection site pain, Lethargy, Nodule, Pain in extremity, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), 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: PreserVision 50mg, Metoprolo 50mgLosartan 100mg Amlodipine 10mg Ecotrin 81mg Tylenol fir arthritis Crestor 40mg Esomeprazole 20mg Nystatin Triamcinolone cream 0.1%
Current Illness: No major illnesses
Preexisting Conditions: High Blood Pressure Heart disease with quadruple by-pass Arthritis
Allergies: NONE
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Sore arm at injection site with small nodule present day after shot. Lethargic, continued sore arm, and feverish. Tylenol for pain and fever Still feeling tired and sore day 3. However, fever is only slightly elevated (99.1) Not enough to warrant medical intervention. Overall feeling as expected, however with 1st and 2nd shot only experienced soreness at the injection site.


VAERS ID: 1754534 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-09-27
Onset:2021-09-28
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lisinopril 20 mg, torvastatin (for chloresterol). 30 mg. 1+ .5 tab.
Current Illness: Nothing, really
Preexisting Conditions: Slightly elevated BP and cholesterol levels?.
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Nothing too bad, some vomiting but mostly diarreah. Red sore right arm, but nothing horrible. All in time?.


VAERS ID: 1754768 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-02-25
Onset:2021-09-28
   Days after vaccination:215
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 019B21A / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Headache, Ocular discomfort, Sinusitis
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Baby asprin; Simvastatin; Losratan; Amlodipine
Current Illness: none
Preexisting Conditions: hypertension, mixed dyslipidemia
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Symptoms include headache Tues eve, Wed morning pressure by eyes. Does get sinus infections off and on. starting on 9/28/21 2018 half of Thyroid removed. Exposures reported: Grown kids were at a reception -people tested positive along with their kids test was Wed. Wife also positive on 10/1/21


VAERS ID: 1754956 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-09-27
Onset:2021-09-28
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Hypoaesthesia, Pallor, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Hypotonic-hyporesponsive episode (broad), Sexual dysfunction (broad)

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

Write-up: Weakness Pale ,tingling and numbness of right finger tips


VAERS ID: 1754965 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-09-23
Onset:2021-09-28
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Back pain, Fatigue, Headache, Type IV hypersensitivity reaction
SMQs:, Retroperitoneal fibrosis (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Clomiphene citrate 25mg
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Five days after injection I began to have a severe headache. Six days after was a severe headache and backache with lots of fatigue. It appears to be a delayed adverse reaction. No fever though. Just bad headache, backache and fatigue. Negative for COVID twice. Is the delayed, adverse reaction normal?


VAERS ID: 1755124 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-09-23
Onset:2021-09-28
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30130BA / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute myocardial infarction, COVID-19, SARS-CoV-2 test positive, Troponin
SMQs:, Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: elavil, lipitor, coreg, vid D, proscar, neurontin, prevacid, lisinopril, xarelto, multivitamin
Current Illness: none
Preexisting Conditions: CAD, MI, afib s/p AV node ablation, pacemaker, hyperlipidemia, stroke
Allergies: diltiazem, aspirin, amiodarone, ibuprofen, sotalol, pantoprazole
Diagnostic Lab Data: troponin, covid PCR swab 10/1/21
CDC Split Type:

Write-up: NSTEMI; tested positive for covid 10/1/21 (received the vaccine 9/23/21).


VAERS ID: 1755605 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-09-27
Onset:2021-09-28
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039D21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Dyspnoea, Dysuria, Headache, Hyperhidrosis, Lethargy, Muscle spasms, Retching, Seizure, Sleep disorder, Thirst
SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Dystonia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Centrum Silver, Viva Naturals Omega-3, Vitamin D3, NOW brand psyllium husks, turmeric, Himalaya Liver Care, as needed 1/2 dose Tizanidine.
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: Penicillin.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Full body convulsions. Violent, alarming. Extreme headache, sweating and thirst, dramatic dizziness and lethargy. Muscle spasms. 1st convulsion lasted 10 minutes, fully conscious, breathing labored but still effective. Slept 15 hours in total, waking every 1.5 to 2 hours, convulsing less upon awakening each time. Drank six bottles of 16 oz water in an 8 hour period without urination. For the next 2 days, the symptoms occurred but became dramatically muted. My stomach is still spasming 4 days removed. Following emergency (as to pain) lower lumbar epidural injections (4) on 10/01, neurologist administering shots said the x-ray showed my stomach to be in spasm and asked how long. He also said that my calf muscle was spasming. I was only aware of the stomach as it was a tangible physical effect. Following 1st dose of Moderna vaccine, inexperienced headache, extremeextreme dizziness and dry heaves (absent vomitting) on the 2nd day.


VAERS ID: 1755607 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-28
Onset:2021-09-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Arrhythmia, Bone pain, Chest X-ray normal, Chills, Diagnostic procedure, Electrocardiogram abnormal, Fibrin D dimer increased, Hypersensitivity, Mouth ulceration, Muscular weakness, Myalgia, Nausea, Pyrexia, Throat tightness, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Peripheral neuropathy (broad), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Cardiac arrhythmia terms, nonspecific (narrow), Osteonecrosis (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: All 3 covid vx
Other Medications: Gabapentin 300mg tid Amlodipine 1 mg sid
Current Illness: None
Preexisting Conditions: Raynauds syndrome Chronic pain
Allergies: Morphine, iodine, naproxen, sunflower seeds, seafood
Diagnostic Lab Data: See above
CDC Split Type:

Write-up: 11:30 pm 9-28-21- fever,chills, nausea,vomiting, excruciating bone and muscle pain . Called dr at 7am on 9-29-21- instructed to take ibuprofen q8h and benedryl q8h. Did seem to help a little. 9-30-21 felt better in am until about noon then fever-chills-nausea- vomiting resumed and throat started to feel tight. Went to er. Treated for allergic reaction possibly from vaccine. Treated with injections of solumedrol, benadryl,zofran, epinephrine, and pepcid. 1 liter of iv fluids given. Labs showed high d dimer results. Cant do ct scan as im allergic to iodine contrast. Did nuclear scan and didnt see any clots. Cxr done showed no problem. Ekg showed abnormal rythmn after epi. Second ekg showed resolved. Sent home on pred for 5 days. 10-1-21 mouth ulcers appeared and legs are weak.


VAERS ID: 1755611 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-27
Onset:2021-09-28
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 UN / SYR

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain lower, Asthma, Chest pain, Chills, Dyspnoea, Electrocardiogram, Headache, Pyrexia
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin c, b12, iron, quercetin, celexa, thyroid medication, inhaler
Current Illness: None
Preexisting Conditions: Allergies, asthma, thyroid
Allergies: Penicillin
Diagnostic Lab Data: EKG
CDC Split Type:

Write-up: Fever, chills, shortness of breath,headache, chest pain, lower abdomen,/side pain, fever, asthma flare up


VAERS ID: 1755739 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: New Jersey  
Vaccinated:0000-00-00
Onset:2021-09-28
Submitted: 0000-00-00
Entered: 2021-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210960300

Write-up: EXPIRED VACCINE ADMINISTERED; This spontaneous report received from a health care professional concerned a 35 year old female. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 206A21A expiry: 21-SEP-2021) dose was not reported, administered on 28-SEP-2021 to Left Arm for prophylactic vaccination. No concomitant medications were reported. On 28-SEP-2021, the patient experienced expired vaccine administered. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of expired vaccine administered was not reported. This report was non-serious. This case, from the same reporter is linked to 20210960415 and 20210960389.


VAERS ID: 1756405 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-09-28
Onset:2021-09-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 3 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chills, Fatigue, Headache, Injection site pain, Lymph node pain, Lymphadenopathy, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lisinopril Chlorthalidone Rosuvastatin Escitalopram Nexium Flonase Xyzal Advil Tylenol
Current Illness: Recovering from rotator cuff surgery in non-injected arm 8-weeks out
Preexisting Conditions: Anxiety, high blood pressure, high cholesterol
Allergies: None
Diagnostic Lab Data: Phone calls with physician on 9/29 and 9/30. Advised rest, hydration, Tylenol and to return for ultrasound on 10/4 if no improvement in swelling.
CDC Split Type:

Write-up: Textbook side effects: pain at injection site, low-grade fever, chills, headache, major body aches similar to flu, extreme fatigue, all for 48 hours. New Symptom during Day 2 a very large, painful and visible golf ball sized swollen lymph node under left arm (injection arm) appeared and has persisted into day 4, though it has decreased in size some. No side effects with either previous shots.


VAERS ID: 1756473 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-09-28
Onset:2021-09-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Cardiac flutter, Decreased appetite, Dry throat, Dyspnoea, Headache, Illness, Influenza like illness
SMQs:, Anaphylactic reaction (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Tachyarrhythmia terms, nonspecific (narrow), 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:
CDC Split Type:

Write-up: Fluttering heartbeat,shortness of breath,very ill with flu like symptoms for 2 days,bad headache for 2 days,loss of appetite and constantly dry throat.


VAERS ID: 1756493 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-09-27
Onset:2021-09-28
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 3 RA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Bell's palsy, Eye pain, Lacrimation increased, Ocular discomfort
SMQs:, Glaucoma (broad), Hearing impairment (broad), Lacrimal disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Atorvastatin 20 mg QD. Amlodipine 10 mg QD. Lisinopril 20 mg QD. Tadalafil 5 mg QD. Tamsulosin 0.4 mg BID. Dutasteride 5 mg QD. Budesonide 0.25mg/2ml nasal irrigation QD. Saw palmetto 640 mg QD. Cinnamon capsules 500 BID. One-a day MVI QD.
Current Illness: None
Preexisting Conditions: GERD/LPR. HTN, controlled. Hypercholesterolemia, controlled. BPH. chronic sinusitis, controlled with budesonide irrigation, no events $g5 years.
Allergies: GI intolerance to PO clindamycin and vancomycin-- $g vomiting
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Day after pfizer vcivid booster, developed R sided occipital head pain (not headache) with sharp intermittent components. Next day, R eve felt "strange" with gritty feeling and occasional tearing. Next day, developed R sided facial weakness (bell''s palsy), Started 60 mg prednisone within 2 hours of developing bell''s palsy after speaking with my PCP by phone as i was out of state for work.


VAERS ID: 1756532 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-27
Onset:2021-09-28
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30130BA / 2 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Exposure during pregnancy, Muscle spasms
SMQs:, Dystonia (broad), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (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: Prenatal Dha Magnesium Thorne Prenatal multivitamin Advocare spark
Current Illness: N/a
Preexisting Conditions: N/a
Allergies: Nka
Diagnostic Lab Data: Pregnancy monitored, baby monitored at hospital
CDC Split Type:

Write-up: Horrible cramping following day from 3 AM- 10 PM. Admitted to hospital to ensure baby was ok.


VAERS ID: 1756544 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-09-21
Onset:2021-09-28
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Bowel movement irregularity, Diplopia, Disorientation, Fatigue, Headache, Hunger, Vision blurred
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Ocular motility disorders (broad), Noninfectious diarrhoea (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: COVID#1, rectal bleeding and other symptoms like mild headache, age: 60; date: Aug. 31, 2021, COVID Pfizer
Other Medications: Amlodipine/Benazepril 5/40, SeroVitol
Current Illness: BP
Preexisting Conditions: BP
Allergies: None
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: Blurred or double vision especially after slight exertion or going up/down stairs, constant fatigue and low-level headache (this has been for more than a week now), mild spatial disorientation (as would be evidenced with --one symptom--incorrect typing of keys on keyboard), lack of proper bowl movement (more than 1 week), enhanced appetite (hungry).


VAERS ID: 1756583 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-26
Onset:2021-09-28
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blister, Gingival swelling, Lip dry, Mouth swelling
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), 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: None
CDC Split Type:

Write-up: Large, protruding blister on the inside of the right cheek. Smaller blister nearby on the same cheek. Swollen gums, slightly swollen on roof of mouth. Very dry lips.


VAERS ID: 1756638 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-09-20
Onset:2021-09-28
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039B21A / 1 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Abdominal distension, Erythema, Pruritus, Skin warm
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Citalopram, labetalol, metformin
Current Illness: N/A
Preexisting Conditions: High Blood Pressure, PCOS
Allergies: N/A
Diagnostic Lab Data:
CDC Split Type:

Write-up: Swelling, itching, redness, hot to the touch 1 week after injection


VAERS ID: 1756658 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-09-28
Onset:2021-09-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH COVID 19 VACCIN / 3 LA / SYR
FLUA4: INFLUENZA (SEASONAL) (FLUAD QUADRIVALENT) / SEQIRUS, INC. - / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Fatigue, Feeling cold, Pruritus, Rash erythematous, Somnolence, Tenderness
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Multiple vitamin, Raloxifene, Prevastatin,Amlopidine Besylate, Synthroid, Hydrochlorothiazide
Current Illness: None
Preexisting Conditions: Underactive thyroid, high cholesterole, elevated blood pressure, arthritis
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: I began to feel very tired and cold and dizzy about 4pm Sept 28, 2021. I then b egan to get itchy and sleepy. My left side began to itch and be sore to touch. I broke out in a bright red rash on my left arm to my elbow, chest, neck. It itched horriblly. I took Tylenol. It did not hellp. I put Benedryl cream on it. It continued itching and spreading . I used Benedryl over the counter pills. It still itches.


VAERS ID: 1756671 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-28
Onset:2021-09-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Dizziness, Fatigue, Injection site pain, Lymphadenopathy, Malaise, Nausea, Pain in extremity, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vasotec, Synthroid, Veltassa, Preservision, Magnesium, D3
Current Illness: None.
Preexisting Conditions: Type 2 Diabetes, Hypertension, Hyperkalemia, Anemia, Kidney Disease
Allergies: Tetracycline, Zosyn, Inderal, Captopril, Shellfish, High Sensitivity to Epinephrine
Diagnostic Lab Data:
CDC Split Type:

Write-up: Injection Site Pain, Tiredness, Chills, Fever, Nausea, Swollen Lymph Nodes (back of head), Arm Pain, Feeling Unwell, Lightheadedness


VAERS ID: 1756672 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-09-28
Onset:2021-09-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Pristique, amlodipine, metoprolol, trazadone, calcium, vitamin D, acetaminophen, tizanidine, a supplement that includes circumin, b lack pepper extract, and ginger
Current Illness: Labial rash
Preexisting Conditions: Chronic back pain
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hive like rash on trunk of body, chills, fatigue


VAERS ID: 1756738 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-09-28
Onset:2021-09-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / 1 AR / IM

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

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

Write-up: Error: Improper Storage (temperature)-


VAERS ID: 1756741 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-09-27
Onset:2021-09-28
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 - / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Crestor, omeprazol, metoporol, singular, omesartan, myrbetric, remron, fish oil, d3, aspirin, fibercon, super b, vit c, zinc, dicocyclin
Current Illness: Sinus infection, viral infection
Preexisting Conditions: Lupus
Allergies: Penicillin. Vicoden chantex
Diagnostic Lab Data:
CDC Split Type:

Write-up: Headache, chills body aches fever


VAERS ID: 1756747 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-09-25
Onset:2021-09-28
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 3 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Dehydration, Fall, Hypophagia, Hypoxia, SARS-CoV-2 test positive
SMQs:, Asthma/bronchospasm (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Accidents and injuries (narrow), Eosinophilic pneumonia (broad), Respiratory failure (broad), Infective pneumonia (broad), Dehydration (narrow), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: Patient received her 3rd dose of Pfizer COVID vaccine on 9/25/21 (dose 1 was on 2/19/21 and dose 2 was on 3/12/21). On 9/28/21, patient was brought to the ED after having multiple falls at home. She reported not eating or drinking well after her booster shot. Patient was found to be dehydrated and COVID (+). Patient was initially hypoxic in the ED at 88% on room air and was started on remdesivir and dexamethasone. The following day, pt was no longer requiring supplemental O2. Pt was discharged after spending 4 days in the hospital.


VAERS ID: 1756752 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-09-28
Onset:2021-09-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / 2 AR / IM

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

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

Write-up: Error: Improper Storage (temperature)-


VAERS ID: 1756761 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-09-28
Onset:2021-09-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / 3 AR / IM

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

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

Write-up: Error: Improper Storage (temperature)-


VAERS ID: 1756781 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-09-28
Onset:2021-09-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Chills, Defaecation disorder, Headache, Myalgia, Nausea, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Aspirin, benazepril, cetirizine, budesonide-fomoterol, Ipratropium-albuterol, DUO-NEB, Cholecalciferol, Celexa, Fluticasone propionate, furosemide, QuaiFENesin
Current Illness: NoCOPD
Preexisting Conditions:
Allergies: Dialitid
Diagnostic Lab Data:
CDC Split Type:

Write-up: Chills, Fever, Headache, Nausea, muscle pain and weakness, a feeling of diarrhea but no diarrhea. This lasted for 24 hours.


VAERS ID: 1756794 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-02-19
Onset:2021-09-28
   Days after vaccination:221
Submitted: 0000-00-00
Entered: 2021-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3249 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Dizziness, Dyspnoea, Hypoxia, Nasopharyngitis, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Respiratory failure (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: prostate CA, HTN/HLD, DM2, CAD s/p CABG x3, BPH, GERD, and OSA
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient presented to the ER on 9/28/21 for SOB and dizziness. He reported "cold symptoms" for 4-5 days PTA. He received 2 doses of Pfizer COVID vaccine (1/29/21 and 2/19/21). In the ER, patient was hypoxic to 89% on room air. He was started on supplemental O2, remdesivir, and dexamethasone since he tested positive for COVID on 9/28/21. Patient''s O2 needs continued to worsen, so Pulmonology was consulted and baricitinib was started on 9/30/21. Patient is currently on day 4 of hospitalization and is requiring 50L heated high flow oxygen on a medical floor.


VAERS ID: 1756799 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-28
Onset:2021-09-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301588A / 3 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Methotrexate
Current Illness: not known
Preexisting Conditions: unknown
Allergies: nka
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient has bruising at the site that looks black and blue and yellow. Patient that she did not see the bruising at time of injection because of the band-aid that was placed over it


VAERS ID: 1756816 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-09-27
Onset:2021-09-28
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD0809 / 1 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Asthenia, Back pain, Fatigue, Gait disturbance, Headache, Initial insomnia, Pain, Pain in extremity
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Depression (excl suicide and self injury) (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: No
Current Illness: No
Preexisting Conditions: No
Allergies: Estrogens
Diagnostic Lab Data: None
CDC Split Type:

Write-up: The day after I received my first covid vaccine I was extremely tired and my whole entire body ached. As of October second I am still very tired, my body aches, I have a headache, and I feel weak. My legs and back ache the most and it has prevented me from going on long walks and I have a hard time getting to sleep because I''m in a lot of pain. I have been taking Tylenol but that only helps get rid of the headache.


VAERS ID: 1756819 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-09-27
Onset:2021-09-28
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: 24 hours of malaise afte 2nd vaccine
Other Medications: Losartan, Pravastatin, Requip, Dexadrine, Trospium, Prevacid
Current Illness: None
Preexisting Conditions: HBP, High cholesterol, Restless legs, Hypersomnia, Hyperactive bladder, Acid Reflux
Allergies: KNA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Symptoms included HA, malaise, low grade fever, chills and body aches. Took acetaminophen. Lasted 24 hours. Reaction to 2nd shot was only malaise that lasted 24 hours.


VAERS ID: 1756822 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-27
Onset:2021-09-28
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 RA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Insulin, hydroxyzine, amliodipine
Current Illness: none
Preexisting Conditions: Diabetic, prinzmetal angina, hyperlipedemia
Allergies: Morphine
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Within 12 hours I was nauseous, headache and low grade fever. Within 24 hours I had thrown up and ached all over. Within 48 hours I had swollen lymph nodes under my right arm, at my wrist and my skin felt as if it had been burned. This lasted for almost 2 full days. By day five my symptoms had gone away. I had no adverse reactions of any kind to the first two shots.


VAERS ID: 1756845 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-09-27
Onset:2021-09-28
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH WA612683 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Extra dose administered, Hypoaesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Medication errors (narrow), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: As described in earlier item, I had the same ulnar nerve effect once per night for 7 nights following my first Pfizer COVID-19 v
Other Medications: Escitalopram 10mg/daily Lamotrigine 100 mg/daily Vitamin D3 6000 IU daily Calcium Multivitamin
Current Illness: Common cold (tested negative for Covid-19)
Preexisting Conditions: Depression
Allergies: Morphine, possibly penicillan
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Woke up while sleeping and my pinky, ring, and L half of middle finger were number (appeared to be ulnar nerve related). This lasted maybe 30 minutes and went away with no treatment. (Note this happened following my first COVID-19 shot, once a night for 7 days. Duration was shorter (~5 minutes each time) and went away with no treatment. I have not experience this other than these 8 occurrences all following the COVID-19 Pfizer injections. All were in my left arm.


VAERS ID: 1756886 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-08-21
Onset:2021-09-28
   Days after vaccination:38
Submitted: 0000-00-00
Entered: 2021-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abortion missed, Exposure during pregnancy, Foetal heart rate abnormal, Ultrasound foetal abnormal, Ultrasound scan vagina abnormal
SMQs:, Malignancy related therapeutic and diagnostic procedures (narrow), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Foetal disorders (narrow), Termination of pregnancy and risk of abortion (narrow)

Life Threatening? No
Birth Defect? Yes
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prenatal vitamin, prenatal probiotic, prenatal omega 3, cetirizine, melatonin
Current Illness: None
Preexisting Conditions: None
Allergies: Latex (rash)
Diagnostic Lab Data: 9/28/21- abdominal ultrasound x1, intravaginal ultrasound x2 with no cardiac activity noted- missed abortion
CDC Split Type:

Write-up: Newly pregnant during vaccination, with EDD 4/29/22. Normal ultrasound at 8 weeks (9/16/21) with developing fetus and yolk sac observed with heart rate measured at 164 bpm. Two weeks later (9/28/21), no cardiac activity seen x 3 ultrasounds; estimated fetal size ~9 weeks, suggesting demise one week prior.


VAERS ID: 1756906 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-09-27
Onset:2021-09-28
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Extra dose administered, Headache, Pain
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: Nexium 20 mg, Calcium Citrate with Mag Zinc Potassium and D3 250 mg, Vitamin D3 2000 IU, Women''s Probiotic, Balanced Vitamin B B-100 , Fish Oil 1000 mg., CoQ10 100 mg, Selenium 100 mcg The above taken daily
Current Illness: None
Preexisting Conditions: GERD
Allergies: Lisinopril, codeine, strawberries, Punica
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Normal side effects: Chills, Aches, Headache, but much more severe than the second injection. I had no noticeable side effects with the first injection and very mild side effects with the second injection. I am reporting this info because everything I''ve read about the side effects of the COVID 19 booster vaccination were that side effects would be similar to the first and second injections and maybe even milder. This was not my experience.


VAERS ID: 1756907 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-24
Onset:2021-09-28
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014F21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Skin sensitisation
SMQs:

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

Write-up: Rash in left V1 nerve distribution began at left scalp and progressed down forehead and eyelid over five days time with subsequent regional left pre-auricular lymphadenopathy. Rash consisted of small groups of painful blisters in lines that later crusted over. There was associated skin sensitivity to touch. This is currently day 5 of signs and symptoms, and I began treatment with valacyclovir because of recent new blisters.


VAERS ID: 1756943 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-09-28
Onset:2021-09-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / SYR

Administered by: Military       Purchased by: ?
Symptoms: Dyspnoea, Headache, Nausea, Palpitations, Urticaria
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (narrow), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Fexofenadine, omprazole
Current Illness:
Preexisting Conditions: depression, anxiety, rhinitis, asthma,
Allergies: pollen, seasonal allergies, cats. dogs, plants, trees, penicillin, shellfish and few more I can''t remember
Diagnostic Lab Data:
CDC Split Type:

Write-up: Headache, racing heart rate, nausea, hive on left shoulder, heavy breathing


VAERS ID: 1757000 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-28
Onset:2021-09-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1816022 / 1 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Asthenia, Blood pressure increased, Dizziness, Headache, Heart rate increased, Pain, Paraesthesia, Pyrexia
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Hypertension (narrow), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Flu vaccine 105.3 fever my age 43 year 2016
Other Medications: Lo-Loestrin Fe
Current Illness: none
Preexisting Conditions: none
Allergies: reaction to previous flu vaccine
Diagnostic Lab Data: Monitoring by paramedic while at vaccination site. pulse oximeter and Blood pressure cuff. Continue to monitor blood pressure at home.
CDC Split Type:

Write-up: On Sept. 28, 2021 after my first dose at 12:30 pm my Heart rate 130''s, Blood Pressure 211/100, lightheaded, weakness began at 12:48 pm. By around 1:35 pm Heart rate down from 130.s and sustained 100''s to mid 80''s, Blood Pressure was still elevated at 150''s-160''s/80''s-90''s and less lightheaded. 6:00pm fever of 100.5 and severe body aches and pins and needles to both hands. Pins and needles to both hands resolved next morning on Sept 29, 2021, fever on and off and severe body aches continue throughout Sept 29, 2021. Headache on Sept 29, 2021 continued all day until Sept 30, 2021


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