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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 81 out of 8,010

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VAERS ID: 1757002 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: California  
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 211A21A / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Facial paralysis, Muscular weakness, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hearing impairment (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Flu vaccine / 23
Other Medications: Vitamin C, Valerian Root at night, SAMe and Vitamin D
Current Illness: Migraines / endometriosis
Preexisting Conditions: Neuropathy / GBS diagnosed in 2013 (residual symptoms since then)
Allergies: Yes.
Diagnostic Lab Data:
CDC Split Type:

Write-up: - High Fever - Slight Paralysis on right side of face - Weakened leg muscles


VAERS ID: 1757009 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: California  
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 30130824 / 2 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Anticoagulant therapy, Blood test, Chest pain, Computerised tomogram, Deep vein thrombosis, Pain in extremity, Ultrasound Doppler abnormal
SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Multivitamin Gummies Spring Valley Vitamin D3 Gummies
Current Illness: None
Preexisting Conditions: asthmatic bronchitis (COPD), melanoma (x3), hiatal hernia, benign bone tumor in left ankle (1978), childhood bacterial immunity deficiencies (1968-1976) No history of blood clots or medication for same
Allergies: None
Diagnostic Lab Data: CATSCAN, Ultrasound and blood work (9/29/21)
CDC Split Type:

Write-up: Sore right leg presented 8 hours after the second shot. Spread to soreness in right chest 32 hours after the second shot. Admitted to Emergency Room 33 hours after the second shot. Ultrasound and CATSCAN with blood work. Diagnosis Deep Vein Thrombosis and second blood clot in right lower leg. Treatment - eliquis (10 mg 2x''s per day).


VAERS ID: 1757020 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: Texas  
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 (JANSSEN)) / JANSSEN 202A21A / 1 AR / SYR

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Fatigue, Headache, Hypoaesthesia, Muscle spasms, Myalgia, Nausea, Paraesthesia, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad), Sexual dysfunction (broad)

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

Write-up: Severe Headache - Sept 25 - Oct 1 Numbness, cramping, and tingling in both arms and legs - Sept 28 through Oct 1 Dizzy - Sept 28-Oct 1 Nausea Sept 28-Oct 1 Faint Sept 28-Oct 1 Muscle Aches Sept 25 - Sept 26 Fatigue/Weakness - Sept 25 - Oct 2


VAERS ID: 1757026 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-23
Onset:2021-09-28
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK LA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Dizziness, Erythema, Injection site erythema, Peripheral swelling, Pruritus, Sleep disorder, Urticaria
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (narrow), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Vestibular disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Took vaccine on 23rd September around noon. Symptoms started late in evening of 28th September. - There was general itching but was most uncomfortable on the scalp, skin under the eyebrows, chin and back. - Hands were slightly swollen and red. There were some red areas on the inside of the left arm. - Slight dizziness; no nausea or headache. Symptoms persisted on 29th September: - Could see redness on the skin of the face where I had scratched. Ears were itchy: not the inside of the ear canal but the outside part of both ears. - Hives (small red dots concentrated in one area under the skin) were visible on the inside of both arms and around armpits. More concentrated at the wrist. Self-medication started on 29th: - Took a Claritine tablet (10mg loratadine) at 1:40 pm. - Symptoms started going away with 2 hours. By 4:00 pm there were no symptoms. 30th September: - Woke up at 2:30 am with itching in hands. They were swollen and red. - Took another Claritine tablet. - Had hives on inside of arms and tops of feet in the morning with general redness on entire arms but symptoms went away after cold shower. Today is Oct 3rd: there have not been any symptoms since last recording. Will continue to take 1 Claritine tablet every 24 hours for another week. All the described symptoms are similar to the reaction I get from Pseudoephedrine (in cold medicine) except that the itching is not this intense and is localized to the hands and feet. I had also expected the skin on my palms and soles of feet to peel, which usually happens at the end of the reaction to pseudoephedrine but this did not happen with the Janssen vaccine.


VAERS ID: 1757036 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Nevada  
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 019F21A / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Pain, Peripheral swelling, Pyrexia, Somnolence
SMQs:, Cardiac failure (broad), Angioedema (broad), 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), Haemodynamic oedema, effusions and fluid overload (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: a light sore arm with the first dose
Other Medications: NKDA
Current Illness: NKDA
Preexisting Conditions: NO
Allergies: FLUCONAZOLE, FLAGYL
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Patient got vaccine at 10 am, by 2pm she started to develop drowsiness, fever and pain (105F). She described she sleep more than 72 hours in 4 days. Pain is severe. Her arm is swollen as big as the size of a softball. She called the nurse line and they told her to apply heat to arm-not working. Patient call pharmacy on 10/2/21, I recommend cold compression for the swelling, help a little bit. Patient did not have pain at this time. I advice patient to see doctor if symptoms not resolve or get worse.


VAERS ID: 1757106 (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: 2021-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301458A / 1 LA / IM

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

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

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


VAERS ID: 1757168 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-06-03
Onset:2021-09-28
   Days after vaccination:117
Submitted: 0000-00-00
Entered: 2021-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 LA / UN

Administered by: Unknown       Purchased by: ?
Symptoms: Acute kidney injury, Anticoagulant therapy, Atrial fibrillation, Atypical pneumonia, Benign prostatic hyperplasia, Blood creatinine increased, C-reactive protein increased, COVID-19, COVID-19 pneumonia, Chest X-ray abnormal, Chronic kidney disease, Condition aggravated, Dehydration, Hyperlipidaemia, Hypertension, Hypothyroidism, Platelet count decreased, Pyrexia, SARS-CoV-2 test positive, Sepsis, Tachycardia, Thrombocytopenia, Ultrasound kidney abnormal, Vaccine breakthrough infection
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Dyslipidaemia (narrow), Haematopoietic thrombocytopenia (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Hypertension (narrow), Cardiomyopathy (broad), Hypothyroidism (narrow), Lipodystrophy (broad), Chronic kidney disease (narrow), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Infective pneumonia (narrow), Dehydration (narrow), Sepsis (narrow), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen-codeine (TYLENOL #3) 300-30 MG Oral Tablet Take 1 tablet by mouth every 12 hours. Yes Information, Historical apixaban (ELIQUIS) 2.5 MG Oral Tablet Take 2.5 mg by mouth 2 times daily. Yes Information, Historical doxazo
Current Illness:
Preexisting Conditions: Atrial fibrillation, BPH, HTN, HLD
Allergies: Codeine
Diagnostic Lab Data: SARS-COV-2, NAA, Detected: 09/28/21
CDC Split Type:

Write-up: Patient required hospitalization due to breakthrough infection. Patient received J&J vaccine on 06/03/21. Patient was hospitalized from 09/28/21 - 09/30/21. Below is copied from discharge summary: Sepsis 2/2 COVID 19 PNA: - meeting sepsis criteria based on fever and tachycardia - O2 at 96% on RA - chest Xray showed atypical PNA - CRP 165 - O2 as needed; pulse Ox-$g ordered home O2 eval $g no O2 required - DVT ppx with eliquis - Hold Decadron IV, no benefit in view of no hypoxemia - Remdesevir for borderline benefit given AKI and $g10 days of symptoms onset-$gdiscussed risk and benefits with pr who agreed to get it. $g received 2 doses - On statin Thrombocytopenia: - 130 $g 113s in the setting of COVID 19 - Monitor as outpatient AKI vs CKD: - 2/2 dehydration - Cr 1.6 $g 1.9 $g 1.4 , follow up as outpatient - Renal US: Bilateral echogenic kidneys noted, which may reflect medical renal disease. No evidence for hydronephrosis. Hypothyroidism: -Resume synthroid HLD: -Resume statin HTN: - Controlled - metoprolol tartrate 25 mg PO BID - IV BP meds prn Chronic Afib on AC: - Rate controlled - Resume eliquis BID 2.5 mg - Resume BB BPH: -Resume terazosin Patient is discharged in stable condition with stable vital signs. All questions rearding hospital course and plan of care after discharge have been answered to satisfaction. Prescriptions for medications needed to be taken after discharge have been given to patient. Patient has been instructed to follow up with PCP, MD within the next 7 days after discharge. Patient verbalizes understanding all given instructions and has no further doubts regarding discharge.


VAERS ID: 1757190 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-09-27
Onset:2021-09-28
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301458A / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Bedridden, Cough, Diarrhoea, Fatigue, Feeling abnormal, Impaired work ability, Lethargy, Myalgia, Nausea, Oropharyngeal pain, Pyrexia, Tremor, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Pseudomembranous colitis (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Day 1: Felt normal until the night. Overnight developed a fever, nausea, muscle aches, sore throat, cough, Diarrhea Day 2: Bed ridden - unable to work, get out of bed, do anything. Diarrhea Day 3 - Throwing up after meals uncontrollably. Able to get out of bed but still feel horrible. Diarrhea Day 4- Day 7 (Current) - Lethargic, wake up feeling exhausted, Shaky, Mild Fever in the morning and at night, Nausea, Diarrhea . Have no energy. Pre vaccine never felt like this before


VAERS ID: 1757237 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-01-27
Onset:2021-09-28
   Days after vaccination:244
Submitted: 0000-00-00
Entered: 2021-10-03
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: Employee tested positive for Covid-19 after being fully vaccinated


VAERS ID: 1757262 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-02-17
Onset:2021-09-28
   Days after vaccination:223
Submitted: 0000-00-00
Entered: 2021-10-03
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, 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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Covid-19 test
CDC Split Type:

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


VAERS ID: 1757267 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-09-28
Onset:2021-09-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301358A / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: Bruising at Injection Site-Severe, Site: Swelling at Injection Site-Severe


VAERS ID: 1757307 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-24
Onset:2021-09-28
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048C21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Alopecia, Crying, Screaming
SMQs:, Hostility/aggression (broad), Depression (excl suicide and self injury) (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Flu vaccine about 10yrs ago. Got very sick for almost a month. It felt like I had the flu 100 times fold.
Other Medications: Clonidine 0.1mg, Topiramate 25mg, Cyclobenzaprine 5mg
Current Illness:
Preexisting Conditions: Nerve pain
Allergies: Penicillin, contrast in CT-Scans
Diagnostic Lab Data:
CDC Split Type:

Write-up: Excessive loss of hair. It started around 4 days after vaccine and now I''m afraid to even wash or brush my hair. It''s falling off in clumps. This is not the normal amount one loses when you brush. I''m talking, I can''t stop crying every time I run my fingers through my head and clumps of hair just fall off. My husband ran to the bathroom cause he heard me screaming and he was horrified at what he saw. There was so much hair on the tub floor that it looked like I was giving myself a haircut. At the rate is falling, if it continues, I don''t know if I will have much hair left, if any, in a month or so.


VAERS ID: 1757505 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-09-28
Onset:2021-09-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822809 / 1 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Chills, Cold sweat, Headache, Pain, Pyrexia, SARS-CoV-2 test negative
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), COVID-19 (broad)

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

Write-up: First day I had fever, chills , cold sweats three days headaches, body aches


VAERS ID: 1757586 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-09-28
Onset:2021-09-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Axillary pain, Bed rest, Condition aggravated, Decreased appetite, Eczema, Fatigue, Headache, Muscle injury, Neuralgia, Pain in extremity, Pyrexia, Tenderness
SMQs:, Peripheral neuropathy (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Accidents and injuries (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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Levothyroxin, Zolpidem, Losartan, Aspirin 81 mg, Atorvastatin, Magnesium, Vitamin D3, L-Tyrosine, Vitamin B 6 & 12
Current Illness: Hamstring injury +
Preexisting Conditions: hypothyroid osteopenia overactive bladder migraines with two (2017/18) being hemiplegic migraines osteoarthritis Basal cell skin cancer
Allergies: Codeine, Lactose sensitivity
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Tender Left arm became sore by 9 PM. During the night, developed temp in the 99.1-99.5 range despite extra strength Tylenol every 8 hrs. with headache. On awakening, noted nerve pain I had related to Hamstring injury I finally thought I''d gotten rid of, resurfaced over multiple body parts as did eczema I hadn''t seen in years on my arms. experienced underarm pain on attempting to raise arm. And although I know they are routine side effects ,I want to include the tiredness, decreased appetite and joint pain so that you know all facets of my experience. When the fever subsided about 1.5 days later, so did the symptoms although the tiredness lasted yet another day. Used ice packs, pushed fluids and rested in bed.


VAERS ID: 1757921 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-09-28
Onset:2021-09-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 035C21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chills, Decreased appetite, Fatigue, Impaired work ability, Injection site pain, Mouth ulceration, Pain in extremity, Palpitations, Tenderness
SMQs:, Severe cutaneous adverse reactions (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Extravasation events (injections, infusions and implants) (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Escitalopram 20mg po daily, Valsartan 160mg po daily, Breo 200/25mcg 1 inhalation qAM, Famotidine 40mg po qd-bid prn
Current Illness: none
Preexisting Conditions: in remission from pulmonary sarcoidosis since 08/2008 diagnosed with hypertension June 2021 depression/anxiety-diagnosed 2005 and well managed with medication and therapy
Allergies: Clindamycin, Monistat, Cymbalta, adhesives
Diagnostic Lab Data: none
CDC Split Type:

Write-up: By approximately 4pm the day I received the vaccine, I felt very tired. My arm the injection site was very sore, but there was no redness there. The next day, 9/2921, the fatigue was overwhelming-I felt like I had been hit by a bus. The pain in my arm was not just at the injection site, but went down my entire arm. I had chills (but no fever), no appetite, and palpitations off and on. I was not able to work on 9/29/21. On 9/30/21, I returned to work and all symptoms had resolved except for the soreness in my arm. By 10/2/21 the soreness in my arm resolved, however, I had developed an ulcer? in my mouth, inside of my upper lip. By 10/3/21, I had that ulcer as well as 3 places on the inside of my lower lip that weren''t ulcerated, but had circular areas of skin peeling off -on the inside of my lower lip, not on the lip itself. As of 10/4/21, these areas are still present and are tender.


VAERS ID: 1758572 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-09-27
Onset:2021-09-28
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 2 RL / UN

Administered by: Public       Purchased by: ?
Symptoms: Cellulitis, Haematoma infection, Headache, Injection site swelling, Pain in extremity
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Armour Thyroid B12 Vitamin C vitamin D Premarin Cream Multi Vitamin
Current Illness:
Preexisting Conditions: Hypothyroidism Myotonic dystrophy
Allergies: Tal win Codeine Amoxicillin Levaquin Piroxicam Butazolidin Erythromycin ZPac Latex
Diagnostic Lab Data:
CDC Split Type:

Write-up: Swelling at injection site was size of dime next morning. Swelling continued each day. Today it is 5x6 measured by doctor. Headaches since Wednesday and pain down leg since Wednesday night. Doctor said celulitis or hematoma that has gotten infected.


VAERS ID: 1758618 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-27
Onset:2021-09-28
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dyspepsia, Fatigue, Headache, Neuropathy peripheral
SMQs:, Peripheral neuropathy (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific dysfunction (narrow), 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? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Headache, fatigue, heartburn, neuropathy


VAERS ID: 1758642 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-07-23
Onset:2021-09-28
   Days after vaccination:67
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 043B21A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006C21A / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Hip surgery, Periprosthetic fracture, SARS-CoV-2 test positive
SMQs:, Osteoporosis/osteopenia (broad), Osteonecrosis (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: Pt was admitted on 9/21 and had a COVID swab done on 9/23 that was negative prior to surgery for a right hip periprosthetic femur fracture. Prior to skilled nursing home placement, pt had a repeat COVID swab completed on 9/28 that was positive.


VAERS ID: 1758679 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-27
Onset:2021-09-28
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040C21A / 2 RA / -

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

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

Write-up: chest pain, difficulty breathing, fever 104, injection site hot with blisters


VAERS ID: 1758731 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-01-06
Onset:2021-09-28
   Days after vaccination:265
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0140 / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3249 / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Oropharyngeal pain, Pyrexia, Upper respiratory tract congestion
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (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? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: History of non-Hodgkin''s lymphoma. Has had a 4-day history of fever, chills, sore throat, and URI symptoms/congestion.


VAERS ID: 1758735 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-28
Onset:2021-09-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 2 LA / IM

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

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

Write-up: Pt was administered Pfizer(for 2nd vaccination) instead of Moderna. Pt informed on 9-28-2021.


VAERS ID: 1758801 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-09-28
Onset:2021-09-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Vaccine error-vaccine was administered past its beyond use date. The vaccine had been stored in the freezer beyond the time frame recommended by the manufacturer.


VAERS ID: 1758806 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-04-06
Onset:2021-09-28
   Days after vaccination:175
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1802068 / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: pzempic, prilosec, metformin, synthroid, gabapentin, farxiga
Current Illness:
Preexisting Conditions: biliary cirrhosis, hypothyroidism, PCOS, osteoarthritis obesity, uncontrolled diabetes
Allergies:
Diagnostic Lab Data: Positive covid on admission
CDC Split Type:

Write-up: Patient came in for endometrial intraepithelial neoplasia


VAERS ID: 1758953 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-09-27
Onset:2021-09-28
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH PP8839 / 3 RA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Headaches, soreness
Other Medications: Metformin 500mg, Allopurinol 100mg, Atorvastatin 10mg, Vitamin D, Multivitamin,
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Break out in hives all over


VAERS ID: 1758954 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-09-15
Onset:2021-09-28
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 UN / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Adenovirus test, Arthralgia, Chest pain, Electrocardiogram ST segment elevation, Enterovirus test negative, Magnetic resonance imaging heart, Myocardial oedema, Myocarditis, Nausea, Pallor, Troponin increased, Ultrasound scan normal, Viral test
SMQs:, Acute pancreatitis (broad), Myocardial infarction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Claritin
Current Illness: None
Preexisting Conditions: Seasonal allergies
Allergies: None
Diagnostic Lab Data: 9/29 troponin: 0.64-$g16-$g18 ; 9/30 troponin: 13-$g12 ; EKG: Diffuse ST segment elevations ; Echo: normal; Cardiac MRI showed edema consistent with myocarditis (10/1). Enterovirus PCR and Adenovirus PCR drawn 9/29 were negative. No other likely cause of myocarditis was identified prior to discharge
CDC Split Type:

Write-up: Woke up at night with severe left shoulder pain, 12 days after 1st vaccination, which receded and he went to bed. No symptoms the next day. Woke up early the following morning (now 14 days after vaccination) with L shoulder pain, chest pain, nausea, pale in color, at which point he was taken to the local ED. He was treated with ibuprofen and colchicine and had symptomatic resolution in less than twelve hours. Troponin began to decrease 12 hours after admission, decreased from high of 18 ng/ml to 0.34 ng/ml at time of discharge 3 days after presentation.


VAERS ID: 1758989 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-03-20
Onset:2021-09-28
   Days after vaccination:192
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: COVID-19, Cough, Oropharyngeal pain, Rhinorrhoea, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none known
Current Illness: none known
Preexisting Conditions: none known
Allergies: none known
Diagnostic Lab Data: PCR+ for Covid on 10/1/2021
CDC Split Type:

Write-up: Client was vaccinated with Moderna vaccines on 3/20 and 4/17/2021 at a pharmacy in . Symptoms started on 9/28 - runny nose , cough, sore throat. Tested + with PCR on 10/1. Reported as a case of breakthrough Covid in a fully vaccinated person


VAERS ID: 1759010 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-09-28
Onset:2021-09-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Vaccine error-vaccine was administered past its beyond use date. The vaccine had been stored in the freezer beyond the time frame recommended by the manufacturer.


VAERS ID: 1759036 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-24
Onset:2021-09-28
   Days after vaccination:216
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 9/28/2021 @ HCF -tested non -PCR positive for COVID-19
CDC Split Type:

Write-up: tested COVID-19 positive $g 14 days after vaccine series


VAERS ID: 1759049 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-09
Onset:2021-09-28
   Days after vaccination:19
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Guillain-Barre syndrome
SMQs:, Peripheral neuropathy (narrow), Guillain-Barre syndrome (narrow), Demyelination (narrow), Immune-mediated/autoimmune disorders (narrow)

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

Write-up: received dose number one of covid pfizer on 9/9, second dose 9/30; presented to ED 10/2 with Guillan-Barre syndrome stating that symptoms started 5 days prior


VAERS ID: 1759074 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-03-19
Onset:2021-09-28
   Days after vaccination:193
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6206 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Hospitalisation, 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: COVID+ on 9/28/21 s/p 2 doses of Pfizer (last on 3/19/21) & admitted to hospital


VAERS ID: 1759082 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-01-13
Onset:2021-09-28
   Days after vaccination:258
Submitted: 0000-00-00
Entered: 2021-10-04
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: Employee tested positive for Covid-19 after being fully vaccinated


VAERS ID: 1759092 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-07-26
Onset:2021-09-28
   Days after vaccination:64
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 091D21A / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, 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:
CDC Split Type:

Write-up: 9/28 symptomatic COVID breakthrough. Inpatient admit 10/2/21


VAERS ID: 1759095 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-09-24
Onset:2021-09-28
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021B21A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dysgeusia, Headache
SMQs:, Taste and smell disorders (narrow)

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

Write-up: On the 4 day after receiving the first dose of the Moderna COVID vaccine he woke with a headache and has been having them since. The headaches started on 9/28/21 as a dull ache type pain at the base of his skull radiating up to his eyes. He rates the pain at a 6 on 1-10 scale without taking OTC Dual Action Advil for some relief. The OTC medication brings the pain down to a 4 on 1-10 scale. He denies any accompanying sx such as nausea, vomiting, visual disturbance, and dizziness. He did report a metallic taste in his mouth for approximately 3 days after getting the vaccine. He is scheduled to be seen today, 10/4/21, at a Urgent Care facility for evaluation and treatment.


VAERS ID: 1759127 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-28
Onset:2021-09-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Fatigue, Injection site erythema, Injection site 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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: I received the 3rd Pfizer COVID vaccine on 9/28/21 and later that day became extremely fatigued with fevers starting that evening. Injection site pain and redness noted the same evening. Intermittent fevers, fatigue and injection site pain/redness continued until Friday, 10/1/21.


VAERS ID: 1759138 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-09-28
Onset:2021-09-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 3 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Oxybutynin Chloride ER 5mg - Take 1 tab by mouth 2 times a day. Calcium 600 - Take 1 tab by mouth 2 times a day. Carbidopa-Levodopa 25/100mg - Take 1 tab by mouth three times a day. Donepezil HCI 10mg - Take one tablet by mouth every day wi
Current Illness: Unknown
Preexisting Conditions: Parkinson''s Disease
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received 2 doses of Moderna Vaccine on 01/22/2021 and 02/24/2021. On 09/28/2021, she came for a Booster vaccine and was given Pfizer.


VAERS ID: 1759200 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-02-19
Onset:2021-09-28
   Days after vaccination:221
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9267 / 2 - / -

Administered by: Pharmacy       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: Tested ~9/28/21 COVID positive
CDC Split Type:

Write-up: COVID Vaccine breakthrough case


VAERS ID: 1759350 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-09-28
Onset:2021-09-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017E21A / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Back pain, Cough, Fatigue, Headache, Muscle spasms
SMQs:, Anaphylactic reaction (broad), Retroperitoneal fibrosis (broad), Dystonia (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: Focalin, Nexium, gabapentin, Singular, tadalafil, testosterone, naproxen, Tylenol, multivitamin
Current Illness: N/A
Preexisting Conditions: ADHD, hypogonadism, paraneoplastic syndrome
Allergies: penicillin
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Approximately 3-4 hours after getting his 3rd Moderna vaccine he developed headache, fatigue, muscle cramps, worsening back pain and cough x 6 days.


VAERS ID: 1759367 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-09-28
Onset:2021-09-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 LA / IM

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

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

Write-up: Vaccine given on 9/28/21 with expiration date of 9/21/21. Janssen notified/consulted;inquiry#0259438. Dr notified/consulted. Patient notified-suggested antibody testing be done 2 weeks after receiving vaccine.


VAERS ID: 1759371 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-03-18
Onset:2021-09-28
   Days after vaccination:194
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6203 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Back pain, Cough, Oropharyngeal pain, Respiratory tract congestion, Vaccine breakthrough infection
SMQs:, Anaphylactic reaction (broad), Retroperitoneal fibrosis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (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: Chronic conditions include A-fib, MI, HTN
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: This case met criteria for vaccine breakthrough review. Symptoms include chest congestion, cough, sore throat and back pain.


VAERS ID: 1759537 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-09-28
Onset:2021-09-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822809 / 1 LA / SYR

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

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

Write-up: PATIENT WENT TO ASK PHARMACIST A QUESTION ABOUT EFFICACY OF VACCINE USING HIS PHONE. AS PHARMACIST WAS LOOKING AT THE PATIEN''TS PHONE, HIS WIFE JUST GAVE PATIENT A SHOT OF THE VACCINE WITHOUT CONSULTING THE PHARMACIST.


VAERS ID: 1759541 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-28
Onset:2021-09-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 212A21A / 1 LA / IM

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

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

Write-up: No adverse event from vaccine in clinic. Patient has previously received Pfizer both doses from another provider earlier this year. Patient was asked on two separate occasions if this was her first COVID-19 vaccine that she stated "yes", patient also registered herself through VRAS state platform for COVID-19 vaccines scheduling. After discovering that patient had Pfizer doses listed in database, admin staff questioned patient again if she had ever received COVID-19 vaccine, she again stated that she had not, when she was shown her record to verify that information was actually her, she finally stated that she did get both doses of Pfizer as indicated in database. She went on to say that her physician instructed her to not tell facility she had been previously vaccinated and to specifically get the Johnson & Johnson COVID-19 vaccine due to a medication she is taking. Notified Nursing Director.


VAERS ID: 1759622 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Nebraska  
Vaccinated:2021-09-28
Onset:2021-09-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002C21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: C-reactive protein increased, Cardiac function test normal, Chest X-ray, Headache, Hypertension, Metabolic function test normal, Myalgia, Tachycardia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Hypertension (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: alprazolam; aripiprazole;busperone;flonase;fluconazole;dyroxazine;metoclopramide;omeprazole, sertraline
Current Illness: none
Preexisting Conditions: female infertility; depression
Allergies: Flagyl; macrobid;sulfa doxycycline
Diagnostic Lab Data: chest X-ray; CRP elevated to 53.93; Cardiac panel WNL; CMP WNL.
CDC Split Type:

Write-up: tachycardia, headache, muscle ache, hypertension. Given IV fluids. Patient responded to fluids, heart rate from 160-116.


VAERS ID: 1759683 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-30
Onset:2021-09-28
   Days after vaccination:90
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: complaint of COUGH, FEVER & NAUSEA The patient describes cough ongoing for nearly eight weeks, following the confirmation of COV19 infection on 8/5/21. In the past three days, she has had fever to 104.9F (reportedly), nausea, with NB emesis and body aches. Cough is minimally productive of white phlegm, no hemoptysis. No chest discomfort, dyspnea, asymmetric calf pain/swelling, orthopnea, pedal edema, neck stiffness, HA, vision or speech changes, focal numbness or weakness, diarrhea, abdominal pain, or urinary complaint.


VAERS ID: 1759697 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Female  
Location: California  
Vaccinated:2021-01-31
Onset:2021-09-28
   Days after vaccination:240
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Dyspnoea, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), 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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 88-year-old female with H/O HTN, COPD, CAD, AFib on Coumadin, COVID 19 positive few days ago, brought into the ED C/O fever and shortness of breath.


VAERS ID: 1759719 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-09-27
Onset:2021-09-28
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301558A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Influenza like illness, Pyrexia, Vaccine positive rechallenge
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Patient stated that she was having flu like symptoms and fever with the second dose (was day 3). She also stated that she had flu like symptoms after her first dose for 10 days. As of our phone conversation her symptoms had not subsided (day 3). She did state that they appeared to be slightly more mild but not much.


VAERS ID: 1760236 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-28
Onset:2021-09-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / IM

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

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

Write-up: Patient received a Moderna Covid-19 Vaccine shot on 19 JUL 2021, and was deployed in support of care. Due to the risk of working with vulnerable, communicable risk of congregate living facilities; this patient was given a dose of the Pfizer Vaccine for his second shot as it was the only vaccine available at the time. No adverse reactions were reported.


VAERS ID: 1760439 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-09-24
Onset:2021-09-28
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

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

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

Write-up: Redness and swelling to left upper arm, developed 4 days after vaccination, hard lump to injection site, persistent redness swelling and pain present at day 10


VAERS ID: 1760643 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-09-27
Onset:2021-09-28
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301358A / 2 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Ibuprofen
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: I have not gone to the doctor for the issue as i can not afford medical bills.
CDC Split Type:

Write-up: Chest pain on the left side from around 8:30AM until around 6:30PM the same night. The chest pain has continued intermittently since receiving the shot. The chest pain is sharp and focused in the left pectoral area.


VAERS ID: 1761022 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-09-27
Onset:2021-09-28
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 3 LA / SC

Administered by: Private       Purchased by: ?
Symptoms: Chills, Headache, Pain, Paraesthesia, Pruritus, Tinnitus, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (broad), Guillain-Barre syndrome (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:
Other Medications: Aspirin 81 mg
Current Illness: Viral illness 2 weeks prior to vaccination, chills, low grade fever, and body aches. Covid and flu negative at that time.
Preexisting Conditions: Endometriosis
Allergies: cephalosporin allergy
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hives all over body with severe itching and tingling, Body aches, chills, Headache, ringing of ears


VAERS ID: 1761234 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-09-27
Onset:2021-09-28
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006D21A / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Axillary pain, Fatigue, Hypersomnia, Injection site pain, Injection site warmth, Lymphadenopathy, Migraine
SMQs:, Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Depression (excl suicide and self injury) (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: on 9/28/21, I woke up with a very tender, sore & hot to touch injection site, I also had a migraine & felt exhausted, ended up sleeping for the rest of the day & the next day. The injection site remained sore & felt hot for approximately a week. By 9/30, the migraine & fatigue let up & I was feeling better. On 10/5/21, I woke up in the middle of the night (approximately 2am) with a tender, sore to touch & swollen right arm pit.


VAERS ID: 1761248 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-01-16
Onset:2021-09-28
   Days after vaccination:255
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 9/28/2021, tested positive.
CDC Split Type:

Write-up: patient tested positive for COVID-19 $g 14 days after vaccine series


VAERS ID: 1761254 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-09-28
Onset:2021-09-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 - / IM

Administered by: School       Purchased by: ?
Symptoms: Asthenia, Fatigue, Headache, Injection site pain, Nausea
SMQs:, Acute pancreatitis (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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: No OTC
Current Illness: No
Preexisting Conditions: Hypercholesterolemia Hyperlipidemia Lung nodule Right lower lobe lung mass Lung cancer (CMS HCC) Headaches GERD Acute diverticulitis Adenomatous colon polyp Motion sickness Hiatal hernia Vitamin D deficiency Osteopenia Mixed anxiety and depressive disorder Grief reaction LGSIL on Pap smear 10/10. normal colp Hypokalemia
Allergies: NKDA
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Headache,Nausea,Extreme weakness,,Fatigue,,soreness at injection site


VAERS ID: 1761325 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-09-27
Onset:2021-09-28
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30125RA / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood pressure increased, Blood test, Chest pain, Condition aggravated, Electrocardiogram, Fatigue, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Hypertension (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Body aches, fatigue, chills
Other Medications: Premarin 0.625 mg, Prometrium, Magnesium 400 mg, Folic Acid, omega 3, Wellbutrin 150 mg
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: Percocet
Diagnostic Lab Data: EKG, Blood Work
CDC Split Type:

Write-up: Chest pain and elevated blood pressure for 3 days. Body aches, low grade fever, fatigue


VAERS ID: 1761357 (history)  
Form: Version 2.0  
Age: 93.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-01-26
Onset:2021-09-28
   Days after vaccination:245
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0142 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Incomplete course of vaccination
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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospitalization (non-ICU) Only received one dose.


VAERS ID: 1761412 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-03-30
Onset:2021-09-28
   Days after vaccination:182
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (UNKNOWN)) / UNKNOWN MANUFACTURER - / 2 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, COVID-19, Chest pain, Chills, Cough, Dyspnoea, Immunodeficiency, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: Cefaclor
Diagnostic Lab Data: Coronavirus 2 PCR Detect, V symptomatic POSITIVE
CDC Split Type:

Write-up: NO record of vaccine in chart, patient reports he received both vaccines in March 2021. Brand not in medical record. Patient reports to the ED with c/o cough, chest pain, shortness of breath, and weakness since yesterday morning. Patient reports that he has a "compromised immune system" and so he called the nurse line and was told to report to the ED. Patient denies fevers but reports some chills. Patient in no obvious distress, airway intact.


VAERS ID: 1761446 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-03-25
Onset:2021-09-28
   Days after vaccination:187
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006B21A / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Ageusia, Asthenia, Atrial fibrillation, COVID-19, Cough, Decreased appetite, Diarrhoea, Dyspnoea, Hypoxia, Pyrexia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Supraventricular tachyarrhythmias (narrow), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Noninfectious diarrhoea (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: UNKNOWN
Current Illness: UNKNOWN
Preexisting Conditions: MD NOTES: Past Medical History: Essential hypertension Hyperlipidemia Hypothyroidism Advanced age of 91 BMI of 19.5 Osteoarthritis of multiple sites
Allergies: CODEINE
Diagnostic Lab Data:
CDC Split Type:

Write-up: MD Notes: Chief Complaint This patient is a 91-year-old pleasant lady awake alert oriented x4 living independently in an apartment and assisted by 2 children high functioning cognitively physically was brought in after she was found to have been weak had loss of appetite cough fever and tested positive for COVID-19. History of Present Illness This patient has cough, dyspnea acute hypoxia fever loss of appetite low energy loss of taste and diarrhea. She has been having her children and caregivers provide food to her apartment. She stated that she has 2 children a son and a daughter. One of her frequent visiting caregiver had tested positive for COVID-19. She had symptoms of cough fever and diminished taste appetite diarrhea about 4 days ago. She has been hypoxic and has dyspnea. Outpatient testing came back positive for COVID-19. She had worsening symptoms of acute hypoxia, atrial fibrillation with rapid ventricular rate and patient being symptomatic elderly 91-year-old was brought and admitted for further evaluation and management of acute hypoxia, newly diagnosed COVID-19 associated. She denies any chest pain shortness of breath. She denies any orthopnea palpitations. She is volume depleted. She has been evaluated in the emergency room now brought into telemetry unit.


VAERS ID: 1761459 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-09-28
Onset:2021-09-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822811 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Bone pain, Diarrhoea, Fatigue, Feeling cold, Headache, Hyperhidrosis, Injection site pain, Nausea, Pain, Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Osteonecrosis (broad), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Tetanus reaction, severely swollen arm, over 40 years ago
Other Medications: Vitamin D3, B complex, zinc, probiotic
Current Illness: none
Preexisting Conditions: none
Allergies: Oxycodone [Opioids-Morphine & Related] Penicillin Tetanus
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Because of history of allergies, facility had me wait 1/2 hour after; several hours after jab administered, sore arm at injection site. Upon waking the next morning, I noticed a rash - diffuse red spots - developing : Abdomen to lower back, few spots on breasts, some on arms, some have white heads; headache; several hours later saw MD for rash; had fever of 101.1, headache worse, arm very painful, body aches; later that day into evening had chills and fatigue. Day 3 severe headache, body aches, bone pain, nausea diarrhea, fatigue, chills, arm pain. These continued into Day 4 with sweating and fatigue worsening. One week later I still have a dull headache, fatigue and intermittent sweating.


VAERS ID: 1761502 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-09-28
Onset:2021-09-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 2 LA / IM

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

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

Write-up: Pfizer vaccine given 33 days after put in the refrigerator. Use by date 9/25/2021


VAERS ID: 1761511 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-02-27
Onset:2021-09-28
   Days after vaccination:213
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Cough, Dyspnoea, Pyrexia, Respiratory tract congestion
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 8 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: congestion, coughing, difficulty breathing, fever


VAERS ID: 1761531 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-03-08
Onset:2021-09-28
   Days after vaccination:204
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal pain
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 8 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: ABDMONIAL PAIN


VAERS ID: 1761535 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-09-28
Onset:2021-09-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 2 LA / IM

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

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

Write-up: Vaccine given at 33 days after refrigerated. Use by date 9/25/21


VAERS ID: 1761545 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-09-28
Onset:2021-09-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 1 LA / IM

Administered by: Private       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 given at 33 days after refrigerated. Use by date: 9/25/21


VAERS ID: 1761554 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-09-28
Onset:2021-09-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 1 LA / IM

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

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

Write-up: Vaccine given 33 days after refrigerated. use by date 9/25/21


VAERS ID: 1761564 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-09-28
Onset:2021-09-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 1 LA / IM

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

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

Write-up: Vaccine given 33 days refrigerated. Use by date 9/25/21


VAERS ID: 1761595 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-09-28
Onset:2021-09-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 1 LA / IM

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

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

Write-up: Vaccine given 33 days refrigerated. Use by date 9/25/21


VAERS ID: 1761607 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-03-30
Onset:2021-09-28
   Days after vaccination:182
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006B21A / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, SARS-CoV-2 test
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 community contact


VAERS ID: 1761608 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-09-28
Onset:2021-09-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 1 LA / IM

Administered by: Private       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 given at 33 days refrigerated. use by date 9/25/21


VAERS ID: 1761649 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-09-28
Onset:2021-09-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 1 LA / IM

Administered by: Private       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 given at 33 days refrigerated. Use by date 9/25/21


VAERS ID: 1761657 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-09-28
Onset:2021-09-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 1 LA / IM

Administered by: Private       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 given at 33 days refrigerated. Use by date 9/25/21


VAERS ID: 1761665 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-09-28
Onset:2021-09-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 3 LA / IM

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

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

Write-up: Vaccine given at 33 days refrigerated. Use by date 9/25/21


VAERS ID: 1761672 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-09-28
Onset:2021-09-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 2 RA / IM

Administered by: Private       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 given at 33 days after refrigerated. use by date 9/25/21


VAERS ID: 1761683 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-26
Onset:2021-09-28
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30230BA / 3 RA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: multivitamins, coq10, probiotics, digestive enzymes, joint supplements
Current Illness: none
Preexisting Conditions: osteoarthritis, osteoporosis
Allergies: sensitivities to amoxycillin, corticosteroids
Diagnostic Lab Data: None needed.
CDC Split Type:

Write-up: 42 hours after my Pfizer Covid19 Booster shot, my right arm developed a large red swollen diamond-shaped rash (possible "COVID ARM"?). No heat or fever. This rash started to dissipate in the next 2 days and was gone altogether by the 5th day. I e-mailed my doctor''s office. They told me that I should report this event to you.


VAERS ID: 1761772 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-02-12
Onset:2021-09-28
   Days after vaccination:228
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Asymptomatic COVID-19, Atrial fibrillation, COVID-19, Condition aggravated, Fall, Hypertension, SARS-CoV-2 test positive, Type 2 diabetes mellitus
SMQs:, Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Supraventricular tachyarrhythmias (narrow), Accidents and injuries (narrow), Hypertension (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: UNKNOWN
Current Illness: UNKNOWN
Preexisting Conditions: ATRIAL FIB DIABETES HTN
Allergies: NO KNOWN ALLERGIES
Diagnostic Lab Data: 9/28/21 : SARS0CoV-2 = DETECTED
CDC Split Type:

Write-up: PRESENTED TO ER ON 9/29/21 SECONDARY TO FALL AT HOME.PATIENT WAS FOUDN TO BE COVID +. ON 9/29/21 TRANSFERED TO MEDICAL CENTER FOR HIGHER LEVEL OF CARE. DX; ATRIAL FIB WITH RVR, HTN, COVID-19-ASYMPTOMATIC. TYPE 2 DIABETES. 10/1/21 DISHCARGED FROM HOSPITAL TO HOME.


VAERS ID: 1761809 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-03-31
Onset:2021-09-28
   Days after vaccination:181
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0150 / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Intensive care, Mechanical ventilation
SMQs:, Acute central respiratory depression (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? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: patient admitted with COVID on 28 Sept. Was in ICU shortly after admission, consult obtained due to high oxygen requirement. On NiPPV initially. Transferred to floor on 1 Oct on NiPPV 15/10 FiO2 80%- transitioned to high flow


VAERS ID: 1761896 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-01-26
Onset:2021-09-28
   Days after vaccination:245
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3249 / 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 10/4 SARS/COV-2, NAAT Positive
CDC Split Type:

Write-up: Breakthrough COVID


VAERS ID: 1761962 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-24
Onset:2021-09-28
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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 error-vaccine was administered past its beyond use date. The vaccine had been stored in the freezer beyond the time frame recommended by the manufacturer.


VAERS ID: 1761991 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-24
Onset:2021-09-28
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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 error-vaccine was administered past its beyond use date. The vaccine had been stored in the freezer beyond the time frame recommended by the manufacturer.


VAERS ID: 1762080 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-07-25
Onset:2021-09-28
   Days after vaccination:65
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory failure, Angiogram pulmonary abnormal, Arteriosclerosis coronary artery, Chest pain, Computerised tomogram abnormal, Diarrhoea, Dyspnoea, Electrocardiogram QRS complex, Electrocardiogram QT interval, Electrocardiogram ST-T segment abnormal, Electrocardiogram abnormal, Exposure to SARS-CoV-2, Intensive care, Laboratory test normal, Lung opacity, Oropharyngeal pain, Osteoarthritis, Oxygen saturation abnormal, Pneumonia, Positive airway pressure therapy, Productive cough, Rhinorrhoea, SARS-CoV-2 test negative, Sinus bradycardia, Sputum purulent, Tachypnoea, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Asthma/bronchospasm (broad), Interstitial lung disease (narrow), Arrhythmia related investigations, signs and symptoms (broad), Disorders of sinus node function (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Pseudomembranous colitis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Other ischaemic heart disease (narrow), Hypersensitivity (broad), Arthritis (narrow), Noninfectious diarrhoea (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: pmhx of CAD w/o stents, fibromyalgia, hypothyroidism, obesity, lymphedema, Hx seizures, anxiety, depression, Hx of decompensated cirrhosis with HE, HCV s/p treatment and SVR
Allergies: haloperidol (pressure in head) phenobarbital (HALLUCINATIONS) No Known Latex Allergy Thorazine Wellbutrin (anxiety) allopurinol (headache)
Diagnostic Lab Data: Diagnostic Results Measurements Intervals Axis Rate: 67 P: 42 PR: 212 QRS: 14 QRSD: 81 T: 70 QT: 418 QTc: 433 Interpretive Statements SINUS RHYTHM WITH FIRST DEGREE AV BLOCK NONSPECIFIC ST & T-WAVE ABNORMALITY Compared to ECG 09/06/2019 10:13:57 T-wave abnormality now present Sinus bradycardia no longer present Electronically Signed On 9-28-2021 22:03:21 [1] (09/28/2021 20:43 CT Chest PE Protocol) FINDINGS: VASCULAR: The study is diagnostic to the level of the subsegmental pulmonary arteries. PULMONARY ARTERIES: No evidence of acute or chronic pulmonary embolism. The pulmonary arteries are normal in size. THORACIC AORTA: Normal in size. PULMONARY VEINS: Normal drainage into the left atrium. CORONARY ARTERIES: Moderate calcified coronary atherosclerosis. SYSTEMIC VEINS: Within normal limits. HEART: The heart is normal in size. No pericardial effusion. CHEST: LUNGS/PLEURA: Bilateral multifocal groundglass and consolidative airspace opacities. No suspicious pulmonary nodules are visualized. No pleural effusion or focal pleural lesion. MEDIASTINUM: No pathologic mediastinal or hilar adenopathy. The visualized thyroid and the esophagus are unremarkable. AXILLA/SOFT TISSUE: No supraclavicular or axillary adenopathy. Regional soft tissues are within normal limits. UPPER ABDOMEN: The gallbladder is surgically absent. Similar appearance of a calcified splenic artery aneurysm measuring 1.5 cm in diameter, unchanged dating back to CT abdomen/pelvis dated 1/26/2017. BONES: No evidence of acute fractures or aggressive osseous lesions. Multilevel degenerative changes of the spine. Bilateral shoulder joint osteoarthrosis. IMPRESSION: VASCULAR: No CT evidence of pulmonary embolism. CHEST: Bilateral multifocal groundglass and consolidative airspace opacities. Findings are consistent with multifocal pneumonia. Consider laboratory evaluation for Covid-19.
CDC Split Type:

Write-up: presented to ER on 9/28 with dyspnea. EMS noted a SP02 of low 80''s on room air. On arrival, vitals wnl except for Sp02 of 86% on room air and tachypnea to 24. Patient was started on bipap 55% Fio2 with an improvement in Sp02 to 91%. CTPE performed which showed no evidence of PE, but multifocal pneumonia. Rapid COVID was negative. Labs were unremarkable. Pulmonary consulted and accepted admission to ICU for bipap therapy for AHRF. Patient reports that her nurses aide tested positive for Covid recently. Patient reports onset of sore throat starting 2 weeks ago. She also endorses a cough productive with "green gobs " which also started 2 weeks ago. Few days later she developed vomiting and diarrhea, which have now resolved. Starting 1 week ago patient developed shortness of breath and chest pain. She endorses some mild rhinorrhea as well.


VAERS ID: 1762118 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-09-28
Onset:2021-09-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA OZICZIA / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Arthralgia, Chest discomfort, Chest pain, Condition aggravated, Dizziness, Dysarthria, Electrocardiogram, Full blood count, Gait inability, Headache, Laryngitis, Metabolic function test, Myalgia, Nausea, Pain, Peripheral swelling, Pyrexia, Rheumatoid arthritis, Sensation of foreign body, Throat clearing
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Vestibular disorders (broad), Arthritis (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (narrow)

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: Aleve 1-2 tabs daily Vitamin B12 1000 mg 1 tab daily Zyrtec 1 tab daily omeprazole 20 mg 1 tab daily none of these taken 12-16 hrs prior to vaccine
Current Illness: Covid 19 infection first tested positive July 26, 2021
Preexisting Conditions: Rheumatoid Arthritis
Allergies: Gluten, Wheat, coconut Bactrim Remicade Detromethorphan
Diagnostic Lab Data: EKG. I did have CBC and CMP completed at my PCP. visit as they were due for physical exam, not as result of event.
CDC Split Type:

Write-up: I waited the allotted 15 minutes with no change in condition. I proceeded to drive home and during the drive (15 min to my home) I began sensing something in my throat requiring me to repeatedly try to clear my throat. By the time I arrived at my home (30 min after injection), I had chest ashiness and tightness, a sense of a lump in my throat, laryngitis and difficulty talking as result, and dizziness, I called Employee Health Vaccine RN who directed me to go to the ER. I arrived to the ER by 0845 and was triaged in. I continued to have the listed symptoms. I was treated with and EKG, vitals assessment, IV Pepcid and IV Benadryl with slow but full relief of symptoms. I was monitored at the ER until roughly 1:00pm and then released. I did follow up with my PCP at 2:30pm that same day. I also did require oral Benadryl 25 mg 3 more times over the next 24 hrs due to return of chest tightness. each time relieved by the Benadryl. The next morning I had a full flare of my RA symptoms with severe joint pain of most joints and unable to walk due to pain. Over the next 48 hrs I also developed fever 102 orally, swelling of upper right arm and deltoid muscle pain, nausea, and headache.


VAERS ID: 1762148 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-01-23
Onset:2021-09-28
   Days after vaccination:248
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9262 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9266 / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: multi vitamins
Current Illness: none
Preexisting Conditions: migranes; history of adenomatous polyp of colon
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Sore throat, chills, fatigue, runny nose. 7 days into illness-rash on torso, starting on 9/27/21


VAERS ID: 1762162 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-03-21
Onset:2021-09-28
   Days after vaccination:191
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6204 / 2 RA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6202 / 1 RA / SYR

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

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

Write-up: Tested positive for covid August 28th. Stuffy head and headache and achy body


VAERS ID: 1762177 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-09-28
Onset:2021-09-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Amnesia, Condition aggravated, Dyspnoea, Epilepsy, Formication, Pain, Sleep disorder, Swelling, Tenderness
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Peripheral neuropathy (broad), Systemic lupus erythematosus (broad), Dementia (broad), Convulsions (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalopathy/delirium (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Generalised convulsive seizures following immunisation (narrow)

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: Took my regular medications
Current Illness:
Preexisting Conditions: Epileptic seizures, high blood pressure
Allergies: Penicillin
Diagnostic Lab Data:
CDC Split Type: vsafe

Write-up: I went into epileptic shock after receiving the vaccine. I was taken to the hospital by ambulance and I do not remember anything else. I am swollen and my body is painful to touch and feels something is crawling inside of me. I have seen many doctors. I saw an allergist Dr. today. I do not have lot# to provide. I also have SOB off and on. I am not been able to sleep. I was prescribed some medication to sleep which helps temporally with little relief.


VAERS ID: 1762220 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: New York  
Vaccinated:2021-09-08
Onset:2021-09-28
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blindness, Ocular hyperaemia, Ultrasound scan
SMQs:, Anaphylactic reaction (broad), Glaucoma (broad), Optic nerve disorders (broad), Retinal disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: multi-vitamin
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: eye dilated, puff test, and all basic eye tests 9/28/21. retinal specialist did a sonogram and repeat of basic eye tests, 09/29/21. retinal specialist did a sonogram and basic eye test again. scheduled for an exam on 10/21/21 to see if blood has cleared or will have surgery
CDC Split Type:

Write-up: loss of vision in left eye began on 9/28/21. Went to ophthalmologist on 9/28/21 . He sent me to a retinal specialist on on 9/29/21. returned to retinal specialist on 10/05/21. waiting for blood to clear from left eye. Until blood clears will not know if it is an artery, vein, blood clot, or a tear.


VAERS ID: 1762292 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-27
Onset:2021-09-28
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Breast feeding, Chest discomfort, Chills, Cough, Fatigue, Injection site pain, Injection site reaction, Injection site swelling, Oropharyngeal pain, Pyrexia, Rash pruritic
SMQs:, Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None.
Preexisting Conditions: Child Hood Asthma
Allergies: Allergic to Ibuprofin, Aspirin, and Mango
Diagnostic Lab Data:
CDC Split Type:

Write-up: The following day after receiving the vaccine, I experienced a tightness in my chest that has been on going. 3 Days after vaccine I experienced fever, sore throat, chills, extreme fatigue, and cough. I am breast feeding an infant and the infant also began to experience same symptoms of illness. On the 8th day after receiving the vaccine, I discovered a large, swollen, itchy and painful rash at the injection site.


VAERS ID: 1762375 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-04-22
Onset:2021-09-28
   Days after vaccination:159
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8734 / 1 UN / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8735 / 2 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Cerebrovascular accident, Chest X-ray, Monoplegia, Oxygen saturation decreased, Patient isolation, Pyrexia, SARS-CoV-2 test positive
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Acute central respiratory depression (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen. aspirin.atorvastatin clopidogrel dexamethason
Current Illness: No
Preexisting Conditions: Chronic hepatitis C, COPD.
Allergies: NoNone
Diagnostic Lab Data: COVID-test: positive. Chest-X-ray
CDC Split Type:

Write-up: F-ever:temperature is 101. -O2saturation 93%. -Right upper extremity hemiplegia due to acute cerebrovascular accident at 9/24. Plan: isolation. DVT prophylaxis. cefepime


VAERS ID: 1762510 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Alaska  
Vaccinated:2021-09-28
Onset:2021-09-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 3 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Extra dose administered, Interchange of vaccine products, No adverse event
SMQs:, Medication errors (narrow)

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

Write-up: Patient received 2 primary dose of Moderna, then given a booster dose of Pfizer No adverse event noted


VAERS ID: 1762523 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-09-28
Onset:2021-09-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / SYR

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

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

Write-up: Hives started at right arm of injection site. Moved down right side of chest and stomach next morning.


VAERS ID: 1763107 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-09-20
Onset:2021-09-28
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014F21A / 2 RA / IM

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

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

Write-up: patient knowingly received two doses of moderna after already receiving J&J vaccine


VAERS ID: 1763953 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-27
Onset:2021-09-28
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 3 RA / IM
FLU4: INFLUENZA (SEASONAL) (FLULAVAL QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS X4J9R / N/A LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Aphasia, Dyspnoea, Injection site erythema, Injection site pain, Injection site swelling, Muscle contracture, Pain, Speech disorder
SMQs:, Anaphylactic reaction (broad), Dementia (broad), Acute central respiratory depression (broad), Psychosis and psychotic disorders (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (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: Wellbutrin XL, Furosemide
Current Illness: None
Preexisting Conditions: History of Asthma Attention Deficit Disorder
Allergies: Allergic to contrast dye, Ramipril, gelatin, pork, beef, shellfish, brazil nuts, pistachios, hazelnuts
Diagnostic Lab Data: None
CDC Split Type:

Write-up: September 28: Presented with pain, redness, and swelling at injection site; body aches started that afternoon; slight fever (99.4); shortness of breath (used rescue inhaler once at work and later on that evening) September 29: Presented with pain, redness, and swelling at injection site; body aches; slight fever (99.6) that resolved by that afternoon; increased shortness of breath (used rescue inhaler multiple times that day at least 5 times); that evening difficulty speaking at times (straining to get words out/neck muscles started to contract when speaking) September 30: Presented with pain, redness, and swelling at injection site; body aches; no fever; increased shortness of breath; continue difficulty speaking September 30: Went to urgent care and was seen at 7:45 am due to increased shortness of breath and was prescribed Flovent HFA 110 mcg October 1-2: Continued symptoms as day prior October 3: Increased shortness of breath and difficulty speaking; only redness at injection site October 4: Returned to urgent care around 4pm due to shortness of breath and difficulty speaking; given triamcinolone acetonide injection and prescribed prednisone 50 mg and instructed to continue with Flovent October 5: shortness of breath is improving


VAERS ID: 1764540 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-02-04
Onset:2021-09-28
   Days after vaccination:236
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012L20A / 2 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asymptomatic COVID-19, COVID-19, Condition aggravated, Hyponatraemia, Mental status changes, SARS-CoV-2 test positive
SMQs:, Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hyponatraemia/SIADH (narrow), Cardiomyopathy (broad), Chronic kidney disease (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen (TYLENOL EXTRA STRENGTH) 500 MG tablet aspirin (HALFPRIN) 81 MG tablet Benzocaine-Menthol 15-2.3 MG LOZG benzonatate (TESSALON) 100 MG capsule brimonidine (ALPHAGAN P) 0.1 % ophthalmic solution bumetanide (BUMEX) 0.5 MG tablet
Current Illness: None known
Preexisting Conditions: Supplemental oxygen dependent Dementia CAD (coronary artery disease) BPH (benign prostatic hyperplasia) COPD (chronic obstructive pulmonary disease) Type 2 diabetes mellitus Hyponatremia
Allergies: Penicillins (hives), statins (hives)
Diagnostic Lab Data: COVID-19 test positive on 9/28/2021.
CDC Split Type:

Write-up: Patient presented to emergency department on 9/28/2021 due to altered mental status and hyponatremia. Patient was found to be COVID-19 positive during screening for hospital admission. He was asymptomatic for COVID-19 infection during admission and required no treatment for symptoms.


VAERS ID: 1764582 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-09-15
Onset:2021-09-28
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site discolouration, Injection site infection, Injection site rash
SMQs:, Hypersensitivity (narrow)

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

Write-up: patient developed an infection on the injection site. she was given an antibiotic course per MD. Rash and discoloration present


VAERS ID: 1764620 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-24
Onset:2021-09-28
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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 error-vaccine was administered past its beyond use date. The vaccine had been stored in the freezer beyond the time frame recommended by the manufacturer.


VAERS ID: 1764625 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-09-24
Onset:2021-09-28
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Vaccine error-vaccine was administered past its beyond use date. The vaccine had been stored in the freezer beyond the time frame recommended by the manufacturer.


VAERS ID: 1764630 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-24
Onset:2021-09-28
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Vaccine error-vaccine was administered past its beyond use date. The vaccine had been stored in the freezer beyond the time frame recommended by the manufacturer.


VAERS ID: 1764635 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-09-27
Onset:2021-09-28
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 3 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Fatigue, Headache, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Arthritis (broad)

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

Write-up: Severe headache, fatigue. pain in arm on the side of injection site, pain in shoulder up to the neck.


VAERS ID: 1764653 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Nebraska  
Vaccinated:2021-09-28
Onset:2021-09-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Burning sensation, Chest discomfort, Diarrhoea, Dyspnoea, Electrocardiogram normal, Fatigue, Feeling abnormal, Headache, Injection site pain, Injection site swelling, Injection site warmth, Lymph node pain, Lymphadenopathy, Mobility decreased, Pain, Pain in extremity
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Dementia (broad), Pseudomembranous colitis (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Arthritis (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Wellbutrin 300mg, Sam-E 400mg, Loratadine 10mg
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: Went to Urgent Care on day 4 - blood oxygen level was good, blood pressure was 120/78 and lungs were clear. Performed EKG test due to chest tightness and results were normal.
CDC Split Type:

Write-up: Headache, tiredness, brain fog and joint pain that still persist over 1 week later. Fever for the first 3 days, highest 100 degrees on day 2 all day. Injection site pain, site was hot & swollen for 5 days, also had intense shooting pain down injection site arm on day 2 from shoulder to fingertips for most of the day. Swollen, burning and painful lymph nodes initially in injection site armpit the first 3 days then both until day 6, unable to put injection site arm down by my side on days 2-5 due to the pain it caused. Diarrhea on day 4. Tightness in chest on day that 4 that felt like a 10 pound weight on my sternum making it hard to take deep breaths so I went to Urgent Care. I occasionally still feel chest tightness over 1 week later. Have been taking 800 mg Ibuprofen at 8 hour intervals to help alleviate symptoms ever since I received the vaccine. Tried a warm compress on injection site armpit for painful lymph nodes on days 2 & 3 but it did not seem to help so discontinued.


VAERS ID: 1764671 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Delaware  
Vaccinated:2021-09-28
Onset:2021-09-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046C21A / 1 LA / IM

Administered by: Military       Purchased by: ?
Symptoms: Dizziness, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

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

Write-up: Pt reported that he felt faint and found himself to be shaking approx 10 min after receiving vaccine; pt was brought back and placed on abed; EMS was activated and pt was transferred to nearest ER


VAERS ID: 1764683 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-09-28
Onset:2021-09-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / SYR

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

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

Write-up: Injection site swollen, red, itchy and painful to the touch. Redness has not went away it periodically will change between painful and itchy. So far its been a little over a week and been consistently.


VAERS ID: 1764802 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Male  
Location: Mississippi  
Vaccinated:2021-09-28
Onset:2021-09-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301358A / 1 RA / IM

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

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

Write-up: Patient received a third booster dose of Pfizer but his first two doses Moderna. No adverse reaction known.


VAERS ID: 1764959 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-01
Onset:2021-09-28
   Days after vaccination:27
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Pulmonary thrombosis
SMQs:, Embolic and thrombotic events, venous (narrow)

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

Write-up: blood clot in lung within 30 days of vaccine booster


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