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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 82 out of 4,799

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VAERS ID: 1427117 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Utah  
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 EW0176 / 2 LA / IM

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

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

Write-up: Error: Booster Given Too Early


VAERS ID: 1427357 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: New York  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-25
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: 1427384 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Nebraska  
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 - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dysgeusia, Heart rate increased, Rash erythematous, Swollen tongue, Tinnitus, Vision blurred
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Hearing impairment (narrow), Hypersensitivity (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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: LISINOPRIL...10 MG...1 DAILY, FLUOXETINE...20 MG...1...DAILY, PANTOPRAZOLE...4 MG...DAILY, METFORMIN...500 MG TWICE DAILY, TESTOSTERONE... 1 ML...WEEKLY
Current Illness: NONE
Preexisting Conditions: TYPE 2 DIABETIC
Allergies: BEE STING ALLERGIES
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: SWELLING OF TOUNGE, HIGH HEART RATE, BLURRED VISION, RINGING IN EARS, METAL TAISTE IN MOUTH, RED RASH ON HEAD AND CHEST. WAS TREATED AT THE EMERGENCY ROOM AND RELEASED.


VAERS ID: 1427389 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-04-03
Onset:2021-06-21
   Days after vaccination:79
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016B21A / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Abortion spontaneous, Cytogenetic abnormality, Foetal heart rate abnormal, Placental transfusion syndrome, Subchorionic haemorrhage, Ultrasound antenatal screen abnormal
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Congenital, familial and genetic disorders (narrow), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Foetal disorders (narrow), Termination of pregnancy and risk of abortion (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations: Previously reported to VAERS - subchorionic hemorrhage in the same pregnancy on May 24. (VAERS ID 1378256)
Other Medications: Progesterone, low dose naltrexone, multivitamin, lexapro, vitamin D
Current Illness: N/A
Preexisting Conditions: West Nile survivor
Allergies: Sulfa
Diagnostic Lab Data: Investigation on the cause of miscarriage is ongoing. It is suspected to be either chromosomal or twin-to-twin transfusion syndrome.
CDC Split Type:

Write-up: Missed miscarriage of 11 week old, mo/di identical twins. Discovered as lack of heartbeat on ultrasound on June 21.


VAERS ID: 1427458 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
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 EW0196 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Dizziness, Dysphagia, Dyspnoea, Flushing, Headache, Hyperhidrosis, Nausea, Pain, Rash, Throat tightness
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (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), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Systemic: Allergic: Difficulty Breathing-Medium, Systemic: Allergic: Difficulty Swallowing, Throat Tightness-Medium, Systemic: Allergic: Rash (specify: facial area, extremeties)-Medium, Systemic: Chest Tightness / Heaviness / Pain-Medium, Systemic: Dizziness / Lightheadness-Medium, Systemic: Flushed / Sweating-Medium, Systemic: Headache-Medium, Systemic: Nausea-Mild


VAERS ID: 1427776 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Unknown  
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 (MODERNA)) / MODERNA - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: carbamazepine, primidone, Vitamin C, Vitamin D, B6, Magnesium, Naproxen
Current Illness:
Preexisting Conditions: Epilepsy, arthritis,
Allergies: benadryl,
Diagnostic Lab Data: N/A--Called Dr to report then called other agency to send a report
CDC Split Type:

Write-up: high fever, severe chills, teeth chattering, pounding headache lasting 30 hours


VAERS ID: 1427874 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: New York  
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 EW0217 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Decreased appetite, Dizziness, Dyspnoea, Heart rate increased, Pain in extremity, Palpitations
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: Being treated for anemia due to low iron in blood, which results in shortness of breath at times and palpitations.
Preexisting Conditions: Have had palpitations on and off throughout my lifetime. Was diagnosed with Hodgkin''s disease in March 1997 due to a mediastinal mass found after the birth my one and only son. Have been in remission since 1998 with no reoccurrence. The chemo and radiation did damage both my thyroid and heart septum. Lower lobe of left lung has scar tissue as a result of pleural fluid collecting there prior to the discovery of Hodgkin''s Lymphoma. Presently am hypothyroid as a result of the treatment and palpitations have occurred more often as I passed the time of the cancer diagnosis.
Allergies: Penicillin and all its derivatives
Diagnostic Lab Data: I plan on making arrangements to see a cardiologist, after the 3 weeks of antibody production so the tests are not skewed. I am wondering if I should keep the appointment for a second vaccine.
CDC Split Type:

Write-up: Woke up Monday, June 21 feeling fine, just a sore arm, and decided to do some mild exercise. After bending at the waist for the fourth time, my heart started racing and I felt like I would faint. The palpitations began at 10:40 AM and continued for 12 hours into the evening. My normal approaches to bring them under control - bearing down, rest, homeopathic remedies and metoprolol - did nothing. Heart rate was as high as 200+ and slowing dropped to 190 for several hours, 180 for several hours, 174 for awhile and after taking the homeopathic remedy thyroidinum it finally dropped to 94 and has gone back to normal. Basically, I spent Monday day lying on my left side waiting for it to stop, trying to belly breathe slowly. I had no appetite, felt faint each time I sat up. Once the palpitations stopped, I have experienced shortness of breath whenever I go upstairs each day this week. However, as I get further away from the vaccination day, the breathlessness is lessening.


VAERS ID: 1427918 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
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 EW0180 / 2 AR / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Chest discomfort, Headache, Pain
SMQs:, Anaphylactic reaction (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 allergy
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Patient (a primary care patient) called our center c/o body aches, soreness, headaches x 5 days after receiving second Pfizer vaccine on 6/21 (from a provider in the community) . Patient also reported constant chest tightness that started yesterday. Per patient, chest tightness feels similar to when he had bronchitis as a child. Pain is tolerable and does not radiate anywhere else, patient stated it is located at the sternum. Denies difficulty breathing. Patient does not sound in distress. Patient denies fever, swelling of face, rash. Patient reported he has not taken any OTC medication to relieve his symptoms. I consulted with MD, was concerned of his chest pain and the possibility of myocarditis from the vaccine. Patient was highly recommended to seek ER ASAP due to his constant chest pain for more than 24 hours. Patient verbally agrees to go to hospital now. I encouraged him for me to call EMS but patient stated he is well enough to have someone drive him and will call a service.


VAERS ID: 1427958 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-03-16
Onset:2021-06-21
   Days after vaccination:97
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6198 / UNK LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6206 / UNK LA / IM

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

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

Write-up: tested positive for covid-19 after completing covid-19 vaccine series


VAERS ID: 1428014 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
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 EW0180 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Father disclosed that information after the event
Other Medications: None
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: Paramedics arrived and conducted EKG, BS, BG.......all negative
CDC Split Type:

Write-up: Pfizer vaccine given. Patient was waiting 15 minutes after vaccine before departing. Patient was accompanied by father and two siblings. Patient fainted while sitting.


VAERS ID: 1428274 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Unknown  
Vaccinated:2001-02-10
Onset:2021-06-21
   Days after vaccination:7436
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9262 / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Angiogram pulmonary abnormal, Anticoagulant therapy, Computerised tomogram thorax abnormal, Cough, Deep vein thrombosis, Dizziness, Dyspnoea, Dyspnoea exertional, Gait disturbance, Pulmonary embolism, Walking distance test normal
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Embolic and thrombotic events, venous (narrow), Parkinson-like events (broad), Thrombophlebitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient is 75 years old male with no significant past medical history except from varicose vein. Patient also reported that he received 2nd dose of by the COVID-19 vaccine in February 2021 presented to ED with chief complaint of exertional shortness of breath and dizziness and cough for 10 days. Patient denies any long travel or prolonged immobilization. No known history of cancer. No recent surgery. Patient stated that he walked 5 mi every day and recently still able to walk but a little winded and need to work slowly due to shortness of breath. CTA chest showed Small caliber pulmonary embolus in the right lower lobe subsegmental pulmonary artery. No evidence of right heart strain. He also had bilateral below knee deep venous thrombosis involving the right posterior tibial vein and left peroneal vein. Patient was started on Eliquis and tolerated Eliquis. He had continuous persistent cough, and he was not found to have pneumonia. His cough improved with antitussives. He saturated well on walk test and was cleared for discharge home to follow up with Heme/onc for the remainder of the work up for hypercoagulable state.


VAERS ID: 1428275 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: Unknown  
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 (MODERNA)) / MODERNA 032M20A / 2 RA / IM

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

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

Write-up: Miscommunication in the pharmacy resulted in the dose being administered greater than 12 hours after the vial had been punctured. Moderna was contacted regarding how to proceed. They said not to re-dose, but it was up to our judgement to contact patient. Patient was contacted. Voicemail was left, encouraging patient to call us if any side effects had occurred. No call back from patient as of yet.


VAERS ID: 1428427 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Unknown  
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 (MODERNA)) / MODERNA 032M20A / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Incorrect product administration duration
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: Miscommunication in the pharmacy resulted in the dose being administered greater than 12 hours after the vial had been punctured. Moderna was contacted regarding how to proceed. They said not to re-dose, but it was up to our judgement to contact patient. Patient was contacted. Voicemail was left, encouraging patient to call us if any side effects had occurred. No call back from patient as of yet.


VAERS ID: 1428435 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: New York  
Vaccinated:2021-06-10
Onset:2021-06-21
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027C21A / 1 RA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Abdominal pain upper, Chills, Diarrhoea, Dizziness, Migraine, Sleep disorder, Vomiting
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Noninfectious diarrhoea (narrow)

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

Write-up: On 6/21/2021 right before I went to bed, I experienced the worst case of chills ever. I paid it no mind, put several comforters on my bed and went to sleep. At approximately 2 AM I awoke with a maximum migraine, dizziness, diarrhea, stomach ache and throwing up. That lasted three days. Although the throwing up has subsided yesterday evening, I?m still experiencing the stomach aches, dizziness and diarrhea. I?m hoping it?s not the vaccine, being that it?s my first dose and it?s scaring me to take the second dose. I have yet to see any other side effects other than what I?ve seen so far


VAERS ID: 1428464 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: California  
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 (MODERNA)) / MODERNA 001C21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Bell's palsy
SMQs:, Hearing impairment (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: NKDA
Diagnostic Lab Data: none
CDC Split Type:

Write-up: left sided bell''s palsy


VAERS ID: 1428669 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-20
Onset:2021-06-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Cough, Facial paralysis, Feeling hot, Feeling of body temperature change, Headache, Hypoaesthesia, Influenza, Muscle spasms, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Peripheral neuropathy (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Eosinophilic pneumonia (broad), Hearing impairment (broad), Tendinopathies and ligament disorders (broad), Infective pneumonia (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: I am taking doxycline for a rosacea on the face and blood of drago homeopathic medicine for the same rosacea.
Current Illness: ninguna
Preexisting Conditions: no
Allergies: no
Diagnostic Lab Data: Just today I am making contacts to go see a neurology specialist
CDC Split Type:

Write-up: On September 26, 2017, four days before having my third baby by cesarean section, I had facial paralysis, which culminated the following month, without noticeable scars on the face, but yes, some sensitivity to cold or sudden changes in temperature . After applying the vaccine, I felt slight body heat and they warned us that we were going to have pain in the arm and possibly cramps, no more. But, the day after the application, I began to feel the flu, cough, muscle pain, slight headache, but on the fourth day of the application, the flu had almost disappeared and I began to feel the same sensation in my body as when I had facial paralysis, I have two fingers slightly numb on my left hand and one finger from my right hand, cramps in my face. My question is what should I do in this case? Do I apply a second dose, can I cancel, what consequences will I have if I apply the second. I know that apparently nobody forces you, but if you have family in another part of the world, you will NEVER be able to see them again, because it is mandatory to go but vaccinated, in fact while they administered it to me, and before applying it, I thought I HAD BEEN SOLD ON IT TOO EASILY, I WANT TO SAY I AGREED BECAUSE I DIDN''T WANT TO STOP SEEING MY FAMILY, but now I think that if something happens to me thanks to this vaccine, I may not be able to see them for a long time or ever.


VAERS ID: 1428671 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Indiana  
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 - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: C-reactive protein, Cardiac imaging procedure abnormal, Catheterisation cardiac normal, Chest pain, Echocardiogram abnormal, Ejection fraction decreased, Electrocardiogram ST segment elevation, Magnetic resonance imaging heart, Myocarditis, Troponin increased
SMQs:, Cardiac failure (narrow), Myocardial infarction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Loratadine, fluticasone, quetiapine
Current Illness: None
Preexisting Conditions: None
Allergies: Penicillin
Diagnostic Lab Data: Serial EKGs and Troponins, Cardiac cath 6/22/21, Cardiac MR 6/23/21, CRP 6/23/21
CDC Split Type:

Write-up: Pt experienced chest pain days 2 and 3 after receiving the second dose of the Pfizer COVID vaccine. He had tombstone ST segment elevation on his EKG and subsequently had a peak troponin of 35. Heart cath revealed normal coronaries. His ejection fraction measured initially by echo at 60% decreased by echo to 35-40%. Cardiac MR was consistent with myocarditis with a partially recovered EF measured at 51%.


VAERS ID: 1428909 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-19
Onset:2021-06-21
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 2 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: Chest pain, heart beat around 100 for few hours. Took Motrin.


VAERS ID: 1428917 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-19
Onset:2021-06-21
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Epistaxis, Headache, Menstruation irregular
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Fertility disorders (broad)

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

Write-up: 2d post receiving the second dose developed a nose bleed - lasted 10 minutes 2d post had headache all day 3d post started her menses (would not have been typically due at that time)


VAERS ID: 1429300 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-06-21
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: COVID-19 virus test; Result Unstructured Data: Positive
CDC Split Type: USJNJFOC20210648299

Write-up: SUSPECTED CLINICAL VACCINATION FAILURE; SUSPECTED COVID-19 INFECTION; This spontaneous report received from a patient via a company representative concerned a male of unspecified age and ethnicity. The patient''s weight, height, and medical history were not reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown) dose, start therapy date were not reported, 1 total for prophylactic vaccination. The batch number was not reported. Per procedure, no follow-up will be requested for this case. No concomitant medications were reported. On 21-JUN-2021, the patient experienced suspected covid-19 infection, and had experienced low symptoms. Laboratory data included: COVID-19 virus test (NR: not provided) Positive. On an unspecified date, the patient had suspected clinical vaccination failure. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the suspected covid-19 infection and suspected clinical vaccination failure was not reported. This report was serious (Other Medically Important Condition).; Sender''s Comments: V0: 20210648299-covid-19 vaccine ad26.cov2.s-Suspected clinical vaccination failure. This event(s) is considered not related. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There are other factors more likely to be associated with the event(s) than the drug. Specifically: SPECIAL SITUATIONS


VAERS ID: 1429456 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 1 LA / OT

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood cholesterol, Erythema, Feeling abnormal, Full blood count, Peripheral swelling, Rash, Rash papular, Scratch
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Dementia (broad), Accidents and injuries (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ZYRTEC ALLERGY
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Allergy
Allergies:
Diagnostic Lab Data: Test Name: Blood cholesterol; Result Unstructured Data: Test Result:Good; Test Name: CBC; Result Unstructured Data: Test Result:Good; Comments: the Blood test standard blood panel like CBC all the things just the mix of Cholesterol
CDC Split Type: USPFIZER INC2021751358

Write-up: I felt my legs like swelling; I had raised rash and both of them on both legs; they were red/I had scratchy redness on my arms; I had scratchy redness on my arms; raised rash; they just felt weird; This is a spontaneous report from a contactable consumer (patient). A 49-years-old female patient received of BNT162b2 (PFIZER-BIONTECH COVID-19 VACCINE, solution for injection, Lot Number: EW0191), via an intramuscular route on 21Jun2021 (at the age of 49-years) as dose 1, single in the left arm for covid-19 immunisation. The patient medical history included allergy. Patient allergic to medicines she don''t take medicine because she always had a reaction to it like, like Morphine, Oxycodone, Ibuprofen, Tylenol. Patient don''t took narcotics. The patient concomitant medications included cetirizine hydrochloride (ZYRTEC) tablet with dose 10 mg for allergy. The patient did not receive any other vaccines within four weeks prior to the vaccination. On 21Jun2021 (5 minutes after vaccination), the patient experienced felt her legs like swelling that they just felt weird and within that 15 minutes after having the shot leg down and her legs, she had raised rash and both of them on both legs and they were red like red and so then, She had scratchy redness on my arms it''s a reaction that she get when she take medicines and she had allergic reaction to them. Patient stated that wanted to have check up she had it last week. It''s just the Blood test standard blood panel like CBC all the things just the mix of Cholesterol all that, Annual Blood work and said Yes everything was good. Patient took Diphenhydramine HCL (BENADRYL) tablet 25 mg as treatment. About 25 minutes after she got with the Pharmacist and he finally can get a thing It was about 25 minutes after the shot is when she got the Benadryl and it took about 30 minutes from the Benadryl 20-30 minutes that the redness is at least went down, she still had the raised rash but her legs were not red like red they were and now she was at home and it''s pretty much subsided the reaction, she don''t have the scratchiness and stuff she had few little spots here and there but not anything. The outcome of the events was recovering. Time (24hr) of vaccination: Consumer stated, "My appointment was at 2:30 but I think it was about 2:35 time I got it I don''t know about 2:35, 2:40 something central time." Additional information has been requested.


VAERS ID: 1429474 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-06-16
Onset:2021-06-21
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Headache, Tinnitus
SMQs:, Hearing impairment (narrow)

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

Write-up: Pt reports severe HA and tinnitus on day 6-9 after immunization. Slowly improving since day 9.


VAERS ID: 1429507 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-06-10
Onset:2021-06-21
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 2 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Dyspnoea, Fall, Seizure, Tremor
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: A month ago, after 1st dose of vaccine
Other Medications: Clonidine 1mg
Current Illness: No
Preexisting Conditions: Autism
Allergies: None
Diagnostic Lab Data: No
CDC Split Type:

Write-up: Had seizure. Fell in shower, started shaking uncontrollably, had difficulty breathing. He had a seizure for the first time in his life 6 days after first dose (already reported). This one was his second seizure ever.


VAERS ID: 1429578 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821288 / N/A LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Limb discomfort, Swelling, Throat irritation
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), 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: Montelukast, Symbicort, albuterol, fexofenadine, topiramate
Current Illness: None
Preexisting Conditions: Asthma, allergies
Allergies: Methylprednisone, dexamethasone, cetirizine, diphehydramine, sulfates, triamcinolone, neosporin, latex, isothiazolinones, aimovig, hibiclens, ibuprofen
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Itchy throat within 4 hours of administration, initially small pea-sized reaction which has continued to grow to the size of an orange and still continues to grow larger each day. The swelling protrudes by 1 cm and causes pressure to radiate towards my fingers.


VAERS ID: 1429657 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-06-15
Onset:2021-06-21
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood creatine phosphokinase increased, Blood creatinine normal, Chromaturia, Myalgia, Pain in extremity, Rhabdomyolysis, Urine analysis
SMQs:, Rhabdomyolysis/myopathy (narrow), Neuroleptic malignant syndrome (broad), Myocardial infarction (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (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, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Patient denies any medications or OTC supplements.
Current Illness: Patient denies any preceding health problems.
Preexisting Conditions: History of congenital albinism. History of reportedly congenital bilateral nystagmus he was told was due to his albinism.
Allergies: NKDA. No food allergies.
Diagnostic Lab Data: On 6/25/2021, he presented to the Hospital. He had bilateral pectoral and thigh pain with dark-tinged urine. He was found to be in rhabdomyolysis with CPK $g70,000. Urine studies were consistent. His creatinine was at 0.7 which is presumably baseline. He was admitted to medicine for rhabdomyolysis. Neurology and rheumatology consulted for possible polymyositis. He received aggressive IV hydration. On 6/26/2021, CPK began to downtrend but still at 56,000. Creatinine stable at 0.7. Continued IV hydration. Planning for muscle biopsy on 6/28/2021.
CDC Split Type:

Write-up: Patient is an 18 year old male with history of albinism and bilateral horizontal nystagmus. No other medical problems. He received the second dose of the Moderna vaccine on 6/15/2021. On 6/21/2021, he developed bilateral thigh/hamstring pain and bilateral pectoral pain that progressively worsened. On 6/24/2021 he noticed red-tinged urine. Patient does not take any medication or OTC supplements. He denies any recent major physical activity or time spent outside.


VAERS ID: 1429779 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 2 LA / IM

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

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

Write-up: Patient was injected with undiluted Pfizer vaccine. No saline diluent was added to the vial of vaccine. the patient received a large dose for the second shot in the two-part series of vaccines. The patient did not speak much English at all. I explained the mistake to the patient''s mother, who was present at the time of the vaccination. she did not speak much English either. She did say she understood, but that is still questionable.


VAERS ID: 1429792 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-20
Onset:2021-06-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1816027 / N/A RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cold sweat, Hangover, Headache, Insomnia, Nausea, 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), 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: N/a
Current Illness: N/a
Preexisting Conditions: N/a
Allergies: N/a
Diagnostic Lab Data:
CDC Split Type:

Write-up: I felt fine the entire day I got the shot, but after falling asleep for the night I woke up feeling like I had the worst hangover of my life. Throbbing back of the head headache, nausea, vomiting, high fever with cold sweats, body aches, insomnia. It felt as though I drank an entire bottle of red wine to myself after not eating all day and went to bed without drinking any water, but worse. 12/10 would not recommend


VAERS ID: 1430084 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: Hawaii  
Vaccinated:2021-06-01
Onset:2021-06-21
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-06-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Chest pain, Deafness unilateral, Ear pain, Migraine, Painful respiration, Tinnitus
SMQs:, Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hearing impairment (narrow)

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

Write-up: Hearing loss (right ear) Non stop Loud Ringing in ear (right ear) Migraine due to ear pain. Pain in left chest when breathing.


VAERS ID: 1430127 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-06-01
Onset:2021-06-21
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-06-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Deep vein thrombosis
SMQs:, Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad)

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

Write-up: Patient developed a lower extremity DVT approximately 2 weeks after receiving the J&J COVID-19 Vaccine. Patient was treated and discharged from our facility on apixaban.


VAERS ID: 1430169 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031A21A / 2 LA / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040A21A / 1 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Formication, Pruritus
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Amlodipine 5mg
Current Illness: None
Preexisting Conditions: High blood pressure
Allergies: Sulfa medications and sulfur
Diagnostic Lab Data: None
CDC Split Type:

Write-up: On the first dose given 5/24/21, I had itching at the site of the injection 2 days after the injection and lasting for 3 days. On the second dose given 6/21/2021, the reaction was more severe similar to my allergic reaction to sulfa. There was itching almost immediately and all over my body as if ants were crawling under my skin. This includes in my scalp as well as under the soles of my feet. Although skin rash did NOT erupt, it felt as if it could have had I not taken Benadryl. The Benadryl was taken around noon on 6/21/2021 within the hour of the injection. When I awakened around 1700hrs, there was still some itching under the skin at the site and throughout my body so I took another Benadryl. The itching at the site continued over the next 5 days; however, it was not so severe to continue taking the Benadryl.


VAERS ID: 1430481 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 1 RA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, Fatigue, Headache, Hypersomnia, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Depression (excl suicide and self injury) (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Long-standing symptoms due to COVID last year including: -Coughing -Shortness of breath -Fatigue
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Persistent headache (started a few hours after receiving vaccine and has been present off/on throughout the week) Fever (started morning after receiving vaccine, peaked at 103 degrees F, lasted 2 days) Fatigue (started morning after receiving vaccine, sleeping 14-16 hours a day with minimal energy during waking hours)


VAERS ID: 1430603 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-02-10
Onset:2021-06-21
   Days after vaccination:131
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013M20A / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Bell's palsy
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: Multi vitamin Tramadol Flexaril Lexapro
Current Illness:
Preexisting Conditions: Neck and shoulder pain
Allergies: Savella, Mirapex, Docy
Diagnostic Lab Data:
CDC Split Type:

Write-up: Bells Palsy


VAERS ID: 1430625 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: New York  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Computerised tomogram, Fall, Injection site warmth, Jaw disorder, Loss of consciousness, Nasal injury, Tooth injury, X-ray
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: X-Ray 06/21/2021 Cat-scan 06/21/2021
CDC Split Type:

Write-up: Pt''s mother states 06/21/2021 after receiving the 1st dose of Phizer vaccination, hot at the site of the injection then blacked-out, fell face first on face. ER visit, Fractured his jaw, nose and knocked out teeth. 06/22/2021 Surgery/plates required, jaw wired. Currently discharged.


VAERS ID: 1431037 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-16
Onset:2021-06-21
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Joint pains rash for 2 weeks similar to an autoimmune syndrome


VAERS ID: 1431093 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-03-04
Onset:2021-06-21
   Days after vaccination:109
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6204 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6206 / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: COVID-19 pneumonia, Chest X-ray abnormal, SARS-CoV-2 test positive
SMQs:, Cardiomyopathy (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: hypertension
Allergies: unknown
Diagnostic Lab Data: abnormal chest x-ray (unknown date)
CDC Split Type:

Write-up: Individual tested positive for COVID-19 on 06/23/2021 and was sent to hospital. Chest x-rays were abnormal and she was diagnosed with COVID pneumonia in both lungs. Was discharged on 06/27/2021 and is currently on 3L of O2


VAERS ID: 1431154 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-04-28
Onset:2021-06-21
   Days after vaccination:54
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0158 / 2 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Blood cholesterol, Blood glucose, Blood test, Burning sensation, Chest pain, Facial pain, Pruritus, Rash
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Glaucoma (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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: heart disease, Caller had stents put in 2006
Allergies: None
Diagnostic Lab Data: Blood work, Blood sugar, cholesterol
CDC Split Type:

Write-up: On the left side of the callers face down to his chest, pain and itching and burning and a rash. The caller went to the ER and the doctors gave benadryl and cream and said it was an allergic reaction. there is still a rash, and it is burning and painful.


VAERS ID: 1431217 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-06-14
Onset:2021-06-21
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

Administered by: Public       Purchased by: ?
Symptoms: Fatigue, Pruritus, Pyrexia, Rash, Rash morbilliform
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (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: metformin hydroxychloroquine hydrochlorathiazide
Current Illness: none
Preexisting Conditions: pseudo gout arthritis , hbp, pre diabetis
Allergies: codeine cipro
Diagnostic Lab Data:
CDC Split Type:

Write-up: 7 days following 2nd vaccine I developed a rash (measles type). It spread around my torso. This began on Sunday evening, no itching or other symptoms. By the evening of the 24th I started a fever and the rash continued to spread on my torso. The 27th the rash started to fade but is very itchy and the low grade fever has continued until present. Also very tiered.


VAERS ID: 1431223 (history)  
Form: Version 2.0  
Age: 10.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0202 / 1 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? 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: It has come to my knowledge that the nurse vaccinated a child under 12 years old. No adverse effects have been reported.


VAERS ID: 1431237 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: South Dakota  
Vaccinated:2021-06-17
Onset:2021-06-21
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Angina pectoris, Increased upper airway secretion, Malaise, Throat irritation
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Other ischaemic heart disease (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: None.
CDC Split Type:

Write-up: My heart feels like it pinches when it beats. The upper part of my heart hurts. I fell sick. My throat has been full of mucus and is scratchy. More importantly my heart hurts. I am a healthy person who is fit with a low resting heartrate.


VAERS ID: 1431250 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Male  
Location: Puerto Rico  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0202 / 1 LA / IM

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

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

Write-up: It has come to my knowledge that the nurse vaccinated a child under 12 years old. No adverse effects have been reported.


VAERS ID: 1431281 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Male  
Location: Puerto Rico  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0202 / 1 LA / IM

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

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

Write-up: It has come to my knowledge that the nurse vaccinated a child under 12 years old. No adverse effects have been reported.


VAERS ID: 1431294 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0202 / 1 LA / IM

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

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

Write-up: It has come to my knowledge that the nurse vaccinated a child under 12 years old. No adverse effects have been reported.


VAERS ID: 1431300 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050C21A / UNK LA / IM

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

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

Write-up: Vaccine given past expiration.


VAERS ID: 1431321 (history)  
Form: Version 2.0  
Age: 9.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0202 / UNK LA / -

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

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

Write-up: It has come to my knowledge that the nurse vaccinated a child under 12 years old. No adverse effects have been reported.


VAERS ID: 1431326 (history)  
Form: Version 2.0  
Age: 9.0  
Sex: Male  
Location: Puerto Rico  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0202 / 1 LA / IM

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

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

Write-up: It has come to my knowledge that the nurse vaccinated a child under 12 years old. No adverse effects have been reported.


VAERS ID: 1431340 (history)  
Form: Version 2.0  
Age: 10.0  
Sex: Male  
Location: Puerto Rico  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0202 / 1 LA / IM

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

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

Write-up: It has come to my knowledge that the nurse vaccinated a child under 12 years old. No adverse effects have been reported.


VAERS ID: 1431349 (history)  
Form: Version 2.0  
Age: 7.0  
Sex: Male  
Location: Puerto Rico  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0202 / 1 LA / IM

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

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

Write-up: It has come to my knowledge that the nurse vaccinated a child under 12 years old. No adverse effects have been reported.


VAERS ID: 1431358 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0202 / 1 LA / IM

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

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

Write-up: It has come to my knowledge that the nurse vaccinated a child under 12 years old. No adverse effects have been reported.


VAERS ID: 1431373 (history)  
Form: Version 2.0  
Age: 9.0  
Sex: Male  
Location: Puerto Rico  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0202 / 1 LA / IM

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

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

Write-up: It has come to my knowledge that the nurse vaccinated a child under 12 years old. No adverse effects have been reported.


VAERS ID: 1431378 (history)  
Form: Version 2.0  
Age: 9.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0202 / 1 LA / IM

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

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

Write-up: It has come to my knowledge that the nurse vaccinated a child under 12 years old. No adverse effects have been reported.


VAERS ID: 1431383 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Chills, Dizziness, Headache, Nausea, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Fever, chills, headache, nausea, dizziness x 1 week.


VAERS ID: 1431413 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Mississippi  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0151 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Fall, Hypotension, Somnolence
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), 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: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: None
CDC Split Type: 904E

Write-up: Received vaccine in clinic room. Eight minutes after receiving COVID-PFE vaccine, patient complained he was ready to go and felt drowsy. The temperature did seem warm in the clinic room, so I escorted them 30 feet to the lobby. As the patient passed through the door to the lobby, his gait, he seemed to lose his ability to remain upright and started to collapse. I was able to catch him prior to hitting the floor. He never lost consciousness, but we moved him into a clinic room to evaluate and further monitor him. His blood pressure was a little low initially at 110/50, but came up to 112/60 (closer to his normal) after five to ten minutes. His pulse was strong and regular. We gave him a cool, wet compress to the forehead, cool water to drink, and chocolate candy. He was able to answer questions appropriately. We monitored him for another 30 minutes before releasing him. His mother was present with him and is a nurse practitioner. I called the Mom on 6/22/21 (the day after the event). She (Mom) reports the patient went home, laid down for about 45 minutes, then played video games. I recommend she considers getting the second dose at either Hospital, so that a higher level of care is available if needed.


VAERS ID: 1431426 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-06-19
Onset:2021-06-21
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 UN / -

Administered by: Private       Purchased by: ?
Symptoms: Cardiac imaging procedure abnormal, Myocarditis, Pericarditis, Troponin
SMQs:, Systemic lupus erythematosus (broad), Cardiomyopathy (broad), Chronic kidney disease (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? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Previous COVID-19 infection
Allergies:
Diagnostic Lab Data: Cardiac MRI showing pericarditis on 6/23/2021. Troponin of 0.4 ng/ml
CDC Split Type:

Write-up: Myopericarditis. Treated with NSAIDs and colchicine.


VAERS ID: 1431431 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-09
Onset:2021-06-21
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 UN / SYR

Administered by: Private       Purchased by: ?
Symptoms: Bell's palsy
SMQs:, Hearing impairment (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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Left Bells palsy abrupt onset on 6/21. House Brackmann scale 5 (severe dysfunction absent forehead movement, incomplete eyelid closure, no movement of the mouth


VAERS ID: 1431483 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-03
Onset:2021-06-21
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047C21A / 2 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048B21A / 1 RA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Acute myocardial infarction, Catheterisation cardiac, Chest discomfort, Chest pain, Echocardiogram normal, Electrocardiogram abnormal, Laboratory test, Myocarditis, Nausea, Palpitations, SARS-CoV-2 test negative, Sinus bradycardia, Sleep disorder, Troponin I increased, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Disorders of sinus node function (narrow), Embolic and thrombotic events, arterial (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Acetaminophen - as needed
Current Illness:
Preexisting Conditions: No significant past medical history
Allergies: No known medication/food allergies
Diagnostic Lab Data: See above documentation of laboratory results - cardiac enzymes (troponin) elevated; ECHO and cardiac catheterization normal.
CDC Split Type:

Write-up: Received 2 doses of COVID19 (Moderna) vaccine - 1st dose: 5/6/2021; 2nd dose: 6/3/2021. Presented to hospital Emergency Dept on 6/22 with complaint of substernal non-radiating chest pain of 1 day duration. Patient reported she was asleep when chest pain began and severity wok her up. Reports the pain "pressure-like" in quality. Associated symptoms include nausea, vomiting, and palpitations. Laboratory tests were performed, including the following: Troponin-I - 6/22/21 09:05 = 1.05; 6/22/21 10:11 = 3.00; 6/22/21 14:09 = 8.00; 6/24/21 12:17 = 8.10; 6/25 06:39 = 7.90 (note: elevated) Coronavirus NAA - 6/22/21 12:15 = not detected Diagnostics tests performed during hospitalization: EKG - 6/22/21 08:59 = sinus bradycardia Echocardiogram - 6/22 11:23 = normal left ventricular systolic dysfunction, LVEF 55-60%; valves normal Pt underwent cardiac catheterization for NSTEMI. No lesions noted. Right coronary artery small and normal; left coronary artery dominant and normal. Pt diagnosed with myocarditis and discharged on 6/25 (3 day hospitalization) with MYOCARDITIS and NSTEMI.


VAERS ID: 1431486 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Condition aggravated, Mania, Tachyphrenia
SMQs:, Psychosis and psychotic disorders (broad), Hostility/aggression (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: MOTRIN 800MG PRIOR TO INJECTION, MELATONIN 5MG AT BEDTIME
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: NONE
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: PT STATES THAT SHE HAS BEEN IN A STATE OF MANIA OR MANIC SINCE JUST AFTER HER LAST SHOT. SHE SUFFERED FROM MANIA ABOUT 20 YEARS AGO BUT HAS NOT NEEDED ANY MEDICAL GUIDENCE FOR SEVERAL YEARS. CHIEF COMPLAINT IS MANIA AND RACING THOUGHTS. RECOMENDED THAT PT BE SEEN THROUGH HER PRIMARY MD BUT SHE DOESN''T HAVE ONE. INCOURAGED HER TO SEEK MEDICAL ATTENTION FOR EVALUATION.


VAERS ID: 1431523 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: California  
Vaccinated:2021-04-01
Onset:2021-06-21
   Days after vaccination:81
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: COVID-19, Dyspnoea, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: the patient tested for COVID-19 on 6/21/2021 and the result came positive , two days before testing the patient have SOB


VAERS ID: 1432350 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-05-17
Onset:2021-06-21
   Days after vaccination:35
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW10182 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness postural
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: Metamucil caplets.
Current Illness: None known.
Preexisting Conditions: None.
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: About 4 1/2 weeks after the 2nd dose I on( 6/22/21 ) woke up and felt DIZZINESS. It''s only positional when the head is turned to the right side or laying down. I don''t know if this is related to the Vaccine but I never had this before so I''m reporting it here just in case you guys can see a pattern here. I''m still experiencing the problem one week after it started, not getting worse but neither getting away. At times it seems that it''s getting better but comes back again same intensity.


VAERS ID: 1432671 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-07
Onset:2021-06-21
   Days after vaccination:45
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 2 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Anaphylactic reaction, Dyspnoea, Heart rate increased, Lip swelling, Nausea, Pharyngeal swelling, Rash, Vomiting
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Anaphylactic/anaphylactoid shock conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: Penicillin
Diagnostic Lab Data: Allergy screening coming up 06/29/2021
CDC Split Type:

Write-up: Anaphylaxis (raised heart rate, rash, nausea and vomiting, swollen lips and throat) difficulty breathing - anaphylaxis under control Cause may be a salad Breathing still doesn?t feel normal


VAERS ID: 1432773 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: New York  
Vaccinated:0000-00-00
Onset:2021-06-21
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Injection site pruritus, Skin mass
SMQs:, Extravasation events (injections, infusions and implants) (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: USJNJFOC20210646832

Write-up: BUMP ON UPPER LIP; ITCHINESS AROUND VACCINATION SITE (LEFT ARM); This spontaneous report received from a patient concerned a 23 year old male. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 206A21A, expiry: 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 bump on upper lip. On 21-JUN-2021, the subject experienced itchiness around vaccination site (left arm). The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from bump on upper lip, and itchiness around vaccination site (left arm). This report was non-serious.


VAERS ID: 1432807 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Alabama  
Vaccinated:0000-00-00
Onset:2021-06-21
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Antinuclear antibody, Blood immunoglobulin A, Diarrhoea, Fatigue, Gastrointestinal pain, Head discomfort, Hyperhidrosis, Migraine with aura, Radioactive iodine therapy
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Pseudomembranous colitis (broad), Malignancy related therapeutic and diagnostic procedures (narrow), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypothyroidism (broad), Hyperthyroidism (broad), Noninfectious diarrhoea (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: MAYZENT SIPONIMOD
Current Illness: Celiac disease; Crohn''s disease; MS; Neoplasm NOS; Vascular disorder NOS
Preexisting Conditions: Medical History/Concurrent Conditions: ANA; Autoimmune disorder; Bowel resection; Graves'' disease; IgA; Radioactive iodine therapy; Comments: Patient has no problems with bowel or bladder control. Patient was not pregnant at time of vaccination.
Allergies:
Diagnostic Lab Data: Test Date: 2011; Test Name: Radioactive iodine therapy; Result Unstructured Data: not reported; Test Name: IgA; Result Unstructured Data: Positive; Test Name: ANA; Result Unstructured Data: Abnormal
CDC Split Type: USJNJFOC20210653880

Write-up: HOT/COLD SWEATS; SEVERE DIARRHEA; AURA MIGRANE; HEAD PRESSURE/HEAVY HEAD; FATIGUE; HIT LOWER COLON; This spontaneous report received from a patient concerned a 45 year old female. The patient''s height, and weight were not reported. The patient''s past medical history included bowel resection, iga, ana, radioactive iodine treatment, graves syndromes, and autoimmune issues, and concurrent conditions included crohns disease, celiac disease, ms, lesions, and stenosis, and other pre-existing medical conditions included patient has no problems with bowel or bladder control. patient was not pregnant at time of vaccination. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown) dose was not reported, administered on 21-JUN-2021 for prophylactic vaccination. Concomitant medications included siponimod fumarate for ms. The batch number was not reported and has been requested On 2011, Laboratory data included: Radioactive iodine therapy (NR: not provided) not reported. On 2021, the subject experienced hit lower colon. On 21-JUN-2021, the subject experienced head pressure/heavy head. On 21-JUN-2021, the subject experienced fatigue. On 21-JUN-2021, the subject experienced aura migraine. On 22-JUN-2021, the subject experienced hot/cold sweats. On 22-JUN-2021, the subject experienced severe diarrhea. Laboratory data (dates unspecified) included: ANA (NR: not provided) Abnormal, and IgA (NR: not provided) Positive. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient was recovering from head pressure/heavy head, hot/cold sweats, fatigue, severe diarrhea, and aura migraine, and the outcome of hit lower colon was not reported. This report was non-seriousc


VAERS ID: 1433203 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-05-21
Onset:2021-06-21
   Days after vaccination:31
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048A21A / 1 LA / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 049C21A / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Nausea
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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: Nausea


VAERS ID: 1433204 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-03-14
Onset:2021-06-21
   Days after vaccination:99
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048I9249 / 2 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Pericarditis
SMQs:, Systemic lupus erythematosus (broad), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: (1)25mg hydrochlorothiazide; (1) 40mg atorvastatin; (1)81mg aspirin; (1)multi vitamin; (2) 500mg calcium;(2) 400iu E; (2) 2000iu D3; (2) 220mg naproxen sodium daily
Current Illness: none
Preexisting Conditions:
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: percarditis


VAERS ID: 1433247 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: Mississippi  
Vaccinated:2021-03-03
Onset:2021-06-21
   Days after vaccination:110
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Pyrexia, Tremor, Urinary tract infection
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (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? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: humira; mobic
Current Illness:
Preexisting Conditions: RA
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: chills and uncontrollable shakes, no fever initially; within a few hours temp was 101.6; cultures and labs showed urinary tract infection; sensitivities showed resistant to rocephin and ceftin; bactrim didn''t prove strong enough; improvement finally began with levaquin; fever persisted 8 days; ibuprofen was required around the clock


VAERS ID: 1433335 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Female  
Location: Montana  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 LA / 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Vaccine was administered at 11 years of age. 2nd dose will be delayed until patient is 12 years old.


VAERS ID: 1433419 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO191 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Erythema, Peripheral swelling, Urticaria
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Zyrtec 10mg 1 daily
Current Illness: Enlarged thyroid, Mitral valve prolapse within normal limits
Preexisting Conditions: Enlarged thyroid, Mitral valve prolapse within normal limits
Allergies: Tylenol, Ibuprofen, Morphine, Sulfa Drugs, Hydrocodone, Codeine, Synthroid, Soy, cashews, pecans, walnuts, cow''s milk/dairy ( whey, casein, protein ), spinach, catfish, celery, bell peppers, all beans,
Diagnostic Lab Data:
CDC Split Type:

Write-up: within 5 minutes of shot, my legs started to swell then broke out into raised hives and bright red all over. The pharmacist gave me Benadryl . Redness subsided after 30 minutes of Benadryl. Hives subsides after several hours later.


VAERS ID: 1433429 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 2 LA / IM

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

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

Write-up: Patient received the dose after the manufacturer recommended freezer storage duration.


VAERS ID: 1433435 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-06-14
Onset:2021-06-21
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 2 AR / IM

Administered by: Private       Purchased by: ?
Symptoms: Electrocardiogram ST segment elevation, Myocarditis, Troponin increased
SMQs:, Myocardial infarction (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (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, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: methylphenidate, sertraline, glargine, lispro
Current Illness: diabetes melilites 1
Preexisting Conditions: diabetes
Allergies: none
Diagnostic Lab Data: elevated troponin, st elevation on ekg
CDC Split Type:

Write-up: myopericarditis


VAERS ID: 1433436 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 2 RA / 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 received the dose after the manufacturer recommended freezer storage duration.


VAERS ID: 1433439 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 LA / IM

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

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

Write-up: Patient received the dose after the manufacturer recommended freezer storage duration.


VAERS ID: 1433442 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Unknown  
Location: Illinois  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 2 RA / 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 received the dose after the manufacturer recommended freezer storage duration.


VAERS ID: 1433445 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 2 LA / IM

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

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

Write-up: Patient received the dose after the manufacturer recommended freezer storage duration.


VAERS ID: 1433448 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-29
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 received the dose after the manufacturer recommended freezer storage duration.


VAERS ID: 1433450 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 2 LA / IM

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

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

Write-up: Patient received the dose after the manufacturer recommended freezer storage duration.


VAERS ID: 1433453 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 LA / IM

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

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

Write-up: Patient received the dose after the manufacturer recommended freezer storage duration.


VAERS ID: 1433456 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 2 LA / IM

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

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

Write-up: Patient received the dose after the manufacturer recommended freezer storage duration.


VAERS ID: 1433461 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-29
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 received the dose after the manufacturer recommended freezer storage duration.


VAERS ID: 1433464 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-18
Onset:2021-06-21
   Days after vaccination:34
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Seizure
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

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

Write-up: R56.9 - Unspecified convulsions


VAERS ID: 1433465 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-29
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 received the dose after the manufacturer recommended freezer storage duration.


VAERS ID: 1433473 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-23
Onset:2021-06-21
   Days after vaccination:59
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER2613 / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0153 / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Abortion threatened
SMQs:, Termination of pregnancy and risk of abortion (narrow)

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

Write-up: O20.0 - Threatened abortion


VAERS ID: 1433477 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-06-17
Onset:2021-06-21
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA UNKNOWN / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Anticoagulant therapy, Aortic dissection, Chest pain, Dizziness, Exposure during pregnancy, SARS-CoV-2 test negative, Troponin increased, 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), Vestibular disorders (broad), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (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, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Prenatal vitamin
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: 6/22/21: troponin levels: 3.180 6/22/21: covid-19: Negative 6/22/21: WBC 15
CDC Split Type:

Write-up: 21 yo pregnant woman, at 28 weeks gestation. EDD: 9/10/21. No complications in pregnancy. Completed series of Moderna covid vaccine. Two days after vaccine she started experiencing new onset chest pain and dizziness. Presented to ED on 6/22/21 and found to have spontaneous coronary aortic dissection (SCAD), with elevated troponin levels (3.180). No evidence of myocarditis. Transferred to hospital, with cardiologist. Currently being treated with blood thinner and beta blocker.


VAERS ID: 1433519 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 2 LA / IM

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

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

Write-up: Patient received the dose after manufacturer recommended freezer storage duration.


VAERS ID: 1433521 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 2 LA / IM

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

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

Write-up: Patient received the dose after manufacturer recommended freezer storage duration.


VAERS ID: 1433528 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 2 AR / IM

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

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

Write-up: Patient received the dose after manufacturer recommended freezer storage duration.


VAERS ID: 1433579 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-20
Onset:2021-06-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Hypersomnia, Malaise, Pain
SMQs:, Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Depression (excl suicide and self injury) (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: Prazosin - 4mg daily at bed time Mirtazapaine - 30mg daily at bed time Olanzapine - 5mg daily at lunch hour Olanzapine - 15mg daily at bed time Bupropian - 150mg 2x daily, one in morning, one at lunch hour
Current Illness: None.
Preexisting Conditions: Mild asthma Vocal chord disfunction
Allergies: Pineapple Ibprofin Cefdiner Ketamine
Diagnostic Lab Data: None as of yet.
CDC Split Type:

Write-up: Initially felt common side effects such as aches generally not feeling well. Then suffered extreme fatigue/tiredness, sleeping 13+ hours over night and multiple hour naps. This has continued a week after the vaccine was administered


VAERS ID: 1433586 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-06-15
Onset:2021-06-21
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0150 / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Blood culture, Chills, Culture stool, Culture urine, Diarrhoea, Exposure during pregnancy, Pain, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Prenatal vitamin for pregnancy
Current Illness: none
Preexisting Conditions: none
Allergies: ancef, Benadryl, shellfish
Diagnostic Lab Data: A variety of blood, urine, and stool cultures were done at Hospital from June 22-24, 2021, but resulted in no clear indication of what caused the illness
CDC Split Type:

Write-up: Event occurred at 37 weeks gestation (estimated delivery is July 12, 2021). Severe vomiting and diarrhea accompanied by fever, chills, and body aches. After 16 hours at home, I went to the hospital at the advise of my midwife. I was admitted and given IV fluids immediately.


VAERS ID: 1433657 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-05-21
Onset:2021-06-21
   Days after vaccination:31
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021C21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Bell's palsy
SMQs:, Hearing impairment (broad)

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

Write-up: Bell''s Palsy - Seen 6/28/2021 - Caregiver or patient concerns: o Cannot close her right eye well and cannot use the right side of her mouth well for 1 week. She is getting watery eyes, no pain in eyes. When she brushes her teeth water comes out the right side of her mouth. She has to take small bites of food b/c otherwise food comes out of her mouth. It is improving. Left eye and left side of mouth is ok. No arm or leg weakness. o Pt vaccinated against covid, 1st dose 4/25/21, 2nd dose 5/21/21.


VAERS ID: 1433669 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-19
Onset:2021-06-21
   Days after vaccination:94
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024M20A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 044A21A / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal pain upper, Asymptomatic COVID-19, Pancreatitis, SARS-CoV-2 test positive
SMQs:, Acute pancreatitis (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Lamictal, losartan, metoprolol tartrate, multivitamin, prilosec, viagra, B1
Current Illness: None.
Preexisting Conditions: peptic ulcer disease, bipolar disorder, hypertension, tinnitus, migraine, hepatic steatosis, GERD, obesity
Allergies: Penicillins
Diagnostic Lab Data: COVID detected PCR on 06/21/21.
CDC Split Type:

Write-up: Fully vaccinated patient admitted to hospital with diagnosis of COVID per PCR. Patient admitted to the hospital on 06/21/21 for left sided upped abdominal pain. Diagnosed with pancreatitis. During admission testing patient has a detected PCR test for COVID. Patient remained asymptomatic for COVID throughout his stay. Discharged on 06/23/2021.


VAERS ID: 1433764 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: California  
Vaccinated:2021-04-09
Onset:2021-06-21
   Days after vaccination:73
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6207 / 2 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0162 / 2 AR / IM

Administered by: Other       Purchased by: ?
Symptoms: Ageusia, Anosmia, Fatigue, Pain, Pyrexia, SARS-CoV-2 test, Sinus congestion, Sinus headache, Sinus pain
SMQs:, Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Biktarvy, creatine, BCAAs, betaine, Omega-3 fatty acids, beta-alanine, whey protein, casein protein, egg protein.
Current Illness: none
Preexisting Conditions: HIV +
Allergies: none
Diagnostic Lab Data: antigen test and PCR test both on 06/24/2021
CDC Split Type:

Write-up: fever (101-101.6), body aches, fatigue, loss of taste and smell, extreme sinus congestion w extreme sinus headaches, sinus area sensitivity


VAERS ID: 1433847 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-06-18
Onset:2021-06-21
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: I was diagnosed with shingles 10 days after


VAERS ID: 1434504 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Hawaii  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034C21A / 1 LA / IM

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

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

Write-up: Had completed two doses of Pfizer vaccine but did not disclose to vaccination staff therefore was given a dose of Moderna vaccine. Reported that he did not feel well the next day after receiving the Moderna dose, was in bed for the entire day, which resolved the next day.


VAERS ID: 1434508 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 054C21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anuria, Aphasia, Chills, Dehydration, Diarrhoea, Energy increased, Feeling abnormal, Hyperhidrosis, Nausea, Pain, Paraesthesia oral, Product dose omission issue, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Dementia (broad), Pseudomembranous colitis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Noninfectious diarrhoea (narrow), Tumour lysis syndrome (broad), Medication errors (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (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, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Valacyclovir Vimpat Topiramate Pantoprazole Levetiracetam Levothyroxine Trazodone Gabapentin Trintellix Seroquel
Current Illness: None
Preexisting Conditions: Bipolar disorder Seizures
Allergies: Sulfa antibiotics Sulfasalazine Abacavir Methocarbamol
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient called 6-27-21 requesting to speak with the pharmacist regarding a medication. upon questioning, the patient reported she was still experiencing side effects from her Moderna Covid-19 vaccine and that she had a significant reaction starting the day after her vaccine was administered. According to the patient, she had tingling lips and felt unusually energetic after the vaccine similar to a manic episode of bipolar disorder. She also reporting starting to have uncontrollable chills. The next day she felt "like a wet towel" where she felt so bad she couldn''t talk. She also reported aches and pains, chills, sweating, nausea and vomiting, and clear, watery diarrhea. She also mentioned she stopped urinating probably due to dehydration. Patient reported stopping her medications due to not being able to keep them down. On 6-25-21 the patient went to the hospital to be treated. She said she was given IV treatment including fluids and Zofran. They also gave her Keppra because she has a history of seizures and had stopped her medications. Patient began to feel better and was able to eat and start her medications again so she was discharged and sent home with Zofran tablets. She also reported taking Imodium tablets for the diarrhea. She states she has been feeling well recently, but is still having chills (shivering). She asked whether she could take more Zofran than prescribed and whether she should start her other medications again because she was worried about upsetting her stomach. I told her I cannot recommend she take her medication other than prescribed and I encouraged her to restart her medication due to her history of seizures. I also told her to call her doctor again on Monday to see if they have any other recommendations or concerns.


VAERS ID: 1437481 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-27
Onset:2021-06-21
   Days after vaccination:114
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9269 / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9810 / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Acute kidney injury, Pulmonary embolism
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Embolic and thrombotic events, venous (narrow), Tumour lysis syndrome (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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: I26.99 - Other pulmonary embolism without acute cor pulmonale N17.9 - Acute kidney failure, unspecified


VAERS ID: 1437574 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-06-20
Onset:2021-06-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Axillary pain, Breast pain, Pain
SMQs:, Lipodystrophy (broad)

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

Write-up: The afternoon after I got the second dose of the vaccine I started to have pain under my arm and along the left side of of my breast. It got more intense overnight and the next day. It started to localize in my underarm area. It was painful to put my arm down. It lasted for a week as intense pain and then it started to resolve. By ten days after the shot it was not painful. I was using ice three times daily and taking pain relievers. Currently the problem has resolved.


VAERS ID: 1437605 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-06-17
Onset:2021-06-21
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / -

Administered by: Private       Purchased by: ?
Symptoms: Blister
SMQs:, Severe cutaneous adverse reactions (broad), Hypersensitivity (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Pain
Other Medications: At night: 1 x Benicar 5mg prescription & 1tbsp Elderberry syrup health food store Day: 1 x Cymbalta 30mg, 1 x Zyrtec 10mg both prescriptions Supplements from Trivani 1 x Vitamin C 135mg 1 x Vitamin D 2000IU 1 x Magnesium 400mg 1 x Immu
Current Illness: None
Preexisting Conditions: Sick building Syndrome exposed to black mold 2002-2005
Allergies: Codeine
Diagnostic Lab Data: None
CDC Split Type: HT475

Write-up: Started getting blisters on hands and leg


VAERS ID: 1437657 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-20
Onset:2021-06-21
   Days after vaccination:121
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / UNK - / -

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

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

Write-up: I63.9 - CVA (cerebral vascular accident) I63.9 - Acute CVA (cerebrovascular accident)


VAERS ID: 1437696 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: New York  
Vaccinated:2021-06-12
Onset:2021-06-21
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Abortion spontaneous, Exposure during pregnancy
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? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: na
Current Illness: na
Preexisting Conditions: na
Allergies: na
Diagnostic Lab Data: Hospitalize 6/23
CDC Split Type:

Write-up: Miscarriage of pregnancy 9-weeks


VAERS ID: 1437741 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-03-19
Onset:2021-06-21
   Days after vaccination:94
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Hospitalization 6/21/21


VAERS ID: 1437765 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: Montana  
Vaccinated:2021-01-18
Onset:2021-06-21
   Days after vaccination:154
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3246 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Tested positive for COVID by nasal swab on 6/21/2021
CDC Split Type:

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


VAERS ID: 1437768 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050C21A / UNK LA / IM

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

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

Write-up: Vaccine given after the expiration date.


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