National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

From the 7/16/2021 release of VAERS data:

Found 479,813 cases where Vaccine is COVID19 and Patient Did Not Die



Case Details (Reverse Sorted by Onset Date)

This is page 81 out of 4,799

Result pages: prev   1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131 132 133 134 135 136 137 138 139 140 141 142 143 144 145 146 147 148 149 150 151 152 153 154 155 156 157 158 159 160 161 162 163 164 165 166 167 168 169 170 171 172 173 174 175 176 177 178 179 180   next


VAERS ID: 1420217 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: New York  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 054C21A / 1 LA / IM

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

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

Write-up: Error: Improper Storage (temperature)


VAERS ID: 1420219 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: New York  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 054C21A / 1 LA / IM

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

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

Write-up: Error: Improper Storage (temperature)


VAERS ID: 1420222 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: New York  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 054C21A / 1 LA / IM

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

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

Write-up: Error: Improper Storage (temperature)


VAERS ID: 1420224 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: New York  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 054C21A / 1 LA / IM

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

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

Write-up: Error: Improper Storage (temperature)


VAERS ID: 1420225 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood test, Computerised tomogram, Confusional state, Electrocardiogram, Headache, Hypoaesthesia, Retching, Seizure, Unresponsive to stimuli
SMQs:, Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Dementia (broad), Convulsions (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: flu vaccine- hives, vomiting, trouble breathing. youth. Hep A 2nd dose - hives, nausea, 2018
Other Medications: prozac, singulair, claritin, testosterone
Current Illness: none
Preexisting Conditions: asthma, allergies
Allergies: eggs, nuts, ibuprofen, ceclor, penicillin
Diagnostic Lab Data: blood work, ekg, ct scan - 6.21.21
CDC Split Type:

Write-up: seizure reaction within 5 minutes of receiving vaccine. dry heaving, unresponsive, seizure, numbness in both arms, confusion, headache for 24+ hours.


VAERS ID: 1420226 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: New York  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 054C21A / 1 LA / IM

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

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

Write-up: Error: Improper Storage (temperature)


VAERS ID: 1420255 (history)  
Form: Version 2.0  
Age: 7.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0202 / 1 UN / IM

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

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

Write-up: Administration error to a 7 year old female. Outside of control and government EUA recommendations.


VAERS ID: 1420356 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-12
Onset:2021-06-21
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 049C21A / 1 LA / IM

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

Write-up: Site: Bruising at Injection Site-Medium, Site: Itching at Injection Site-Medium, Site: Pain at Injection Site-Medium, Site: Redness at Injection Site-Medium, Site: Swelling at Injection Site-Medium


VAERS ID: 1420359 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: New York  
Vaccinated:2021-06-20
Onset:2021-06-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Inflammation, Tenderness, Testicular pain, Ultrasound scan normal
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: ADHD Congenital Sucrase Isomaltase Deficiency
Allergies: Amoxycillin - belly rash
Diagnostic Lab Data: Ultrasound at ED on 6/21 confirmed good blood flow - no torsion
CDC Split Type:

Write-up: Left testicle pain. Went to ED on 6/21 night. Ultrasound showed good blood flow. Urologist felt this was not a case of torsion and discharged us with diagnosis of "inflammation". We follow up with pediatric urologist tomorrow. Symptoms have improved with Ibuprofen, but testicle is still sore to touch. No obvious heat, swelling, or redness. Just extremely sore to touch and move testicle around.


VAERS ID: 1420363 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: New York  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 049C21A / 2 LA / IM

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

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

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


VAERS ID: 1420380 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Flushing, Hyperhidrosis, Hypotension
SMQs:, Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Hypersensitivity (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

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

Write-up: Systemic: Flushed / Sweating-Severe, Systemic: Hypotension-Severe


VAERS ID: 1420476 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0170 / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chills, Extra dose administered, Injection site erythema, Interchange of vaccine products, Pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Fluoxetine HCI 20mg daily
Current Illness: None
Preexisting Conditions: Anxiety/Depression
Allergies: NKDA
Diagnostic Lab Data: None, just observation.
CDC Split Type:

Write-up: On 6/21/21, patient came into clinic for a nurse only appointment to receiver her Men B vaccine. Her father is a physician in the clinic and he approached his nurse about her coming in. The nurse thought she heard him say, she was coming in for her Covid vaccine too in addition to the Men B vaccine. The nurse prepared both the Men B and Pfizer Covid vaccines and administered. Patient was inadvertently given a 3rd Covid vaccine. She has already received 2 Moderna Covid vaccines on 01/16/2021 and 02/14/2021. On 06/21/21 she developed chills and body aches, on 06/22/21 the chills and body aches continued, on 06/23/2021 the chills and body aches resolved but she has a small localized reddened area at injection site with mild pain.


VAERS ID: 1420486 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003C21A / 1 LA / -

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

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

Write-up: At the time of shot patient is report that around the injection site is red swollen and inching... symptoms got worse as she got home.. itching starting 06/22


VAERS ID: 1420575 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Energy increased, Palpitations, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: clonipine, lexapril, protonix, zofran, tylenol , crestor
Current Illness: dry cough
Preexisting Conditions: depression, ocd, ptsd
Allergies: aspirin, zeriltol, tramadol, frenigan
Diagnostic Lab Data: no
CDC Split Type:

Write-up: pt. had good results from vax , had super energy , cleaned and felt like she had extreme energy . After about 05;00 pm her energy dissipated when pt laid down heart felt like it was beating hard., only adverse event is left arm has a tingle that feels like electrical pulse that last seconds..


VAERS ID: 1420597 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011D21A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: not at time of injection
Preexisting Conditions: allergies,
Allergies: gluten, dairy, nuts,
Diagnostic Lab Data: no labs, given prescription
CDC Split Type:

Write-up: swelling of the face and lips. painful occurred 12 hours after vaccination. patient seen by provider and received prednisone prescription


VAERS ID: 1420611 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / UN

Administered by: Private       Purchased by: ?
Symptoms: Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Estridol birth control
Current Illness: None
Preexisting Conditions: None
Allergies: Na
Diagnostic Lab Data: Nothing was done
CDC Split Type:

Write-up: My daughter fainted immediately after receiving the vaccine. I was not there so I do not know all the details. My daughter does not have needle anxiety and has never had problems with vaccines before.


VAERS ID: 1420690 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-06-04
Onset:2021-06-21
   Days after vaccination:17
Submitted: 0000-00-00
Entered: 2021-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 2 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test normal, Chest discomfort, Crying, Dyspnoea, Echocardiogram, Electrocardiogram normal, Pain in extremity, Urine analysis
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Depression (excl suicide and self injury) (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: 6/22 EKG - abnormal urine - normal blood - normal echocardiogram - showed fluid build up in pericardia sac
CDC Split Type:

Write-up: Patient felt like he was having an asthma attack on the night of the 21st when playing outside with friends (running and climbing). He has never had asthma, but said his chest was tight and it was hard to breathe. He said when he stopped and sat for a while it seemed to get better. He went to sleep at about 2am and woke me up at 5:20am crying. His chest hurt really bad and the pain was traveling down his arm. When we took his blood pressure at home it was 205/125 and his heart rate was 112. We went to the emergency room at hospital immediately. Once there they did an EKG. The doctor said there was not reason to be alarmed, but the EKG showed signs of possible pericarditis. They then took blood work, a urine sample, an xray and did an echocardiogram. The doctor told us that the blood work did not show any signs of an actual heart attack or any damage done to the heart. She said the echocardiogram showed some fluid build up in the pericardia sac surrounding his heart. She said this is considered pericardia. She mentioned that some young men are having this happen after being vaccinated. She said we seem to have caught it early. They gave him Tordal through his IV when we were there and that took his pain away. We were told to follow up with a cardiologist within 24-48 hours. We have an appointment at Hospital tomorrow at 10:45am.


VAERS ID: 1420700 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026D211A / 2 RA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Body temperature increased, Dizziness, Headache, Vaccination site swelling
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Headache, temperature, dizziness and swelling in the arm where vaccination was given.


VAERS ID: 1420705 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1820095 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest discomfort, Lip swelling, Oropharyngeal discomfort
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Received immunization 9:13am. Approximately 10 minutes later, patient complained of a feeling of her lower lip swelling. Also complained of chest tightness and clearing her throat. 9: 27am patient was given 0.30cc epinephrine at the doctor''s office. She was then sent to the emergency room where she was given Benadryl and sent home.


VAERS ID: 1420748 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-17
Onset:2021-06-21
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / SYR

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

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

Write-up: chills, fever, muscle pain, swollen lymph nodes, head ache, arm pain


VAERS ID: 1421022 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-05-25
Onset:2021-06-21
   Days after vaccination:27
Submitted: 0000-00-00
Entered: 2021-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 048B21A / 1 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Atrophy, Basophil count decreased, Basophil percentage, Bilirubin urine, Blood glucose, Blood urine, Computerised tomogram, Electrocardiogram, Eosinophil count decreased, Eosinophil percentage, Feeling hot, Full blood count, Haematocrit decreased, Haemoglobin decreased, Hypoaesthesia, Immature granulocyte count, Lymphocyte count, Lymphocyte percentage, Mean cell haemoglobin, Mean cell haemoglobin decreased, Mean cell volume normal, Mean platelet volume normal, Monocyte count decreased, Monocyte percentage, Neutrophil count normal, Neutrophil percentage, Nitrite urine, Platelet count normal, Protein urine, Red cell distribution width decreased, Specific gravity urine increased, Tremor, Urine analysis, Urine ketone body, Urine leukocyte esterase, Urobilinogen urine, Vitamin C, White blood cell count normal, pH urine
SMQs:, Haematopoietic erythropenia (broad), Haematopoietic leukopenia (narrow), Peripheral neuropathy (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (narrow), Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Proteinuria (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: pcn
Diagnostic Lab Data: Urinalysis with reflex to culture, if indicated [252485784] Collected: 06/23/21 1309 Order Status: Completed Specimen: URINE,CLEAN CATCH (CCMS) Updated: 06/23/21 1315 Glucose UA PENDING NEGATIVE MG/DL Protein UA PENDING <30 MG/DL Bilirubin UA PENDING NEGATIVE Urobilinogen UA PENDING <2 MG/DL pH UA PENDING <7.0 Blood UA PENDING NEGATIVE Ketones UA PENDING NEGATIVE MG/DL Nitrite UA PENDING NEGATIVE Leukocyte Esterase UA PENDING NEGATIVE UR Appearance PENDING CLEAR Specific Gravity UA PENDING <1.036 Color PENDING YELLOW Clinitest PENDING Ascorbic Acid PENDING MG/DL Site PENDING Comment, Urine Culture PENDING CBC w Auto Diff [252485780] (Abnormal) Collected: 06/23/21 1255 Order Status: Completed Specimen: Blood Updated: 06/23/21 1305 White Blood Cell Count 8.3 4.3 - 10.5 THOUS/uL Red Blood Cell Count 4.11 3.93 - 5.07 MIL/uL Hemoglobin 11.5 Low 11.8 - 14.8 GM/DL Hematocrit 36.2 35.6 - 45.0 % Mean Corpuscular Volume 88.1 83.5 - 95.9 FL Mean Corpuscular Hemoglobin 28.0 27.4 - 32.0 PG Mean Corpuscular Hemoglobin Conc 31.8 31.5 - 34.7 G/DL Rdwcv 13.9 11.8 - 14.2 % Rdwsd 44.9 37.2 - 47.8 FL Platelet Count 295 167 - 402 THOUS/uL Mean Platelet Volume 10.3 8.8 - 12.0 FL Nucleated Red Blood Cells 0.0 0.0 /100 WBC''S Abs NRBC 0.0 0.0 THOUS/uL Differential Type AUTO Neutrophils 65.1 34.0 - 67.9 % Lymphs 20.0 Low 20.4 - 48.6 % Monocytes 8.1 5.0 - 11.5 % Eos 5.0 1.0 - 5.4 % Basos 1.3 0.2 - 1.3 % Neutrophils Absolute Count 5.4 2.1 - 6.6 THOUS/uL Lymphocytes Absolute Count 1.7 1.2 - 3.9 THOUS/uL Monocytes Absolute Count 0.7 0.3 - 0.8 THOUS/uL Eosinophils Absolute Count 0.4 0.1 - 0.4 THOUS/uL Basophils Absolute Count 0.1 0.0 - 0.1 THOUS/uL Imm Gran 0.5 0.1 - 0.7 % Abs Imm Gran 0.04 0.0 - 0.1 THOUS/uL EKG [252485788] Resulted: 06/23/21 1303 Order Status: Completed Updated: 06/23/21 1304 CT Head wo Contrast [252485783] Collected: 06/23/21 1251 Order Status: Completed Updated: 06/23/21 1301 Narrative: EXAMINATION: CT Head without Contrast, Axial Imaging with 2-D Coronal and Sagittal Reconstruction. INDICATION: "Seizure" COMPARISON: None FINDINGS: No mass, midline shift, intracranial hemorrhage, areas of acute macrovascular ischemia, or acute osseous abnormality. No extra-axial fluid collections. Mild bilateral parietal cortical atrophy. Ventricles are normal for age. Slightly dilated Virchow-Robin CSF spaces in the inferior basal ganglia/capsule region. Minimal if any chronic periventricular and deep cerebral white matter microvascular disease in the cerebral hemispheres. Normal gray-white differentiation, with brain parenchyma otherwise unremarkable. Visualized orbits are unremarkable. No significant disease in the partially visualized paranasal sinuses or mastoid air cells. IMPRESSION: 1. No acute intracranial abnormality. 2. Minimal if any chronic periventricular and deep cerebral white matter microvascular disease in bilateral cerebral hemispheres. 3. Mild bilateral parietal cortical atrophy. This CT exam was performed using one or more of the following dose reduction techniques: automated exposure control, adjustment of the mA and/or kV according to patient size, and/or use of iterative reconstruction technique. Radiation Dose: 1118.3 mGy*cm total DLP
CDC Split Type:

Write-up: ER: PT STATES SHE THINKS SHE MAY BE HAVING SEIZURES. PT STATES 2 DAYS AGO SHE HAD AN EPISODE WHERE HER FEET GET HOT THEN GETS NUMB, THEN TRAVELS UP THE REST OF HER BODY. HER LEG GOES STRAIGHT OUT AND THEN HER ARM WRAPS AROUND HER HEAD AND SHE STARTS SHAKING. PT STATES HAD 4 EPISODES 2 DAYS AGO AND 2 EPISODES TODAY.


VAERS ID: 1421025 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003CZ1A / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Chest discomfort, Dyspnoea, Head discomfort, Loss of consciousness, Paraesthesia oral
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

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

Write-up: 17 minutes after injection my tongue felt heavy and weird. Then my head felt heavy. Shortly after I passed out. The staff said my BP was in 180s. My normal BP is 100-110. Heart rate stayed around 115. Ice packs used and remained laying down for 30 minutes until heaviness passed. Oxygen remained normal although it felt hard to breathe. Just a heaviness on my chest.


VAERS ID: 1421041 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-01
Onset:2021-06-21
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025C21A / 2 RA / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003C21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Decreased appetite, Erythema, Fatigue, Groin pain, Headache, Immediate post-injection reaction, Oropharyngeal pain, Pain in extremity, Pharyngeal swelling, Pyrexia, Skin warm
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Osteonecrosis (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Benadryl, multi vitamin, Quercetin, NAC
Current Illness: Sore throat occasionally
Preexisting Conditions: None
Allergies: Latex, copper, cyndomyacin antibiotic
Diagnostic Lab Data:
CDC Split Type:

Write-up: Beginning 20 days post 2nd vaccine dose: fever, chills, headache, low grade fever, sore throat, throat slightly swollen, shooting pain in left breast (around implant) with hot and red skin. Continuing for 3 days as of reporting today. Immediately Post 2nd vaccine dose: low grade fever; chills; fatigue; low appetite; pain in leg, groin, and back lymph nodes lasting less than 48 hours.


VAERS ID: 1421061 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 061C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cardiac flutter, Extrasystoles, Feeling abnormal
SMQs:, Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Dementia (broad), Tachyarrhythmia terms, nonspecific (narrow), Hypokalaemia (broad)

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

Write-up: Pt states heart fluttering, rush, feeling terrible run down. Still continuing, feels as though heart skips a beat ever so often, refuses medical care.


VAERS ID: 1421113 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1820095 / 1 - / -

Administered by: Public       Purchased by: ?
Symptoms: Ageusia, Influenza like illness, Injection site swelling, Pain in extremity
SMQs:, Taste and smell disorders (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: Sertraline
Current Illness:
Preexisting Conditions: Diabetic, high blood pressure
Allergies: Morphine
Diagnostic Lab Data:
CDC Split Type:

Write-up: Sore arm, swollen shoulder on the side where the shot was injected , flu like symptoms, no taste.


VAERS ID: 1421283 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051C21A / 2 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Angiogram, C-reactive protein, Chest X-ray normal, Chills, Computerised tomogram head, Dizziness, Dyspnoea, Electroencephalogram, Full blood count, Headache, Intensive care, Laboratory test, Magnetic resonance imaging, Palpitations, Paraesthesia, Procalcitonin, Rash, Red blood cell sedimentation rate, SARS-CoV-2 test negative, Seizure, Seizure like phenomena, Tachycardia, White blood cell count normal
SMQs:, Anaphylactic reaction (narrow), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Ibuprofen, Singulair, Claritin, Albuterol MDI
Current Illness:
Preexisting Conditions: Asthma, seasonal allergies, migraines
Allergies: Animal Dander; Mold; Peanut
Diagnostic Lab Data: 6/22 to 6/23/21: CXR, CT Head, MRI; CTA Chest; Neuro Consult; Infectious Disease Consult; Cardiology Consult; EEG; Labs (CRP, ESR, COVID testing, CBC, Chem-7, Procalcitonin, etc.)
CDC Split Type:

Write-up: Rec''d Moderna Dose #2 and developed HA, chills and tingling sensation in her fingers. Rash reportedly appeared on her arm. Rec''d Benadryl and rash disappeared. After a nap that day, pt awoke with SOB, palpitations, dizziness, and rash returned on right arm and right neck. Came to ED for evaluation (6/22/21 @ 0514). Tachycardic. In ED, pt''s mother noted pt would say something & then repeat what she said seconds later. Dx with seizure in ED and given Ativan 2mg IV. CXR, CT of head, and CTA of chest were all unremarkable. Afebrile, WBC normal, no COVID-19 detected. Pt admitted to ICU for further evaluation and treatment. Also had seizure-like activity during ID MD''s exam 6/23/21.


VAERS ID: 1421304 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 018B21A / 1 LA / IM

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

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

Write-up: 16 Year old patient received Moderna Vaccine.


VAERS ID: 1421337 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Dyspnoea, Palpitations, Rash, Swelling face
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: On June 23, 2021 three hours following COVID-19 vaccination patient complaints of face swelling with edema, palpitations, skin rash and respiratory difficulties. She visited the emergency room were symptoms were controlled and she was discharge home.


VAERS ID: 1421367 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: New York  
Vaccinated:2021-06-16
Onset:2021-06-21
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Cardiac telemetry, Chest pain, Dizziness, Dyspnoea, Extra dose administered, Hypersomnia, Intensive care, Palpitations, Pyrexia, Troponin increased
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Depression (excl suicide and self injury) (broad), Vestibular disorders (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Fluoxetine Zyrtec allergy Fluticasone spray Benadryl
Current Illness: none
Preexisting Conditions: 17 y/o male with history of mild troponin elevation with nonspecific St changes after a toxic ingestion of Mucinex seen by cardiology in 2020 and anxiety (on Prozac) now here with acute onset of chest pain, palpitations, and dizziness.
Allergies: Shellfish
Diagnostic Lab Data: Troponin, telemetry
CDC Split Type:

Write-up: 17 y/o male presented to ED (6/21) after experiencing "chest pain" with exercise (playing basketball). This occurred 5 days after receiving his 3rd dose of his Pfizer vaccine (6/16). He received a 3rd dose at the recommendation of his PMD after being informed that his 2nd dose was expired at the time when he had received it on 6/7 Following this vaccination he "slept for 18-20 hours" and had subjective fevers which self-resolved after 24 hours. He developed dyspnea, acute onset of R-sided/mid chest pain and the sensation that his heart was racing. He presented to the ED and was admitted to the PICU for monitoring. Labs revealed elevated troponin (240 ng/L) which downtrended to 89 ng/L by 6/23. Concern for myocarditis vs pericarditis in setting of recent Pfizer COVID-19 vaccine; started on ibuprofen 400mg PO q6h.


VAERS ID: 1421379 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-06-16
Onset:2021-06-21
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, Fatigue, Headache, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: acetaminophen (TYLENOL) 500 MG tablet meloxicam (MOBIC) 15 MG tablet nicotine (Nicoderm CQ) 21 MG/24HR patch Omega-3 Fatty Acids (fish oil) 1000 MG capsule capsule propranolol (INDERAL) 20 MG tablet hydrOXYzine (ATARAX) 25 MG tablet ibuprof
Current Illness: None
Preexisting Conditions: Cardiac and Vasculature Hypertriglyceridemia Endocrine and Metabolic Class 2 obesity in adult Gastrointestinal Abdominal Hemorrhoids Genitourinary and Reproductive Fibrocystic disease of breast Mental Health Other recurrent depressive disorders (not meeting MDD criteria) GAD (generalized anxiety disorder) PTSD (post-traumatic stress disorder) Panic attacks Ineffective coping Family discord Anxiety Musculoskeletal and Injuries Thumb amputation status, right Back pain Ganglion cyst of left foot Pulmonary and Pneumonias Solitary lung nodule
Allergies: Latex
Diagnostic Lab Data: None at this time
CDC Split Type:

Write-up: Diffuse Rash, Arthralgias, Fatigue, Headache


VAERS ID: 1421416 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: California  
Vaccinated:2021-03-21
Onset:2021-06-21
   Days after vaccination:92
Submitted: 0000-00-00
Entered: 2021-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805031 / UNK LA / -

Administered by: Other       Purchased by: ?
Symptoms: Hypopnoea
SMQs:, Acute central respiratory depression (narrow), Respiratory failure (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: Eliquis Baby aspirin Mcphormin A medication for high heart rate
Current Illness:
Preexisting Conditions: single bypass mild congestive heart failure Diabetes
Allergies: Sulfur Antibiotic that is given for bladder infection
Diagnostic Lab Data: Taking therapy
CDC Split Type:

Write-up: Patient stated that his breathing becomes shallow when resting or seeping. Patient is afraid to go to sleep.


VAERS ID: 1421459 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036C21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: 14 y.o. patient administered Moderna outside of approved age recommendations (Moderna currently approved for patients 18 y.o. and older)


VAERS ID: 1421504 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-06-01
Onset:2021-06-21
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 2 RA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Confusional state, Dizziness, Hot flush, Troponin increased, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Cymbalta 60mg Wellbutrin 300mg
Current Illness: None
Preexisting Conditions: Asthma, Vocal Chord Dysfunction
Allergies: Pet dander. Seasonal. Claritin.
Diagnostic Lab Data: 06/22/2021 elevated tropinin T high sensitivity
CDC Split Type:

Write-up: 2.5 weeks after second dose. Hives all over body. High tropinin T High sensitivity test. Confusion, dizziness, lightheaded, chills, hot flashes.


VAERS ID: 1421768 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-06-18
Onset:2021-06-21
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 1 RA / IM

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

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

Write-up: Patient was supposed to receive Moderna second dose but instead got Pfizer vaccine


VAERS ID: 1421822 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: New York  
Vaccinated:2021-06-05
Onset:2021-06-21
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test normal, Lymph node pain, Pain in extremity, Palpitations, Renal function test normal
SMQs:, Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Patient taking Zejula (Niraparib) 100mg once every night
Current Illness:
Preexisting Conditions: Remission from stage 4 cancer
Allergies: NONE
Diagnostic Lab Data: Patient blood work came back normal. ECHO is scheduled to be completed. Kidney function came back normal. Patient will be monitored by cardiologist and put on a heart monitor if palpitations continue. Patient will also be tested for the presence of covid antibodies.
CDC Split Type:

Write-up: Patient received first dose on 5/15/2021 of the Pfizer Covid vaccine in the right arm. Patient experienced mild pain on the arm as well as lymph nodes on neck for few days after dose 1. The patient received dose 2 on 6/5/2021 in the right arm. Patient experienced pain on the left side under her arm as well as the same lymph node pain. On Monday 6/21/21 patient experienced heart palpitations around 2pm. On Tuesday 6/22/2021 patient experienced palpitations again around 2pm and spoke to oncologist and was advised to have VAERS report submitted.


VAERS ID: 1421845 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: No adverse event, 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 was give 3 hours and 12 minutes after vial was punctured and left at room temperature. Per Janssen, there are no updates on stability beyond the 2 hours at room temperature. Patient has not reported any adverse events as a result of this event.


VAERS ID: 1422039 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-17
Onset:2021-06-21
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026D21A / 1 - / -

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

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

Write-up: Swelling and large red rash at injection site. It gives off heat. And been having massive headache since the day after injection.


VAERS ID: 1422044 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-04-08
Onset:2021-06-21
   Days after vaccination:74
Submitted: 0000-00-00
Entered: 2021-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dysmenorrhoea, Heavy menstrual bleeding, Menstruation irregular, Nausea
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Fertility disorders (broad)

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

Write-up: Irregular period. Heavier flow than normal. More extreme cramping and nausea than usual.


VAERS ID: 1422063 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site erythema, Injection site pruritus, Injection site reaction, Injection site warmth, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Bupropion XL 150mg Alprazolam 0,5mg
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: From what I''ve read online, it''s "Covid Arm" A welt, some itching, soreness, redness, "warm" to the touch at the site of the injection The weirdness is because I keep reading that this is a delayed reaction. This wasn''t delayed. And it''s mostly females. I''m not one of those either.


VAERS ID: 1422098 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022B21A / 2 LA / IM

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: Unknown at this time


VAERS ID: 1422320 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-18
Onset:2021-06-21
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 2 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dysuria, Protein total increased, Urine analysis abnormal
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness:
Preexisting Conditions:
Allergies: N/A
Diagnostic Lab Data: Urinalysis showed no infection but revealed higher protein levels present
CDC Split Type:

Write-up: Burning when urinating


VAERS ID: 1422523 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022B21A / 2 RA / IM

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: UNknown


VAERS ID: 1422529 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022B21A / 2 LA / IM

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: Unknown


VAERS ID: 1422537 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / SYR

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

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

Write-up: Shortness of breath Severe chest pain Strong heart beat Fever Headache Severe stomach pain Unable to sleep


VAERS ID: 1422539 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022B21A / 2 RA / IM

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: Unknown


VAERS ID: 1422544 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022B21A / 2 LA / IM

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: Unknown


VAERS ID: 1422551 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022B21A / 2 LA / IM

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: Unknown


VAERS ID: 1422556 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022B21A / 1 RA / IM

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: Unknown


VAERS ID: 1422737 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022B21A / 2 LA / IM

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: Unknown


VAERS ID: 1422749 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022B21A / 2 LA / IM

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: Unknown


VAERS ID: 1422790 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-03-22
Onset:2021-06-21
   Days after vaccination:91
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP6955 / N/A LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Abortion spontaneous, Exposure during pregnancy, Human chorionic gonadotropin
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Termination of pregnancy and risk of abortion (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: Daily women?s multivitamin and vitamin D
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: HCG test to confirm miscarriage by doctor
CDC Split Type:

Write-up: Miscarriage at 6.5 weeks pregnant 6/23/21


VAERS ID: 1422814 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Rhinorrhoea, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Patient got the 1st dose of pfizer and was fine at the time of administration. However, as she sat down on the chair for observation, that was when she fainted and fell off but someone was there to catch her. After a minute, she regained her consciousness back. We took her BLOOD PRESSURE and it was normal. Ambulance came and took her to hospital. Yesterday, her sister came to pharmacy and asked if it was normal for her to keep having runny nose. We told her she might feel like flu-like symptom but to be safe, it''s better she goes to see her primary doctor/urgent care.


VAERS ID: 1423028 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Texas  
Vaccinated:0000-00-00
Onset:2021-06-21
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Anxiety, Body temperature, Chest pain, Chills, Heart rate, Myalgia, Pain, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210621; Test Name: Heart rate; Result Unstructured Data: 88 BPM heart rate; Test Date: 20210621; Test Name: Body temperature; Result Unstructured Data: fever 102
CDC Split Type: USJNJFOC20210648161

Write-up: BODY ACHE; CHEST PAIN; ANXIETY; 88 BPM HEART RATE; BODY CHILLS; MUSCLE ACHE; FEVER 102; This spontaneous report received from a consumer concerned a patient of unspecified age and sex. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unk) dose was not reported, administered on 21-JUN-2021 16:00 for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On 21-JUN-2021, the subject experienced body ache. On 21-JUN-2021, the subject experienced chest pain. On 21-JUN-2021, the subject experienced anxiety. On 21-JUN-2021, the subject experienced 88 bpm heart rate. On 21-JUN-2021, the subject experienced body chills. On 21-JUN-2021, the subject experienced muscle ache. On 21-JUN-2021, the subject experienced fever 102. Laboratory data included: Body temperature (NR: not provided) fever 102, and Heart rate (NR: not provided) 88 BPM heart rate. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the fever 102, body ache, chest pain, anxiety, 88 bpm heart rate, body chills and muscle ache was not reported. This report was non-serious.


VAERS ID: 1423254 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-16
Onset:2021-06-21
   Days after vaccination:97
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045A21A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 044B21A / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, SARS-CoV-2 test positive
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Vit.D Tricor, metformin, simvastatin,
Current Illness: Dyslipidemia, former smoker, type 2 diabetic, HTN, occlusion of L internal carotid artery
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: swabbed pos covid 6.21.21
CDC Split Type:

Write-up: dizziness


VAERS ID: 1423306 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-05-10
Onset:2021-06-21
   Days after vaccination:42
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: SARS-COV-2 RAPID 08-JUN-21
CDC Split Type:

Write-up: PT TESTED POSITIVE FOR COVID 19 AFTER BEING FULLY VACCINATED.


VAERS ID: 1423307 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Oklahoma  
Vaccinated:2021-06-18
Onset:2021-06-21
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025C21A / 1 LA / IM

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

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

Write-up: Headache, nausea, fatigue, diarrhea, achy


VAERS ID: 1423386 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-06-17
Onset:2021-06-21
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: Rash developed on entire body but mainly upper body


VAERS ID: 1423423 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8735 / UNK LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Disorientation, Dizziness, Lethargy
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Hypoglycaemia (broad), Dehydration (broad)

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

Write-up: patient experienced lethargy, dizziness, and disorientation for about an hour.


VAERS ID: 1423437 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-05-20
Onset:2021-06-21
   Days after vaccination:32
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6203 / 2 - / -

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

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

Write-up: Patient hospitalized after testing positive for COVID-19. Patient is fully vaccinated.


VAERS ID: 1423467 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Mississippi  
Vaccinated:2021-06-15
Onset:2021-06-21
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test, Chest X-ray normal, Chills, Cough, Dyspnoea, Ear pain, Fatigue, Pain, Respiratory tract congestion
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Psoriasis
Allergies: None
Diagnostic Lab Data: chest x-ray normal blood work didn''t get results
CDC Split Type:

Write-up: short of breathe, body aches, chills, ear aches cough, congestion, fatique


VAERS ID: 1423478 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-06-18
Onset:2021-06-21
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Gait inability, Heart rate increased, Myalgia, Pyrexia, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Eliquis and metoprolol.
Current Illness:
Preexisting Conditions: Blood clot in right leg, both hips replaced.
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Couldn''t walk, tiredness, muscle pain, fever, vomiting, elevated heart rate.


VAERS ID: 1423498 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / UNK - / IM

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

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

Write-up: Pfizer covid vaccine was held in freezer past beyond use date, and administered. expired 6/15, given 6/21


VAERS ID: 1423517 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-27
Onset:2021-06-21
   Days after vaccination:25
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027B21A / 2 RA / -

Administered by: Private       Purchased by: ?
Symptoms: Back disorder, Gastric disorder, Ultrasound abdomen
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Atenolol, Spironolactone, Amloditinebesylahe, Pravastatin
Current Illness: N/A
Preexisting Conditions: High Blood Pressure
Allergies: N/A
Diagnostic Lab Data: Ultrasound and CT scan
CDC Split Type:

Write-up: Started to have back and went to the doctor got a ultrasound on stomach Monday June 21st. Tuesday got a call saying he needed to be seen by specialty. He had a 6cm aorta in his stomach. They went to see the doctor that morning and he is going to have surgery so it doesn''t bust but first he needs to get a CT scan to see what the damage is. Surgery will be done next week after the CT scan is done.


VAERS ID: 1423560 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-11
Onset:2021-06-21
   Days after vaccination:102
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 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? 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: Breakthrough case of COVID-19


VAERS ID: 1423632 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Maine  
Vaccinated:2021-06-17
Onset:2021-06-21
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 AR / IM

Administered by: Other       Purchased by: ?
Symptoms: Bacteraemia, Catheter site infection, Cerebral infarction, Chills, Condition aggravated, Laboratory test, Magnetic resonance imaging head abnormal, Malaise, Nausea, Pyrexia, Thrombocytopenia, Vomiting
SMQs:, Acute pancreatitis (broad), Haematopoietic thrombocytopenia (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sepsis (broad), Opportunistic infections (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: APAP, Cymblata, Dilaudid, Ativan, Metoprolol, Octreotide, Zofran, Compazine, Requip, Fentanyl
Current Illness:
Preexisting Conditions: Short Gut Syndrome secondary to Colectomy for Hirschsprung Disease, Chronic malnutrition, TPN Dependent with a chest port with hx of multiple port infections. Anxiety, Bipolar.
Allergies: Contrast, Motrin, Levaquin, Lithium, Macrobid, PCN, NSAIDs, Tape, Surgical Glue
Diagnostic Lab Data: Labs, MR Imaging 06/21 - $g 06/24 (Date of This Report)
CDC Split Type:

Write-up: Patient was admitted to the hospital 4 days after the dose with gram negative bacteremia from a port infection, also found to have an infarction of the splenium of the corpus callosum on MR imaging, acute on chronic thrombocytopenia. DDx include a thrombotic thrombocytopenic process. Patient reports fevers, chills, malaise, N/V starting the morning after vaccine leading up to the presentation to the hospital.


VAERS ID: 1423728 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 3 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: No adverse event, Product storage error
SMQs:, Medication errors (narrow)

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

Write-up: Patient received dose #2 of Pfizer vaccine on 6/6/2021 @ Vaccination CLINIC and was notified by email that vial was left in freezer past recommended time frame. Medication expired beyond its freezer allowable date. Email recommended patient get re-vaccinated with dose again. Affiliated Physicians re-administered dose on 6/21/2021 as recommended. No adverse reactions identified on site.


VAERS ID: 1423861 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-14
Onset:2021-06-21
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 049C21A / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Pleurisy, Pulmonary pain
SMQs:, Systemic lupus erythematosus (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: Loratadine, Citalopram
Current Illness: None at all.
Preexisting Conditions: Occasional asthma with allergies
Allergies: Seasonal allergies
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Pleurisy - Severe pain around left lung for about 4 days. I''ve had it diagnosed before. Did not see doctor this time. Treated at home. It is almost resolved now.


VAERS ID: 1424009 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Diarrhoea, Dysphagia, Hypoaesthesia oral, Paraesthesia oral, Pharyngeal hypoaesthesia, Pharyngeal paraesthesia
SMQs:, Anticholinergic syndrome (broad), Pseudomembranous colitis (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), Noninfectious diarrhoea (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: Azathioprine 50mg, cetirizine 10mg, gabapentin 300mg TID, hydroxychloroquine 200mg BID, Imuran 50mg BID, ipratropium nasal spray 0.03% 2 sprays BID, lactulose, linzess 145mcg 1-2 tabs/day, naltrexone 17g BID, omeprazole 20mg BID, albuterol
Current Illness: None
Preexisting Conditions: Autoimmune hepatitis, fibromyalgia
Allergies: Codeine, fentanyl, morphine
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Approximately 5 minutes after receiving vaccine, patient developed numbness and tingling around her mouth, inside her mouth and in her throat. She did feel like it was difficult to swallow due to not being able to feel the inside of her mouth, but denied any swelling. BP was elevated initially to the 170s/90s, SpO2 remained $g92 throughout. Lungs were clear on exam, there was no asymmetry to her face and no visible swelling. She was given 50mg IM Benadryl and symptoms improved within 20 min. She was advised to take another 50mg of Benadryl at home and go to ED if symptoms returned. Symptoms did not return, but one day after vaccine did develop mild diarrhea.


VAERS ID: 1424082 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-03-12
Onset:2021-06-21
   Days after vaccination:101
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 044A21A / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: COPD, Hypertension, immunocompromised
Allergies:
Diagnostic Lab Data: COVID-19 RNA DETECTION BDMAX posiitve 06/21/2021
CDC Split Type:

Write-up: pt has covid 19


VAERS ID: 1424097 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Headache
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: Hydrochlorothiazide
Current Illness:
Preexisting Conditions: High blood pressure
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Tiredness, fatigue, headache.


VAERS ID: 1424183 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-01-18
Onset:2021-06-21
   Days after vaccination:154
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3249 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / 2 LA / IM

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

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

Write-up: Diagnosed with shingles.


VAERS ID: 1424250 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-01-27
Onset:2021-06-21
   Days after vaccination:145
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3248 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL8982 / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Bell's palsy, Chest X-ray, Computerised tomogram, Electrocardiogram, Full blood count, Urine analysis
SMQs:, Hearing impairment (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: vitamin d, 81 mg aspirin
Current Illness: none
Preexisting Conditions: type 2 diabetes, hypertension, hypercholesterolemia
Allergies: yellow tail (fish),
Diagnostic Lab Data: CAT scan,ECG, EKG, chest xray, CBC, UA
CDC Split Type:

Write-up: right side Bells Palsy onseto five (5) months post injection


VAERS ID: 1424280 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-04-22
Onset:2021-06-21
   Days after vaccination:60
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 UN / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 UN / SYR

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? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: hydroxychloroquine, methotrexate
Current Illness:
Preexisting Conditions: Diabetes Mellitus Type 2, DVT, Rheumatoid Arthritis, Sleep Apnea
Allergies: unknown
Diagnostic Lab Data: Positive COVID-19 PCR on 6/21
CDC Split Type:

Write-up: Hospitalized, vaccine breakthrough


VAERS ID: 1424390 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 LA / IM

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

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

Write-up: PATIENT RECIEVED THE DOSE AFTER MANUFACTURER RECOMMENDED FREEZER STORAGE DURATION.


VAERS ID: 1424455 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 2 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Product administration 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: n/a
Current Illness: n/a
Preexisting Conditions: Asthma
Allergies: n/a
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was advised that the pharmacy mixed the vaccine with the wrong saline/solution.


VAERS ID: 1424460 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011D21A / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain upper, Chest pain, Injection site rash, Pain, Vision blurred
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Hypersensitivity (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: VITAMIN B1, C500MG, B2, B6, B12, ZINC 5OMG, FOLIC ACID 1MG, D 50000U, ASPIRIN 81MG, PHENTERMINE 37.5MG, ALPRAZOLAM 1MG
Current Illness: NA
Preexisting Conditions: NA
Allergies: NA
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: BODY ACHES, BLURRED VISION, STOMACH CRAMPING, RASH AT INJECTION SITE, CHEST PAINS


VAERS ID: 1424868 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? 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 fell down but was unaware of doing so, he almost immediately was conscious again and went and sat down, he was sweating all over for about 15 minutes as well; he was given a bottle of water and was observed until the EMS arrived: after they arrived and checked him out he left without the EMS


VAERS ID: 1425007 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-06-20
Onset:2021-06-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 2 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Dizziness, Fear, Headache, Pain, Palpitations, Tension headache
SMQs:, Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: One-A-Day Men''s Multivitamin Suppliment
Current Illness:
Preexisting Conditions: Folliculitis
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pfizer-BioNTech COVID-19 Vaccine EUA Events: Severe chills, body aches, headache, tension headache, palpations, fever, lightheadedness.


VAERS ID: 1425030 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-06-13
Onset:2021-06-21
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Joint swelling, Musculoskeletal stiffness, Rash, Rash erythematous, Rash pruritic
SMQs:, Anaphylactic reaction (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Ibuprofen
Current Illness: N/A
Preexisting Conditions: Psoriasis
Allergies: Penicillin
Diagnostic Lab Data: Contact provider for results.
CDC Split Type:

Write-up: Itchy, painful, burning red rash all over body. Swollen, stiff joints


VAERS ID: 1425258 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-06-18
Onset:2021-06-21
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO187 / 1 LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO187 / 2 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin C, Vitamin D, Iron, Fish Oil, Calcium, Vitamin B-6, Vitamin B-12, Folic Acid, Green tea extract, Lutein, Vitamin E
Current Illness: stye (inside of right eyelid)
Preexisting Conditions:
Allergies: some seafood, sun light, some chemicals
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: 06/21 PM: Rashes / Hives from the scalp to the chest, including face, neck, upper back, arms, wrists and hands, red, patchy and very itchy Took Cetirizine Hydrochloride 10mg * 1 tablet 06/22 whole day: Rashes / Hives from the scalp to belly, red, patchy and very itchy Took Cetirizine Dihydrochloride 10mg * 1 tablet 06/23 whole day: Rashes / Hives from the scalp to thighs, red, patchy and very itchy 06/24 AM: Rashes / Hives all over the body, from face to legs, ankles and insteps, red, patchy and very itchy Took Zyrtec 10mg * 1 tablet


VAERS ID: 1425761 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-06-18
Onset:2021-06-21
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1820096 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test, Chest X-ray normal, Chills, Cold sweat, Dehydration, Dizziness, Fatigue, Muscular weakness, SARS-CoV-2 test negative, Urine analysis
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Vestibular disorders (broad), Hypoglycaemia (broad), Dehydration (narrow), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Gabapentin, Effexor, inositol, birth control, fluconazole
Current Illness: Valley fever (no symptoms, clear chest X-ray)
Preexisting Conditions: Asthma, eczema, migraines, PCOS, endometriosis
Allergies: Coconut, nuts, fish, macrobid, imitrex
Diagnostic Lab Data: COVID-19 test (negative), chest X-ray (clear), blood tests (no sign of infection), urinalysis (elevated ketones)?6/23/2021
CDC Split Type:

Write-up: Chills, cold sweats, dizziness, fatigue, muscle weakness, other dehydration symptoms


VAERS ID: 1425827 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-06-21
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210647358

Write-up: RARE SKIN REACTION; This spontaneous report received from a patient concerned a female of unspecified age. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin, and batch number were not reported) dose was not reported, administered on 18-JUN-2021 for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On 21-JUN-2021, the subject experienced rare skin reaction. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from rare skin reaction. This report was non-serious.


VAERS ID: 1425852 (history)  
Form: Version 2.0  
Age: 97.0  
Sex: Female  
Location: New York  
Vaccinated:0000-00-00
Onset:2021-06-21
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Blood pressure measurement, Hypotension, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210621; Test Name: Blood pressure; Result Unstructured Data: low blood pressure 98/68
CDC Split Type: USJNJFOC20210648927

Write-up: THROWING UP; LOW BLOOD PRESSURE 98/68; This spontaneous report received from a consumer concerned a 97 year old female. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported.The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 206A21A, expiry: UNKNOWN) dose was not reported, administered on 21-JUN-2021 for prophylactic vaccination. No concomitant medications were reported. On 21-JUN-2021, the subject experienced throwing up. On 21-JUN-2021, the subject experienced low blood pressure 98/68. Laboratory data included: Blood pressure (NR: not provided) low blood pressure 98/68. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from throwing up, and low blood pressure 98/68. This report was non-serious.


VAERS ID: 1425916 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-05-20
Onset:2021-06-21
   Days after vaccination:32
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 2 LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 2 LA / -

Administered by: Other       Purchased by: ?
Symptoms: Arthralgia, Cardiac murmur, Chest pain, Dyspnoea, Heart rate increased, Tachyarrhythmia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Tachyarrhythmia terms, nonspecific (narrow), Arthritis (broad), Dehydration (broad), Hypokalaemia (broad)

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

Write-up: Right side chest pain and shoulder pain, shortness of breath and rapid heart rate. These effects seem to happen randomly and with varying degrees or intensity. Started experiencing effects 6/21 in the evening. Went to urgent care 6/24. Diagnosed at this time with heart murmur and tachyarrhythmia. Seeking referral to cardiologist.


VAERS ID: 1425921 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-06-04
Onset:2021-06-21
   Days after vaccination:17
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: C-reactive protein increased, Chest discomfort, Echocardiogram normal, Electrocardiogram normal, Fatigue, Full blood count normal, Malaise, Metabolic function test normal, Myocarditis, Pyrexia, Red blood cell sedimentation rate increased, Troponin
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Humira
Current Illness: none
Preexisting Conditions: Behcet''s disease - uveitis and oral ulcers
Allergies: none
Diagnostic Lab Data: Initial troponin 604 ng/L at 4pm on 6/24/2021 Repeat troponin 584 ng/L at 7:25pm on 6/24/2021 ESR 23 mm/hr CRP 14.31 mg/dL normal CBC and CMP
CDC Split Type:

Write-up: Patient was diagnosed with myocarditis on 6/24/2021 after 4 days of fever, malaise, fatigue, and an episode of chest discomfort. His evaluation revealed elevated inflammatory markers, CRP and ESR, and elevated troponin levels. His EKG and echocardiogram were normal. He has been started on colchicine.


VAERS ID: 1425929 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-06-14
Onset:2021-06-21
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / IM

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

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

Write-up: hives, swelling around mouth


VAERS ID: 1426139 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: New York  
Vaccinated:2021-03-25
Onset:2021-06-21
   Days after vaccination:88
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: SARS-COV-2 RAPID 21-JUN-21
CDC Split Type:

Write-up: PT TESTED POSITIVE FOR COVID 19 AFTER BEING FULLY VACCINATED.


VAERS ID: 1426440 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-02-24
Onset:2021-06-21
   Days after vaccination:117
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute kidney injury, Adenovirus test, Asthenia, Bordetella test negative, COVID-19, Chlamydia test negative, Condition aggravated, Coronavirus test negative, Dyspnoea, Enterovirus test negative, Human metapneumovirus test, Human rhinovirus test, Influenza A virus test negative, Influenza virus test negative, Mycoplasma test negative, Peripheral swelling, Respiratory syncytial virus test negative, Respiratory viral panel, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (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? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: aspirin 81 mg tablet atorvastatin (LIPITOR) 40 mg tablet bumetanide (BUMEX) 2 mg tablet calcitrioL (ROCALTROL) 0.25 mcg capsule CARTIA XT 120 mg 24 hr capsule carvediloL (COREG) 25 mg tablet cloNIDine (CATAPRES) 0.1 mg tablet cyanocobalamin
Current Illness:
Preexisting Conditions: Non-Hospital S/P drug eluting coronary stent placement Sinus bradycardia Right bundle branch block PAC (premature atrial contraction) Snoring Hypertension associated with type 2 diabetes mellitus (CMS/HCC) Coronary artery disease involving native coronary artery of native heart without angina pectoris Long term current use of anticoagulant Ascending aortic aneurysm (CMS/HCC) Mixed hyperlipidemia Benign prostatic hyperplasia with lower urinary tract symptoms Idiopathic peripheral neuropathy Type 2 diabetes mellitus with stage 4 chronic kidney disease, without long-term current use of insulin (CMS/HCC) CKD (chronic kidney disease) stage 4, GFR 15-29 ml/min (CMS/HCC) Benign paroxysmal positional vertigo due to bilateral vestibular disorder Erectile dysfunction due to diseases classified elsewhere Lumbar degenerative disc disease Abnormal gait Joint contracture of the ankle and foot Olecranon bursitis of left elbow Tremor Iron deficiency anemia, unspecified Facial lesion Vitamin D deficiency Insomnia, unspecified type Shortness of breath Sleepiness Chronic cough Abnormal chest CT
Allergies: Ciprofloxacin
Diagnostic Lab Data: 06/22/21 1844 Respiratory virus detection panel Collected: 06/22/21 1547 | Final result | Specimen: Swab from Nasopharynx Adenovirus Not Detected Mycoplasma pneumoniae Not Detected Chlamydophila pneumoniae Not Detected Parainfluenza Not Detected COVID-19 SARS-CoV-2 Overall Result DetectedCritical Enterovirus/Rhinovirus Not Detected Coronavirus Not Detected Respiratory Synctial Virus Not Detected Influenza A Not Detected Bordetella pertussis Not Detected Influenza B Not Detected Bordetella parapertussis Not Detected Metapneumovirus Not Detected 06/22/21 1705 COVID-19 (SARS CoV-2,RNA Molecular Amplification) Collected: 06/22/21 1547 | Final result | Specimen: Swab from Nasopharynx COVID-19 SARS-CoV-2 Overall Result DetectedCritical 06/22/21 1705 COVID-19 PCR - Asymptomatic screening for admission Collected: 06/22/21 1547 | Final result | Specimen: Swab from Nasopharynx
CDC Split Type:

Write-up: Asymptomatic screening for admission for AKI ED to Hosp-Admission Current 6/22/2021 - present (3 days) MD Last attending ? Treatment team AKI (acute kidney injury) (CMS/HCC) Principal problem Review of Systems Constitutional: Negative for chills and fever. General weakness. HENT: Negative for ear pain and sore throat. Eyes: Negative for pain and visual disturbance. Respiratory: Positive for shortness of breath. Negative for cough. Cardiovascular: Positive for leg swelling. Negative for chest pain and palpitations. Gastrointestinal: Negative for abdominal pain and vomiting. Genitourinary: Negative for dysuria and hematuria. Musculoskeletal: Negative for arthralgias and back pain. Skin: Negative for color change and rash. Neurological: Negative for seizures and syncope. All other systems reviewed and are negative.


VAERS ID: 1426480 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 1 RA / IM

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

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

Write-up: Patient''s parent wrote on the vaccine consent form to make the child 12 years old and eligible for the Pfizer vaccine. The patient''s true date(11 years old- not eligible for the vaccine). This was found when our central processing team recognized that was already a patient of our pharmacy under the true date


VAERS ID: 1426505 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-06-18
Onset:2021-06-21
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: oral infection 2 weeks prior treated with clindamycin
Preexisting Conditions: right bundle branch block
Allergies: cefprozil and cephalosporines
Diagnostic Lab Data: troponin - max 8000 on 6/23 , echo normal
CDC Split Type:

Write-up: chest pain developed 6/21, admitted to the hospital with diagnosis of myocarditis 6/22


VAERS ID: 1426834 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Fatigue, Headache, Insomnia, Pain, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: In order in which they occurred: Fatigue, chills, fever, body aches, headache, and vomiting. Treatment included cooling packs and ibuprofen, and when I was finally able to sleep I woke up with just exhaustion the next day.


VAERS ID: 1427061 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW186 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Syncope, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Dizziness / Lightheadness-Severe, Systemic: Fainting / Unresponsive-Severe


VAERS ID: 1427076 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Confusional state, Dizziness, Lethargy, Syncope, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Dizziness / Lightheadness-Medium, Systemic: Fainting / Unresponsive-Medium, Additional Details: Pt expressed she can pass out after vaccines and blood draws. i explained process, side effects and what to expect. I had pt look at her mom during admin. Patient did fabulous and told she did amazing as not even a speck of blood. About 5 mins later i asked pt hiow she was, which was good. About 15 mins later, she seemed lethargic and said she was dizzy. I asked questions, took Temp and got ice packs. I then called EMS as patient was not responding appropriastely. BP, O2, HR were perfect


VAERS ID: 1427085 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anaphylactic reaction, Anxiety, Chest discomfort, Dysphagia, Throat tightness
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Anticholinergic syndrome (broad), Anaphylactic/anaphylactoid shock conditions (narrow), 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 (broad), Hypersensitivity (narrow), Hypoglycaemia (broad)

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

Write-up: Systemic: Allergic: Anaphylaxis-Medium, Systemic: Allergic: Difficulty Swallowing, Throat Tightness-Medium, Systemic: Chest Tightness / Heaviness / Pain-Medium, Systemic: ANXIETY-Medium, Additional Details: WE CALLED 911, paramedics came and her oxygen, heart rate, bpwas fine. pt was given option of going to hospital, but she did not want to go.


VAERS ID: 1427091 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-06-17
Onset:2021-06-21
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood lactate dehydrogenase increased, C-reactive protein increased, Chest X-ray normal, Chest pain, Echocardiogram normal, Electrocardiogram QT interval, Electrocardiogram normal, Haemoglobin normal, Headache, Magnetic resonance imaging heart, Malaise, Myocardial necrosis marker, Neutrophil percentage, Pyrexia, QRS axis, Respiratory tract congestion, SARS-CoV-2 antibody test negative, Troponin T increased, Viral titre, White blood cell count increased
SMQs:, Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), COVID-19 (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, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: loratadine 10 mg PO PRN allergy symptoms
Current Illness: None
Preexisting Conditions: None
Allergies: No known allergies
Diagnostic Lab Data: WBC 11.66 LDH 308 Troponin T 0.25 trended down to 0.04 at discharge CRP 2.74 SARS-CoV-2 antibody non-reactive Relevant Diagnostic Images/Studies: Echo 6/23: ? Normal valvular function. ? Normal left ventricular size and systolic function. Normal indices of diastolic function. ? Qualitatively normal right ventricular systolic function. ? No pericardial effusion. ? Poor acoustic windows; pulmonary venous connections and distal coronary artery branches were not well seen. EKG 6/24: Rate: 81 Axes/P: 52 QRS: 34 T: 46 Intervals/PR : 130 QRS: 88 QT: 383 QTC: 445 Clinical Dx: Chest pain Code Diagnosis 7000 Normal ECG Tests Pending
CDC Split Type:

Write-up: Patient is a previously healthy 15 year-old presenting with chest pain and elevated troponin in the setting of recently receiving his second COVID vaccine. He was in his USOH and received his second COVID vaccine 6/17. He subsequently experienced tactile fevers, headache, and malaise for two days that resolved. Then 6/21 he developed congestion and chest pain. It is in the center of his chest, not pleuritic but worsened with sneezing/coughing. Tylenol/Motrin help, but given persistence of the pain he presented to the hospital ED. Lyme titers were sent, troponin at 1814 was 2.12, then at 1646 2.49 (normal <0.06), chem was normal, CBC had wbc 11.5 with 66% neut and Hgb 12.3. EKG and CXR were reportedly normal. He received Tylenol and Ativan and was transferred for further management. In the ED, he was afebrile with normal VS. Repeat troponin was 0.25. EKG was normal. Given elevated troponin, he is being admitted for further workup and serial cardiac enzymes and EKG. Hospital Course: Patient was admitted to the cardiology floor for troponin and chest pain monitoring. His troponin levels were trended x4 and showed return to normal. Just prior to discharge, troponin level was 0.04 (normal < 0.09). His EKG was normal throughout, and at discharge showed normal sinus rhythm. He did not have any chest pain prior to leaving the hospital. On discharge, he was tolerating a normal diet. Plan for return was discussed with family for cardiac MR on 6/25. Return precautions were discussed and family expressed understanding.


VAERS ID: 1427094 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 1 LA / IM

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

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

Write-up: Systemic: Weakness-Mild, Additional Details: Patient felt dizziness and just fell down and recover right away . I pharmacist gave some water and check vital and she was fine and made her sit down for 30 min. then send her home


VAERS ID: 1427097 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Fatigue, Flushing, Headache, Hyperhidrosis, Hypoaesthesia, Lethargy, Syncope, Tongue biting
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Dizziness / Lightheadness-Medium, Systemic: Exhaustion / Lethargy-Medium, Systemic: Fainting / Unresponsive-Severe, Systemic: Flushed / Sweating-Medium, Systemic: Headache-Mild, Systemic: Numbness (specify: facial area, extremities)-Mild, Additional Details: Pt fainted a minute after recieving his vaccine. Was unresponsive for a few seconds and got up after. Bite his tongue from the fall head first. Paramedics were called and he was quickly evaluated with no vitals out of range. He went home and napped and after follow up call, feels better now 7 hours later. He confirmed had light headache,was tired so napped and also had tingling in his arm and also confirmed he did not drink water or eat anything before his visit. Now he feels fine.


VAERS ID: 1427101 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Product preparation issue
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: Error: Incorrect Reconstitution


VAERS ID: 1427105 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Flushing, Hyperhidrosis, Hypotension, Nausea, Syncope, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

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

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


VAERS ID: 1427112 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Confusional state, Nausea, Syncope, Tremor, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Confusion-Mild, Systemic: Fainting / Unresponsive-Mild, Systemic: Nausea-Mild, Systemic: Vomiting-Mild, Additional Details: Patient was given vaccine and walked to observation area, with mom. He sat down and few minutes later he started shaking, seemed to faint/was unresponsive. He slipped/was lowered to ground where he came to, but started vomiting. He vomited several times and was confused. 911 was called and the paramedics arrived. Water was offered by pharmacy staff, but was not taken. Paramedic stated to pharmacist that patient did not show signs of being post-seizure. Patient was put on strecther by paramedics


Result pages: prev   1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131 132 133 134 135 136 137 138 139 140 141 142 143 144 145 146 147 148 149 150 151 152 153 154 155 156 157 158 159 160 161 162 163 164 165 166 167 168 169 170 171 172 173 174 175 176 177 178 179 180   next

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?EVENTS=ON&PAGENO=81&PERPAGE=100&ESORT=ONSET-DATE&REVERSESORT=ON&VAX=COVID19&DIED=No


Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166