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From the 11/12/2021 release of VAERS data:

Found 875,292 cases where Vaccine is COVID19 and Patient Did Not Die

Government Disclaimer on use of this data



Case Details (Reverse Sorted by Onset Date)

This is page 84 out of 8,753

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VAERS ID: 1831976 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-10-27
Onset:2021-10-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 071F21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cellulitis, Infection
SMQs:

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

Write-up: Error: Infection / Cellulitis (diagnosed by MD)-


VAERS ID: 1831978 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-10-27
Onset:2021-10-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 071F21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cellulitis, Infection
SMQs:

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

Write-up: Error: Infection / Cellulitis (diagnosed by MD)-


VAERS ID: 1831979 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-10-27
Onset:2021-10-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 071F21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cellulitis, Infection
SMQs:

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

Write-up: Error: Infection / Cellulitis (diagnosed by MD)-


VAERS ID: 1831980 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-10-27
Onset:2021-10-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 071F21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cellulitis, Infection
SMQs:

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

Write-up: Error: Infection / Cellulitis (diagnosed by MD)-


VAERS ID: 1831981 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-10-27
Onset:2021-10-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 071F21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cellulitis, Extra dose administered, Infection
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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Error: Infection / Cellulitis (diagnosed by MD)


VAERS ID: 1831982 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-10-27
Onset:2021-10-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 071F21A / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cellulitis, Infection
SMQs:

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

Write-up: Error: Infection / Cellulitis (diagnosed by MD)-


VAERS ID: 1831983 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-10-27
Onset:2021-10-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 071F21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cellulitis, Infection
SMQs:

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

Write-up: Error: Infection / Cellulitis (diagnosed by MD)-


VAERS ID: 1832095 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-26
Onset:2021-10-27
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypotension, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

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

Write-up: Fainted (low blood pressure).


VAERS ID: 1832255 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-26
Onset:2021-10-27
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 062E21A / 3 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Extra dose administered, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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 stated she broke out in a rash on her upper body the day after the vaccine. The rash lasted for 2 days. She did not have this reaction with the first 2 vaccines.


VAERS ID: 1832267 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-10-26
Onset:2021-10-27
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Dizziness, Headache, Nausea, Pain, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre 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? 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: Sulpha
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Morning after injection, I woke up feeling lower energy, a bit lightheaded, borderline nauseous and 100.4 fever. Headache off and on. Body aching throughout the day with fever spiking to 101.7 by 6 pm. Symptoms passed by morning of 2nd day.


VAERS ID: 1832332 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-10-26
Onset:2021-10-27
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2593 / 3 LA / IM
FLU4: INFLUENZA (SEASONAL) (FLUARIX QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS HZ2JR / UNK RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Mobility decreased, Neck pain, Pain, Pain in extremity
SMQs:, Parkinson-like events (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Patient started pain on right arm within 24 hours from receiving the shot. She did not notice any swelling, redness or warmth around the injection site on her right arm. Patient was not able to raise her right arm, pain on the right upper arm was radiating to the neck and down the arm and into the torso. Patient tried taking Tylenol Extra strength with not much relieve. Patient came in on 10/31/21 to report to us. Patient will continue with Tylenol or Motrin and schedule an appointment with her PCP ASAP. We will follow-up with patient in the next few days.


VAERS ID: 1832334 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-10-25
Onset:2021-10-27
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939903 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Axillary pain, Erythema, Hyperaesthesia, Induration, Pruritus, Skin warm
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (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: Fish oil, Acyclovir, Cetirizine, Pravastatin, Pantoprazole, HCTZ, Metoprolol, Losartan, Ezetimibe, PreserVision AREDS, CoQ10, Baby ASA, Tylenol, Lexapro
Current Illness: None
Preexisting Conditions: HTN, macular degeneration
Allergies: NKDA
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Sore-to-touch; hot, itching; pain under left arm. Red and hard-to-touch. Ice applied multiple times during the day. Tylenol taken PRN.


VAERS ID: 1832359 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-03-08
Onset:2021-10-27
   Days after vaccination:233
Submitted: 0000-00-00
Entered: 2021-10-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1802068 / 1 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Chest X-ray normal, Chronic obstructive pulmonary disease, Condition aggravated, Dyspnoea exertional, Forced expiratory volume, Hypomagnesaemia, Normocytic anaemia, Procalcitonin, Pulmonary function test, Respiratory viral panel, SARS-CoV-2 test positive, Urine analysis, Vaccine breakthrough infection
SMQs:, Haematopoietic erythropenia (broad), Pulmonary hypertension (broad), Chronic kidney disease (broad), Infective pneumonia (broad), Hypokalaemia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: albuterol (PROVENTIL) 2.5 mg, Nebulization, EVERY 4 HOURS PRN ? albuterol (Ventolin HFA) 108 (90 Base) MCG/ACT Inhalation Aerosol Solution 2 puffs, Inhalation, EVERY 6 HOURS PRN ? albuterol 108 (90 Base) MCG/ACT Inhalation Aerosol Solution
Current Illness:
Preexisting Conditions: HTN, HLD, PAD, COPD
Allergies: NKA/NKDA
Diagnostic Lab Data: SARS-COV-2, NAA, Detected :
CDC Split Type:

Write-up: Patient required hospitalization due to breakthrough infection, Patient received J&J vaccine on 03/08/2021. Patient required hospitalization from 10/27/2021 - 10/28/2021. Below is copied from discharge summary: Patient is a 73 y.o. female patient who is being discharged today. Hospital Course: Patient is a 73 y.o. female with a history of hypertension, hyperlipidemia, peripheral artery disease, carotid stenosis and COPD not on home oxygen who presented to the emergency department with complaints worsening dyspnea on exertion x2 weeks. Chest x-ray neg. Afebrile. Patient given steroids, Duoneb treatments and doxycycline in ER Acute COPD exacerbation do to COVID 19 . - FEV1 42% pred, GOLD 3, PFT 8/19/21 - Curretly on Oxygen 2lts - Home Oxxygenqualification test done and qualified - Dexamethsone 6mg Po day x 10days - Albuterol inhaler prn - Procal 0.18, no need ffor AB - Negative respiratory panel, urine antigens - Contineu primary care prescribed meds Hypomagnesemia - repleted Normocytic anemia - stable, monitor, outpatient PCP follow up Hypertension - cont amlodipine, carvedilol, losartan and HCTZ Hyperlipidemia - cont statin Peripheral artery disease - cont aspirin Gastroesophageal reflux disease - home medication non formulary, cont with Protonix Dispo: Dc home today with above recs. Patient is discharged in stable condition with stable vital signs. All questions rearding hospital course and plan of care after discharge have been answered to satisfaction. Prescriptions for medications needed to be taken after discharge have been given to patient. Patient has been instructed to follow up with PCP within the next 7 days after discharge. Patient verbalizes understanding all given instructions and has no further doubts regarding discharge.


VAERS ID: 1832401 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-10-23
Onset:2021-10-27
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-10-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 0171 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anticoagulant therapy, Cognitive disorder, Computerised tomogram normal, Eye swelling, Facial paralysis, Headache, Magnetic resonance imaging normal, Scan with contrast normal, Speech disorder, Vision blurred
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Anticholinergic syndrome (broad), Dementia (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Hearing impairment (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Zyrtec
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: I reported the episode to my doctor the next day and was advised to go to the ER. I was admitted October 28, 2021 and discharged October 30, 2021. Two CT scans (one with contrast) were performed and one MRI. All three days were normal. At discharge I was given prescriptions for one baby aspirin per day and 20mg of Lipitor per day. I will call my primary physician tomorrow for a referral for a neurologist.
CDC Split Type:

Write-up: Severe pain, left side of my head, close to my temple. In addition, I experienced extreme blurred vision. I had been reading some information regarding psychotherapy at the time of the onset of my symptoms. I looked down at the words and could not comprehend their meaning and struggled with heir pronunciation. the episode was brief. Later, I noticed when I looked in the mirror that the left side of my face was drooping slightly and I am still slightly swollen under my left eye and my left cheekbone. I also continue to have a dull headache.


VAERS ID: 1832411 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: North Dakota  
Vaccinated:2021-10-26
Onset:2021-10-27
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Glossodynia, Herpes zoster, Nasal discomfort, Stomatitis
SMQs:, Severe cutaneous adverse reactions (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Opportunistic infections (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: Soybean oil. Thyme. Coco processed with alkali
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Came down with shingles. Sores in my mouth and tongue and in my right nostril


VAERS ID: 1832897 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-10-27
Onset:2021-10-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 0FF2589 / 3 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Chills, Lymphadenopathy, Pain
SMQs:, 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: trisprintek - birth control
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: dilantin
Diagnostic Lab Data: none
CDC Split Type:

Write-up: body aches, chills, swollen right under armpit lymph node (3+ days)


VAERS ID: 1832900 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-10-25
Onset:2021-10-27
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain upper, Menstruation irregular
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Fertility disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Birth control, singular, zinc, vitB12, magnesium, vitD
Current Illness: None
Preexisting Conditions: None
Allergies: Sulfa/bactrim
Diagnostic Lab Data:
CDC Split Type:

Write-up: Stomach pain in the middle of the night (12 hours post vaccine) and started my my period randomly 36 hours after shot.


VAERS ID: 1832912 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-27
Onset:2021-10-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 061E21A? / 3 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Electric shock sensation, Extra dose administered, Headache, Tremor
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Medication errors (narrow), Hypoglycaemia (broad)

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

Write-up: Patient presented to doctor''s office complaining of headache in the form of electric shock in the left parietal area that lasts for few seconds, pain is severe, symptoms started in the middle of the night Wednesday after having a Covid vaccine booster Wednesday afternoon, happens every few minutes, causes her head and sometimes whole body to shake, tried Tylenol and Motrin with some improvement. Exam unremarkable now, continue Motrin 800 mg 3 times daily with food and follow-up if no improvement.


VAERS ID: 1832949 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-10-27
Onset:2021-10-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 UN / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? 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: fever, body aches, chills and feelings of malaise


VAERS ID: 1832972 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-10-27
Onset:2021-10-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / IM

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

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

Write-up: body aches, lymphadenopathy with tenderness to palpation left axilla


VAERS ID: 1833001 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-10-26
Onset:2021-10-27
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939905 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Burning sensation, Erythema, Paraesthesia, Ultrasound scan normal, X-ray abnormal
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: 2018 Prevanar23, Influenza, Zoster*same time (Cellulitis) treating with IV fluids
Other Medications: Fish Oil, Garlic Oil, Thyroxin, Amlodipine, Atorvastatin, Pentoprosol, Metoprolol, Probiotic, Co-Q10, Turmeric, Preservision, D2 Vitamin
Current Illness: N/A
Preexisting Conditions: COPD, Thyroid Removed, Former Smoker
Allergies: Acipifex, Nexium, Levaquin
Diagnostic Lab Data: Ultrasound 10/29/2021 X-Ray 10/29/2021
CDC Split Type:

Write-up: Pt. states that after receiving the 3rd Booster of Moderna 10/26/2021, started experiencing symptoms 10/27/2021 of tingling sensation above the right thigh, outer right hip area *red dots with sensation of burning and right backside. 10/29/2021 Hospital communications with Nurse with recommendations for Emergency Room visit. 10/29/2021 Emergency Room visit *Ultrasound and X-Ray examined for Blood Clots (Normal). Treating Physician diagnosed with *Immune-Response to Vaccine. Still continuing to experience symptoms.


VAERS ID: 1833003 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-10-27
Onset:2021-10-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 019F21A / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Chills, Condition aggravated, Headache, Myalgia, Pyrexia, Rash
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: sore arm for a few days with flu shots; rash, sore arm with swelling with the first 2 Moderna Covid shots; additionally vertigo/
Other Medications: Myrbetriq; Synthroid; Flonase; aselastin; Flovent; Vagifem; metronidizol topical gel; multivitamin; vitamin D; calcium
Current Illness: none
Preexisting Conditions: asthma; hypothyroid; arthritis; osteopenia
Allergies: none known
Diagnostic Lab Data: none
CDC Split Type:

Write-up: fever; chills; achy joints; sore muscles; slight headache in PM 10/27/2021 through about noon on 10/28/2021 rash on 10/28/2021-10/20/2021


VAERS ID: 1833041 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-10-27
Onset:2021-10-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822811 / 1 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Chills, Feeling cold, Hyperhidrosis, Muscle spasms, Myalgia, Seizure
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Dystonia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Eosinophilic pneumonia (broad), Generalised convulsive seizures following immunisation (narrow), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

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

Write-up: Convulsions 10/27/21 @11:30pm Muscle pain and cramping Cold chills Sweats


VAERS ID: 1833099 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Nebraska  
Vaccinated:2021-10-27
Onset:2021-10-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Dizziness, Injection site pain, Injection site warmth, Limb discomfort, Nausea, Pain in extremity, Retching
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad)

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: Topiromate, Lyrica, Ursadile
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: Sulfa, Codeine, Vantine, Morphine
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Pt. states that after receiving the 3rd Booster of Phizer 10/27/2021, started experiencing symptoms of pain at injection site, warm to the touch, pressure in the left arm, nausea, dizziness, and dry vomiting. Lasting 36 hours, no noted Primary visit/communications. Still experiencing nausea and pain in the left arm.


VAERS ID: 1833111 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-10-27
Onset:2021-10-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822809 / 1 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Computerised tomogram, Dizziness, Epistaxis, Fatigue, Feeling of body temperature change, Headache, Impaired work ability, Nausea
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: fluticasone nasal pantoprazole
Current Illness:
Preexisting Conditions: Elevated BP without diagnosis of hypertension Obesity Tobacco User
Allergies: provera shellfish
Diagnostic Lab Data:
CDC Split Type:

Write-up: She went to HCF and received a J&J COVID vaccine around 1000. She then became nauseous and left work at 1300 and went home to rest. On Thursday at 0100, states she woke up and could not lift head up due to her head hurting so bad. She did get up and went to bathroom and nose started bleeding continuously until 0400. Slept through the rest of night and rested all day Friday (headache and tired). Friday night into Saturday, was hot/cold states she took Tylenol for headache. Sunday stated she felt much better and was fine. Reported to work this am at 0800 and started feeling dizzy/lightheaded/nauseous. Co-worker took BP which was elevated (172/120). Manager sent her to ED where she was subsequently sent to a stroke recovery unit and has had 2 CT scans and additional testing. She does have slight left leg weakness and was ordered TPA tre atment which she refused. She remains in observation at this time for more testing and dependent upon results may be kept overnight.


VAERS ID: 1833118 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-10-27
Onset:2021-10-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Dizziness, Extra dose administered, Fatigue, Headache, Injection site pain, Lymphadenopathy, Myalgia, Nasal congestion, Nausea
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Shingrix vaccine Age 63 Dose given 10/29/2018. Symptoms were hives, reddened area, slight fever, chills, nausea, achiness.
Other Medications: Prilosec, MVI, Vit D3, Vit C,
Current Illness: None
Preexisting Conditions: Arthritis
Allergies: Medic- Aluminum Oxide, Oxycodone, Hydrocodone-Actaminophen, Nucynta
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Pain in Right Arm at injection site and muscle achiness lasted 3 1/2 days, severe headache lasting 2 days, fatigue, chills, nausea , nasal stuffiness and dizziness lasting one day. Discomfort in lymph nodes under right arm and slightly in right breast lasting 4 days.


VAERS ID: 1833127 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-10-26
Onset:2021-10-27
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939903 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Body temperature increased, Chills, Headache, Pain, Pruritus, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Valsartan 160mg, Rosuvastatin calcium 40mg, Anastrozole 1mg, Pantoprazole sod 40mg, baby aspirin 81mg, vit d3, Otezla 30mg, Wellbutrin
Current Illness: no
Preexisting Conditions: Blood pressure, cholesterol
Allergies: no
Diagnostic Lab Data: no
CDC Split Type:

Write-up: Woke up the next morning with a slight headache. Had the chills and couldn''t get warm. She had a temp of 102. 4. She took some tylenol and her temp subsided. She stated she was achy like she had the flu. She notice that the bottom of her feet started to itch as well as her hands and wrist. She realized she had hives and she took Benadryl which stopped the itchiness for a few hours.


VAERS ID: 1833144 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Louisiana  
Vaccinated:2021-10-27
Onset:2021-10-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822811 / 1 LA / IM

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

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

Write-up: Received Vaccine in left arm on 10/27/2021. On 10/28/2021 developed rash to right axillae. No other symptoms.Given Prescription for topical medication


VAERS ID: 1833157 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-01-29
Onset:2021-10-27
   Days after vaccination:271
Submitted: 0000-00-00
Entered: 2021-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011M20A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025A21A / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Exposure to SARS-CoV-2, Upper respiratory tract infection
SMQs:, 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: ?Metoprolol Succinate ER 50 MG Tablet Extended Release 24 Hour 1 tablet Orally Once a day ?Eliquis 5 MG Tablet take 1 tablet twice a day ?Dutasteride 0.5 MG Capsule 1 capsule Orally Once a day ?Centrum Silver Ultra Mens Tablet as
Current Illness: none
Preexisting Conditions: Hyperlipidemia. Paroxysmal atrial fibrillation. Chest pain, a) nuclear stress test 2011 and 2013 normal. Mixed sleep apnea. DVT right leg 2010. Benign essential tremor. BPH with elevated PSA, prostate biopsies benign 2006, 2013. Multiple skin cancer excisions (including melanoma and basal cell carcinoma). History of adenomatous colonic polyps.
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: URI symptoms off/on 1-2 weeks, daughter tested positive on 10/27/21


VAERS ID: 1833160 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-10-26
Onset:2021-10-27
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0175 / 3 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Lupus, rheumatoid arthritis
Allergies: Sulfa drugs, NSAIDS, apples, strawberries, kiwi, mango, papaya, guava, coconut
Diagnostic Lab Data:
CDC Split Type:

Write-up: Red large rash on upper arm. Warm to the touch (slightly itchy). Has gotten larger and redder since first appearing day after vaccine (six days now)


VAERS ID: 1833184 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-10-20
Onset:2021-10-27
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012F21A / 1 LA / SYR

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

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

Write-up: I got a large hot red rash at the site of injection, it spread to the rest of my body. It was exactly 7 days after getting the shot. I went to the doctor and was given NAC, Allergy medication, Prednisone, famotidine, and Triamcinolone to treat.


VAERS ID: 1833255 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-27
Onset:2021-10-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301558A / 2 LA / SYR

Administered by: School       Purchased by: ?
Symptoms: Dizziness postural, Ear pain, Fatigue, Feeling abnormal, Headache, Interchange of vaccine products, Malaise, Nausea
SMQs:, Acute pancreatitis (broad), Dementia (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Medication errors (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: no
Preexisting Conditions: osteoarthritis; over weight; pre-diabetes
Allergies: none known
Diagnostic Lab Data: I have not yet seen a doctor
CDC Split Type:

Write-up: I was first vaccinated with J & J; Pfizer is my 2nd shot. I first became tired directly after, had a slight headache, and then later around 7:00PM I had a pain in my left ear. In the evening I noticed feeling dizzy when a went to bed and it still continues when I move my head to one side or the other, sit up, and sometimes when I lay down. Today, November 1, 2021, I felt a bit ill, and my head feels tired, and slight nausea. This is day 5 after the vaccine.


VAERS ID: 1833342 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Idaho  
Vaccinated:2021-10-26
Onset:2021-10-27
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 3 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Angiogram, Blood lactic acid increased, Computerised tomogram head, Laboratory test, Mental disorder, Metabolic encephalopathy, Systemic inflammatory response syndrome
SMQs:, Lactic acidosis (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Dementia (broad), Noninfectious encephalopathy/delirium (narrow), Tumour lysis syndrome (broad), Hypoglycaemia (broad), Sepsis (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: COPD, HTN, DM II, acquired thrombocytopenia, osteoporosis, psoriatic arthritis, CAD,
Allergies: Eye dilation drops
Diagnostic Lab Data: All tests 10/27/2021. Please contact for test results.
CDC Split Type:

Write-up: Acute metabolic encephalopathy. Presented to our clinic day after vaccination only oriented to self and shortly before not even oriented to self. Reportedly at baseline very sharp w/o evidence of cognitive decline. Febrile at 102.4, pulse 102, meeting SIRS criteria. No other obvious source, therefore likely systemic inflammatory reaction from vaccine. No-focal deficits that would indicate stroke, but recommended going to ER for further evaluation. At ER, septic workup performed as well as laboratory studies. Lactate elevated but otherwise labs pretty unremarkable. CT head and CT angio head/neck performed w/o acute findings. Patient''s mental status reportedly began to spontaneously improve in ER, and discharged.


VAERS ID: 1833354 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-10-27
Onset:2021-10-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026D21A / UNK - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Migraine, Pain
SMQs:

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

Write-up: PATIENT STATED SHE HAD EXTREME FATIGUE, MIGRAINE, BODY ACHES AND EXTREME TIRENESS THAT LASTED FOR THREE DAYS.


VAERS ID: 1833360 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-10-27
Onset:2021-10-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Decreased appetite, Extra dose administered, Fatigue, Malaise, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: metoprolol 50mg, clopidogrel 75mg,lisinopril 40mg, amlodipine 2.5mg, atorvastatin 40mg, aspirin 81mg, vitamin D 5000IU, vitamin B12 1000mcg, Tums, methysulfonylmethane 1500mg, glucosamine hydrochloride 1500mg.
Current Illness: None
Preexisting Conditions: I need knee replacements.
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Pfizer-BioNTech COVID-19 Vaccine EUA. (booster shot). Side effects: Tiredness, chills, fever, feeling unwell, decreased appetite. Fever began about 9PM (12 hours after injection) and continued to increase for about 4 hours at which time it "broke". When the fever broke the chills stopped. Tiredness and decreased appetite continued for 37 hours during which time I slept almost continuously. Thereafter, during a period of 3 days my appetite returned and I began to feel better. I seem to be fine now


VAERS ID: 1833386 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-06-30
Onset:2021-10-27
   Days after vaccination:119
Submitted: 0000-00-00
Entered: 2021-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 2 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Vaccine breakthrough infection
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Amlodipine 10mg; Furosemide 20mg; Ferrous Sulfate 325mg; Lisinopril 40mg; Simvastatin 40mg; Spiriva inhaler; Tramadol 50mg
Current Illness:
Preexisting Conditions: Diabetes mellitus; hypertension; coronary artery disease; hyperlipidemia; morbid obesity; asthma
Allergies: Combivent; Sulfa and Theo-Dur
Diagnostic Lab Data:
CDC Split Type:

Write-up: Breakthrough hospitalized patient that was fully vaccinated


VAERS ID: 1833405 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-10-20
Onset:2021-10-27
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 3 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: HUMIRA, LISINOPRIL, SULFASALAZINE
Current Illness: NONE
Preexisting Conditions: PSORIATIC ARTHRITIS
Allergies: NONE
Diagnostic Lab Data: NA AT THIS TIME
CDC Split Type:

Write-up: CHEST PAIN, DISCOMFORT WITH EXERTION


VAERS ID: 1833408 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-10-27
Onset:2021-10-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1855194 / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Dizziness, Erythema, Mouth swelling, Nausea, Swollen tongue, Vision blurred
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (narrow), Anticholinergic syndrome (broad), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: mens multivitamin (Code Age is the brand name)
Current Illness: None
Preexisting Conditions: None
Allergies: neosporan
Diagnostic Lab Data: None
CDC Split Type:

Write-up: swollen tongue and roof of mouth, face felt swollen (not sure it was it just felt like alot of pressure on the face) that lasted approx 4 hrs light headed, nauseated (lasted 24 hrs) and blurred vision that lasted 4 hrs. I had a 4in red line on my forearm/wrist with pain (not constant pain just every once in awhile i''d get a shooting pain in wrist ) that went away after approx 3 hours


VAERS ID: 1833434 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-10-27
Onset:2021-10-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8020 / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood pressure increased, Blood test, Dysgeusia, Electrocardiogram, Feeling abnormal, Full blood count abnormal, Heart rate increased, Hot flush, White blood cell count increased
SMQs:, Haematopoietic leukopenia (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Hypertension (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Metformin, Flovent, multi vitamin, turmeric, inositol, maca powder, cordyceps, fish oil, CBD
Current Illness: N/a
Preexisting Conditions: Asthma, PCOS
Allergies: N/a
Diagnostic Lab Data: EKG Blood test to check for heart attack CBC which showed elevated white blood cell count
CDC Split Type:

Write-up: I felt totally fine for about an hour after the vaccine and also after my 2 doses of the vaccine back inMarch and April. I had a sudden hot rush that came up the back of my neck and into my head. Felt like blood rushing in and I felt very weird and heard popping. I felt heavy and had an aluminum taste in my mouth. My wife put her Apple Watch in me and my heart rate was 150 sitting down and I had been sitting down prior to the reaction. I felt strange enough to have her call 911 because I was worried I was having a brain aneurism or stroke. She took me to the hospital because the 911 operater said it may take a while for an ambulance to come because they were short staffed. My heart rate and blood pressure were elevated while in the ER.


VAERS ID: 1833474 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: D.C.  
Vaccinated:2021-10-27
Onset:2021-10-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Condition aggravated, Extra dose administered, Fatigue, Headache, Interchange of vaccine products, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Jansen COVID vaccine
Other Medications: Lisinopril 5 mg
Current Illness: None
Preexisting Conditions: None (slight high blood pressure)
Allergies: No
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: This was a Moderna booster 6 months after my Jansen vaccine. I had a similar, not quite as bad reaction, to the Jansen. Reaction to the Moderna booster: Significant headaches, chills, muscle aches for four hours followed by an additional 18 hours of deep fatigue. All AEs fully resolved


VAERS ID: 1833505 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-21
Onset:2021-10-27
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Pityriasis rosea
SMQs:

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

Write-up: Development of pityriasis rosea rash 1 week after Pfizer booster.


VAERS ID: 1833521 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-10-25
Onset:2021-10-27
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 035C21A / 3 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Erythema, Pruritus, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Syntheroid-Tradjenta-Lisinopril-Indapemide-Toprll XL-Fenofibiate-Pravastain-norvast-Potassium Chloride-Magnesium-Multi-Vitamins
Current Illness: None
Preexisting Conditions: Diabetis-
Allergies: Aspirin
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Swelling-Itching-Redness Starting on 10/27/2021


VAERS ID: 1833547 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-04-10
Onset:2021-10-27
   Days after vaccination:200
Submitted: 0000-00-00
Entered: 2021-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Nasopharyngitis
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lysine 1000mg tablet (1 tablet orally once a day); multivitamins (1 tablet once a day); Turmeric curcumin 500mg capsule (1 tablet oral once a day); Vitamin D 1000IU tablet (2 tablets orally once a day); Albuterol Sulfate HFA 108 (90 base) M
Current Illness:
Preexisting Conditions: Hypothyroid; anxiety/depression; rosacea; allergic rhinitis; mixed urinary incontinence; psoriatic arthritis (2011); history of basal cell carcinoma (chest - 6/99); history of viral meningitis (1992); RAD; basal cell carcinoma; mixed urge and stress incontinence; history of HSV-1
Allergies: Codeine, sulfa
Diagnostic Lab Data:
CDC Split Type:

Write-up: Cold-like symptoms starting on 10/27/2021.


VAERS ID: 1833575 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-10-26
Onset:2021-10-27
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Headache
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: metoprolol, hctz, isosorbide mononitrate, valsartan
Current Illness: none
Preexisting Conditions: HTN, CAD, cor pulmonale, OSA on cpap, angina
Allergies: morphine
Diagnostic Lab Data:
CDC Split Type:

Write-up: headache and fatigue for 6 days so far after vaccination


VAERS ID: 1833609 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-10-25
Onset:2021-10-27
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939904 / 3 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Body temperature increased, Extra dose administered, Malaise, Odynophagia, Oropharyngeal pain, Pain, Poor quality sleep, SARS-CoV-2 test negative, Tonsillar ulcer, Upper respiratory tract infection
SMQs:, Agranulocytosis (broad), Neuroleptic malignant syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Depression (excl suicide and self injury) (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (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: 2020 Flu Shot - had aches and pains, and fever, then I was fine after one day
Other Medications: ? Amlodipine 10mg once daily ? Metoprolol Succinate XL 25mg once daily ? Omeprazole 20mg once daily ? Sertraline 100mg once daily ? Hydrocodone 10mg once daily ? MS Contin 15mg once daily ? Vitamin D 1000 iu once daily ? Probiotic ? Gummy
Current Illness: Beginning of September - diarrhea (unknown origin)
Preexisting Conditions: Hypertension, osteoarthritis, anxiety disorder
Allergies: Tetracycline, seasonal allergies
Diagnostic Lab Data: COVID-19 test was negative
CDC Split Type: vsafe

Write-up: My booster was on Monday 10/25 and I felt great that day and Tuesday, but Wednesday night at 9-10PM, I realized had a really sore throat, but I went to bed and didn?t sleep really well. I had aches and pains. When I got up, I took my temperature, and it was 100.00. I was achy, etc. My throat was really sore. I took a flashlight and looked at my throat. And I had 5-6 white spots or sores on my tonsils on the left side. It was very tender underneath my jaw. So I spent that day (Thursday) not feeling good. I took ibuprofen during the day and rested and drank fluids. I thought if I didn?t feel good the next day, I would go see the doctor. I still felt crummy but I wasn?t running a fever the next day but my throat still hurt. Hurt to talk and swallow. I went to see my doctor, he did a COVID test which was negative, and he prescribed Dexamethasone and I was required to swish it around and swallow it and do that for 3-5 days. I?ve taken it for 3 days and I didn?t take any today. I do still feel raspy, and I still have the spots on my tonsil, but it isn?t painful anymore. And my doctor put down on the diagnosis that it was an upper respiratory tract infection of unspecified type. Feeling back to normal now.


VAERS ID: 1833624 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-10-25
Onset:2021-10-27
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026D21A / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypoaesthesia, Lymphadenopathy, Thrombosis
SMQs:, Peripheral neuropathy (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Guillain-Barre syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sexual dysfunction (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: Psoriasis
Allergies: None that I''m aware of
Diagnostic Lab Data:
CDC Split Type:

Write-up: Underneath my left armpit, my lymph node swelled and enlarged to the size of a baseball, which has never happened before in my life even after receiving other vaccines such as the flu vaccine. Also, 2 days post-vaccine, I experienced thrombosis of my right leg, specifically the upper thigh area. Now I must get up and walk around often as that area of my leg goes numb and tingles for a while, which if left long enough without walking around turns into sharp pains in that area. I am still experiencing that as well along with the enlarged lymph node under my armpit. I have had neither symptoms before in my life or symptoms similar to that.


VAERS ID: 1833679 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-10-27
Onset:2021-10-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 18225809 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test abnormal, Coagulopathy, Seizure
SMQs:, Haemorrhage laboratory terms (broad), 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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Baby Aspirin
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: Gluten Intolerant
Diagnostic Lab Data: Blood Work 11/01/2021
CDC Split Type:

Write-up: Pt. states that after receiving the 1st dose of J&J 10/27/2021, started experiencing symptoms immediately of convulsing seizure lasting a little over a minute. 911 dialed Fire Department arrived and examined, pt. was transported by acquaintance for Observation within household. Primary visit 11/01/2021 Blood Work ran (Abnormal) White Blood Cells clotting.


VAERS ID: 1833716 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-10-27
Onset:2021-10-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Amnesia, Confusional state, Disorientation
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (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: Losartan Lovastatin B12 Fish oil D3
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Confusion and disoriented. Not able to remember names, or past events. Symptoms have lasted 5 days and just now starting to clear up.


VAERS ID: 1833811 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-10-25
Onset:2021-10-27
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8020 / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Blood alkaline phosphatase increased, Blood calcium decreased, Blood chloride decreased, Blood sodium decreased, C-reactive protein increased, Chest X-ray abnormal, Computerised tomogram thorax normal, Dyspnoea, Endotracheal intubation, Fatigue, Fibrin D dimer, Haematocrit decreased, Haemoglobin decreased, Intensive care, Lung opacity, N-terminal prohormone brain natriuretic peptide increased, Pleural effusion, Procalcitonin, Respiratory depression, SARS-CoV-2 test positive, Troponin increased
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Liver related investigations, signs and symptoms (broad), Anaphylactic reaction (broad), Angioedema (broad), Haematopoietic erythropenia (broad), Haemorrhage laboratory terms (broad), Interstitial lung disease (narrow), Systemic lupus erythematosus (broad), Myocardial infarction (narrow), Acute central respiratory depression (narrow), Biliary system related investigations, signs and symptoms (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Hyponatraemia/SIADH (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acyclovir, amiodarone, atorvastatin, clopidogrel, digoxin, furosemide, midodrine, glucosamine-chondroitin, Preservision, Benefiber
Current Illness:
Preexisting Conditions: CHF stage D, atrial fibrillation, actinic keratosis, BPH, Bowen''s disease, macular degeneration, hypertension, hyperlipidemia, lymphoma, IBS
Allergies: niacin
Diagnostic Lab Data: 11/1/21 COVID-19 rapid: positive Chest X-ray: extensive bilateral airspace opacities, with small right pleural effusion HGB: 11.4; HCT: 34 D-dimer: 1.62 pro-BNP: 12,838 Calcium: 8.2; Sodium: 128; chloride: 93 High sensitivity troponin: 63 Procalcitonin: 0.18 CRP: 37.6 CT PE: no evidence of PE Alk phos: 158
CDC Split Type:

Write-up: The patient reports that about 2 days after vaccination with his Pfizer booster shot, he began feeling weak and fatigued. Patient is acutely short of breath. On initial presentation to the ED, patient was 94% on RA, but patient continuously decompensated during ED stay progressing from RA, to nasal cannula, to high flow nasal cannula, and finally to requiring intubation. The patient has received dexamethasone and is admitted to ICU.


VAERS ID: 1833912 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: Utah  
Vaccinated:2021-10-27
Onset:2021-10-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: no
Preexisting Conditions: Unknown
Allergies: Unknown
Diagnostic Lab Data: O2 sat 98 Pulse 80
CDC Split Type:

Write-up: Patient passed out after vaccination and started shaking in a "seizure" like manner. Client quickly recovered.


VAERS ID: 1833919 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-10-27
Onset:2021-10-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017F21A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Enlarged uvula, Hypersensitivity
SMQs:, Angioedema (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: 31-year-old gentleman was getting his first moderna vaccine for COVID-19 this morning when he started to have an allergic reaction and swelling of his uvula. He has a history of a tree nut allergy. He carries epinephrine injection. He received epinephrine injection as well as Benadryl around 11:45 AM today. He states since then symptoms have been improved significantly. No difficulty breathing. No itching. Patient states symptoms have significantly improved since arrival in the ED today. Patient was brought here by EMS for treatment.


VAERS ID: 1834234 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-10-27
Onset:2021-10-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032F21A / 2 LA / IM

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

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

Write-up: Severe rash, wells and itching over entire body


VAERS ID: 1834246 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: Hawaii  
Vaccinated:2021-09-18
Onset:2021-10-27
   Days after vaccination:39
Submitted: 0000-00-00
Entered: 2021-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 1 UN / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / 2 UN / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Acute myocardial infarction, Back pain, Catheterisation cardiac abnormal, Chest pain, Coronary artery occlusion, Coronary artery thrombosis, Electrocardiogram ST segment elevation, Pain, Pain in extremity, Thrombectomy, Troponin I increased
SMQs:, Myocardial infarction (narrow), Retroperitoneal fibrosis (broad), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: Had Covid prior to vaccination.
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: EKG showed ST elevations in 2 3 and aVF, he has had ST elevations in leads V4, V5, V6. Taken to cardiac Cath Lab where he was found to have coronary thromboembolic disease he underwent mechanical thrombectomy to an occluded distal right coronary artery he also went a mechanical thrombectomy to the distal LAD. 10/28 Troponin I level of 43.3.
CDC Split Type:

Write-up: ST-elevation myocardial infarction secondary to coronary thrombus. Patient reported chest pain, midsternal w/ radiating to back and arm, onset 1130 on 10/27.


VAERS ID: 1836188 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-10-11
Onset:2021-10-27
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301358A / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Skin discolouration
SMQs:, Hypotonic-hyporesponsive episode (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: Losartan, amlodipine,Pravastatin,tamsulosin, multivitamin pills, glucosamine,fish oil pills and low dose aspirin daily and acetiminophen when needed.
Current Illness:
Preexisting Conditions: Neuralgia from shingles.
Allergies: Tramadol.
Diagnostic Lab Data: None.
CDC Split Type: Do not know

Write-up: Black and blue area about size of golf ball noticed after removed bandaid two weeks later. Now over 3 weeks later it is still there.


VAERS ID: 1836461 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-10-27
Onset:2021-10-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939902 / UNK - / -

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

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

Write-up: NO ADVERSE EVENT OCCURED. VACCINE ADMINSTERED PAST BEYOND USE DATE.


VAERS ID: 1836467 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-10-27
Onset:2021-10-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939902 / UNK - / -

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

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

Write-up: NO ADVERSE EVENT OCCURED. VACCINE ADMINSTERED PAST BUD


VAERS ID: 1836468 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-10-27
Onset:2021-10-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939902 / UNK - / -

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

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

Write-up: NO ADVERSE EVENT OCCURED. VACCINE ADMINSTERED PAST BEYOND USE DATE.


VAERS ID: 1836470 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-10-27
Onset:2021-10-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939902 / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Expired product administered, No adverse event
SMQs:, Medication errors (narrow)

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

Write-up: NO ADVERSE EVENT OCCURED. VACCINE ADMINSTERED PAST BEYOND USE DATE.


VAERS ID: 1836476 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-10-27
Onset:2021-10-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939902 / UNK - / -

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

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

Write-up: NO ADVERSE EVENT OCCURED. VACCINE ADMINSTERED PAST BUD


VAERS ID: 1836508 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-10-27
Onset:2021-10-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 3 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: 1. Ferrous Sulfate 2. Ensure Complete 3. Robaxin 750 mg 4. Nifedipine XL 60 mg 5. Prilosec 40 mg 6. Prednisone 50 mg 7. Xarelto 20 mg 8. Sennakot 8.6-50mg
Current Illness: Cyclic emesis post needle biopsy
Preexisting Conditions: Hypertension Diffuse large B-cell lymphoma of lymph nodes of multiple regions
Allergies: NKA
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: Patient had an appt schedule through MyChart for COVID booster. The vaccine was ordered by the Medical Assistant and the screener questions were completed per protocol. The Medical Assistant then drew up the medication and scanned into the chart. Medical Assistant verbalized they did not didn''t look closely at the last given date of his 2nd COVID vaccine. The chart was opened in the room to document and patient identifiers were completed. The COVID booster was given to patient 3 months early and the patient was then notified after injection that is was given 3 month in advance. Patient stated they were aware. Patient then informed the medical assistant that due to his diagnosis of cancer that his Oncologist wanted him to have it sooner. The medical assistant then spoke with with Dr. in regards to the vaccine given early. Dr. completed a chart review on the patient. Dr. then stated that he will be fine due to his current health issues even with receiving the vaccine too soon. Leadership was also notified of the error and patient was monitored for 15 minutes post vaccination with no adverse reactions to the vaccine.


VAERS ID: 1836568 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-10-27
Onset:2021-10-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 061E21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Axillary pain, Chills, Decreased appetite, Fatigue, Injection site erythema, Injection site pain, Injection site rash, Musculoskeletal stiffness, Pain, Pain in extremity, Pyrexia, Sleep disorder, Somnolence
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: 1st and 2nd Covid shots 02/2021, 03/2021-Moderna
Other Medications: Calcium 600mg w/ Vitamin D3 800 IU 2x daily, Vitamin B12 500mg 1x daily,
Current Illness: None
Preexisting Conditions: Covid arm, Osteopenia
Allergies: Ibeprofin, Mold, Dust, Perfume, Dyes, Makeups, Poison Ivy
Diagnostic Lab Data:
CDC Split Type:

Write-up: Sore arm, pink circle w/ tiny white center at injection site. Soreness in arm got worse and evening progressed. Interfered with sleep. Did not take medication . Next day, 10/28/2021, no appetite, achy and stiff, tired, sleep off and on all day. Injections site reactions was bigger yet fainter, 1 1/2 to 2 inches around. Less painful, no trouble sleeping. 10/29/2021, sore arm and arm pit. Still tired, possible chills. Small pink circle with red center at injections site. On inside of arm, 2inch above and 3 to 4 inches below injection site, there was blotchy light pink rash. No itch with rash. Slightly feverish overnight. 10/30/2021, rash was darker pink and achy. Slight chills. Temperature 1 degree higher than normal. Overnight, slightly feverish, slept well. 10/31/2021, briefly feverish No longer had underarm tenderness. Sore arm was gone. Covid rash was barely visible. 11/01/2021 all symptoms resolved.


VAERS ID: 1836631 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-10-26
Onset:2021-10-27
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034C21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Amnesia, Atrial fibrillation, Condition aggravated, Dizziness, Heart rate irregular, Intensive care, Loss of consciousness, Oxygen saturation decreased
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), Supraventricular tachyarrhythmias (narrow), Dementia (broad), Acute central respiratory depression (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiac arrhythmia terms, nonspecific (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Respiratory failure (broad), Hypoglycaemia (broad), Infective pneumonia (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: warfarin 2.5mg warfarin 5mg atorvastatin 40mg diltiazem ER 180mg capsule sotalol 120mg
Current Illness: A. Fib She is going for heart ablation on 11/5/2021
Preexisting Conditions: A. Fib
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Day after receiving booster of Moderna, after waking from a nap on couch, she was extremely dizzy. Patients husband took her to ER and her heart was going crazy in A. Fib. She said her husband told her she had passed out before leaving the house. They then put her in ICU to get heart rate under control. She had virtually no oxygen blood level and her memory was non-existent. She spent several days in ICU. Patient was already scheduled for heart ablation on Nov. 5. Still going through with procedure. Dr. put her on Amiodarone to control heart in mean time.


VAERS ID: 1836735 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-10-27
Onset:2021-10-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026D21A / 3 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Extra dose administered, Fatigue, Muscular weakness, Paraesthesia, Transient ischaemic attack
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Ischaemic central nervous system vascular conditions (narrow), Embolic and thrombotic events, arterial (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Medication errors (narrow)

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

Write-up: Tingling in right index feeling, weakness in right leg and hand, fatigue, was diagnosed with TIA (Transient Ischemic Attack).


VAERS ID: 1836765 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-01-11
Onset:2021-10-27
   Days after vaccination:289
Submitted: 0000-00-00
Entered: 2021-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027L20A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037K20A / 2 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: COVID-19, Diarrhoea, Nasal congestion, Pyrexia, SARS-CoV-2 test positive
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: binax rapid antigen test positive for COVID 10/27/21
CDC Split Type:

Write-up: tested positive for COVID 10/27/21- complained of low grade temp, nasal congestion, loose stools- reports sig other tested pos 10/20/21


VAERS ID: 1836807 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-10-27
Onset:2021-10-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 320308D / 3 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Flovent HFA 110 mcg/inh inhalation aerosol, 2 puffs prn ProAir HFA 90 mcg/inh inhalation aerosol, 1-2 puffs q 4-6 hrs prn ZyrTEC Liquid Gels 10 mg oral capsule
Current Illness:
Preexisting Conditions: Asthma
Allergies: House Dust, pet fur, mold, trees, grass, pollin
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient was given a pfizer covid 19 booster at age 15, this is not recommended for patients under 18.


VAERS ID: 1836821 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-10-26
Onset:2021-10-27
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939904 / UNK LA / IM
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 2 - / -

Administered by: Public       Purchased by: ?
Symptoms: Ageusia, Anosmia, Chest discomfort, Cough, Fatigue, Injection site pain, Injection site swelling, Pyrexia, Rhinorrhoea
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (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? No
Previous Vaccinations:
Other Medications: Yes- Claritin
Current Illness: None
Preexisting Conditions: HTN
Allergies: Yes-Environmental
Diagnostic Lab Data:
CDC Split Type:

Write-up: Per Client, received second dose of Moderna COVID 19 vaccine in the left arm on 10/26/2021. Next day on 10/27/2021, left arm at site swollen and painful. Later in day on 10/27/2021, symptoms of fever, runny nose, slight loss of taste and smell, fatigue, intermittent cough and slight chest discomfort, for now over a week since vaccine on 10/26/2021. Client dose have underlying medical conditions and taking prescription medications. Client reported taking over the counter Tylenol for pain and fever. PHN provided COVID 19 vaccine education with Client. PHN recommend that Client follow up with PCP, go into Urgent Care, ER or call 911 for medical emergency. Per Client, will be follow up with PCP and COVID 19 test


VAERS ID: 1836852 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-10-27
Onset:2021-10-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026D21A / 3 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal discomfort, Chills, Extra dose administered, Feeling abnormal, Feeling hot, Headache, Pruritus, Rash
SMQs:, Anaphylactic reaction (broad), Dementia (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Triamterene/HCTZ 37.5-25 mg CertaVite 1 a day vitamin Calcium Carbonate 600 mg with Vitamin D3 Probiotic Multi-Enzyme 1 of each once per day
Current Illness: 10/21/2021 - Cortizone shot left hand to treat "trigger Finger" 10/15/2021 - High dose senior flu shot - left arm
Preexisting Conditions: optic migraine vertigo ocasionally
Allergies: 2016 Azrithmyocin 250 mg
Diagnostic Lab Data: None
CDC Split Type:

Write-up: 10/27 - Evening chills and shivers, intense headache, upset stomach, rash on arm 10/28 - Stayed in bed most of day - only had 1/2 banana, water, crackers - chills gone, but still intense headache and upset stomach, rash on arm 10/29 - Starting to feel better, ate 3 regular but smaller meals, napped in afternoon (not normal for me), still felt warm, headache and stomach upset more mild, rash smaller but still itchy 10/30 - Feeling more normal - headache about gone but still some "brain fog" The first 2 regular doses gave me rash on arm, very mild headache and very mild stomach upset so surprised that this half dose had such adverse reaction.


VAERS ID: 1836897 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-10-26
Onset:2021-10-27
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822811 / 1 RA / IM

Administered by: Work       Purchased by: ?
Symptoms: Fatigue, Injection site pain, Injection site swelling, Injection site warmth, Muscle spasms, Pain, Pain in extremity
SMQs:, Dystonia (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: In 2018 I had a severe reaction to the flu vaccine. I lost all control of my arm for several hours and then had the worst pain
Other Medications: Zyrtec daily during seasonal allergy season Spring & fall Calcium supplement D3 supplement One a day supplement
Current Illness: none
Preexisting Conditions: none
Allergies: Bee stings Had severe reaction to flu vaccine previously
Diagnostic Lab Data: none
CDC Split Type:

Write-up: No pain at injection site 10/26/2021 Didn''t notice anything in the evening either. On 10/27 0660-noticed pain - 1-2 on scale of 10 Gradually getting worse over the week. Up to 5/10 today. Slightly swollen, warm to touch, feels similar to a burn type of pain. radiates to diameter about 4 inches from injection site. Clothing sleeve is very irritating over the site. Also having achy type of pain from mid lower arm to finger tips. It''s a feeling I can''t describe. I can still type and do my job, but it is constantly there and hurts 2-3 / 10 pain Having major cramps in arm several times a day. Mostly in my hand/forearm area up to elbow. Pain during the cramps is 7-8 / 10. ( I do have some cramping from a previous injury, but only occasionally - a few times a week) this is so much more and much more pain involved. And finally, I am so tired it''s difficult to stay awake. That is so unusual for me. I''m actually eating ice while working to try to stay awake and focused. ( I hate chewing on ice, but it works) This is not even close to what I went through before, but it is highly distressing and frustrating to deal with. .


VAERS ID: 1836912 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2021-10-26
Onset:2021-10-27
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 3 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Condition aggravated, Tachycardia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (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: Thermotabs
Current Illness: none
Preexisting Conditions: IBS, fibromyalgia, POTS
Allergies: soy, dairy, corn
Diagnostic Lab Data:
CDC Split Type:

Write-up: Tachycardia- I have POTS and have intermitent boughts of tachycardia that respond well to Thermotabs. Since the vaccine, I have had much more persistent tachycardia (100-110 sitting) that is not just triggered by orthostatic changes, and I have had to take nearly double the amount of salt tabs to manage it. It is now the 7th day of this. Starting to improve, and having less frequent episodes.


VAERS ID: 1836937 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-01
Onset:2021-10-27
   Days after vaccination:26
Submitted: 0000-00-00
Entered: 2021-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Bronchitis
SMQs:

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

Write-up: Bronchitis


VAERS ID: 1836951 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-10-27
Onset:2021-10-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 2 LA / SYR

Administered by: Military       Purchased by: ?
Symptoms: Pain
SMQs:

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

Write-up: Body Aches - Had body aches for 4 days following my 2nd dose of this vaccine.


VAERS ID: 1837039 (history)  
Form: Version 2.0  
Age: 92.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-10-26
Onset:2021-10-27
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 071F / 3 LA / IM

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

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

Write-up: Systemic: Fainting / Unresponsive-Medium, Systemic: Flushed / Sweating-Mild, Systemic: Nausea-Mild, Systemic: Vomiting-Mild, Additional Details: PATIENT CALLED TO REPORT ABOUT 24 HOURS AFTER RECEIVING VACCINE THAT HE ATE LUNCH, THEN STARTED FEELING NAUSEOUS AND SWEATY, THEN HE VOMITTED X1 AND FAINTED, WAS OUT FOR ABOUT 1-2 MINS PER HIS WIFE. HE IS FEELING FINE NOW, DIDNT REPORT TO US UNTIL A WEEK AFTER HIS SHOT. PATIENT HAS HAD SYNCOPE PRIOR, BUT LAST TIME WAS ABOUT A YEAR AGO, SO HE IS ATTRIBUTING THIS TO HIS COVID VACCINE MODERNA BOOSTER SHOT


VAERS ID: 1837088 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-10-26
Onset:2021-10-27
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Induration, Pain in extremity, Pyrexia, Skin warm, Thrombosis
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Extravasation events (injections, infusions and implants) (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Jentadueto, Spironolactone, Levocetirizine, Fexofenadine
Current Illness: N/A
Preexisting Conditions: Diabetic, asthma, Pituitary adenoma
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type: vsafe

Write-up: I noticed a pain in my back right leg. Around the time of me getting ready for bed it was really hurting. So, I took aspirin. I also have a fever. The spot does not stick out, but you could feel something under skin on my leg. It was not a bit or anything like that. It has not got worst or better. It is warm to touch. It think it is a blood clot. I have contacted my doctor for an appointment.


VAERS ID: 1837185 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-10-02
Onset:2021-10-27
   Days after vaccination:25
Submitted: 0000-00-00
Entered: 2021-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30130BA / 3 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dyspnoea, Extra dose administered, Hypoaesthesia, Pruritus
SMQs:, Anaphylactic reaction (narrow), Peripheral neuropathy (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sexual dysfunction (broad)

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

Write-up: Client received Pfizer booster on 10/2/2021 by pharmacist at client''s place of employment. A few minutes after receiving booster, he complained of shortness of breath, itching and numbness in hands and feet. Pharmacist administered epinepherine 0.3cc SQ and called EMS. EMS evaluated client and he recovered. Symptoms subsided. Client offered to be taken to emergency room but he declined. Client observed until stable. Client stated he never had a problem previously with COVID-19 or any other vaccine. He previously received Pfizer vaccine on 3/29/2021 and 4/19/2021. Call to client on 10/28/2021 and 11/2/2021 for follow up. He is doing well with no problems and has had no return of any symptoms.


VAERS ID: 1837223 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Mississippi  
Vaccinated:2021-10-27
Onset:2021-10-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA N/A / 3 UN / -
FLU4: INFLUENZA (SEASONAL) (AFLURIA QUADRIVALENT) / SEQIRUS, INC. - / 1 UN / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Dyspnoea, Eye inflammation, Oropharyngeal pain, Pain, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Corneal disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: chills,101.3 fever, eyes feels inflamed, body sore, sore throat, couldnt breathe while trying to sleep


VAERS ID: 1837238 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-10-27
Onset:2021-10-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 071F21A / 1 RA / IM

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

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

Write-up: Clinician was reviewing patient questionnaire and discussing J&J and Moderna vaccine. Moderna vaccine was covered on the table and a dose of J&J was brought to the clinician on a separate tray and both vaccines were labeled. Following his discussion, he accidently picked up the Moderna vaccine and administered that instead of the J&J which the patient requested. Patient will return for her second Moderna in 28+ days.


VAERS ID: 1837380 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-10-27
Onset:2021-10-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939902 / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Expired product administered, No adverse event
SMQs:, Medication errors (narrow)

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

Write-up: NO ADVERSE EVENT OCCURED. VACCINE ADMINSTERED PAST BUD


VAERS ID: 1837382 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-04-29
Onset:2021-10-27
   Days after vaccination:181
Submitted: 0000-00-00
Entered: 2021-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6207 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood lactate dehydrogenase increased, C-reactive protein increased, COVID-19 pneumonia, Chest X-ray abnormal, Computerised tomogram thorax abnormal, Condition aggravated, Cough, Diarrhoea, Dyspnoea, Fatigue, Fibrin D dimer normal, Intensive care, Lung infiltration, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (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? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: prostate cancer (remission), radiation enteritis recurrent diarrhea (secondary to previous) asthma, mild intermittent alcohol abuse
Allergies: NKA
Diagnostic Lab Data: In the ED on 11/1/2021 vitals were notable saturations of 80s on RA at rest but O2 requirements escalated quickly and he is now on ~10L. Labs were significant for CRP~22, LDH 334, d-dimer wnl. Chest x-ray (extensive bilateral infiltrates consistent with COVID pneumonia), CT scan (negative for PE)
CDC Split Type:

Write-up: presents to ED on 11/1/2021 with 6 days of fevers, cough, myalgias, fatigue, worsening dyspnea and diarrhea. Unclear exposure but has been spending time with his spouse and adult daughter. Vaccinated in April 2021. He noticed today that his cough and dyspnea were getting worse and his spouse insisted he come to the hospital. Patient admitted to ICU for increased O2 requirements, is still admitted at the time of this entry.


VAERS ID: 1837393 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-10-27
Onset:2021-10-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939902 / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Expired product administered, No adverse event
SMQs:, Medication errors (narrow)

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

Write-up: NO ADVERSE EVENT OCCURED. VACCINE ADMINSTERED PAST BUD


VAERS ID: 1837400 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-10-27
Onset:2021-10-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939902 / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Expired product administered, No adverse event
SMQs:, Medication errors (narrow)

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

Write-up: NO ADVERSE EVENT OCCURED. VACCINE ADMINSTERED PAST BUD


VAERS ID: 1837405 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-10-27
Onset:2021-10-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939902 / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Expired product administered, No adverse event
SMQs:, Medication errors (narrow)

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

Write-up: NO ADVERSE EVENT OCCURED. VACCINE ADMINSTERED PAST BUD


VAERS ID: 1837414 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-10-27
Onset:2021-10-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939902 / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Expired product administered, No adverse event
SMQs:, Medication errors (narrow)

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

Write-up: NO ADVERSE EVENT OCCURED. VACCINE ADMINSTERED PAST BUD


VAERS ID: 1837420 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-10-27
Onset:2021-10-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939902 / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Expired product administered, No adverse event
SMQs:, Medication errors (narrow)

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

Write-up: NO ADVERSE EVENT OCCURED. VACCINE ADMINSTERED PAST BUD


VAERS ID: 1837422 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-10-27
Onset:2021-10-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939902 / UNK - / -

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

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

Write-up: NO ADVERSE EVENT OCCURED. VACCINE ADMINSTERED PAST BUD


VAERS ID: 1837430 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-10-27
Onset:2021-10-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939902 / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Expired product administered, No adverse event
SMQs:, Medication errors (narrow)

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

Write-up: NO ADVERSE EVENT OCCURED. VACCINE ADMINSTERED PAST BUD


VAERS ID: 1837437 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: California  
Vaccinated:2021-10-25
Onset:2021-10-27
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Ageusia, Autoimmune disorder, COVID-19, Cough, Decreased appetite, Flushing, Pain, Pyrexia, Respiratory tract congestion, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (narrow), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Multiple for Diabetes and Hypertension
Current Illness: urinary Tract Infection early October
Preexisting Conditions: Diabetes, Hypertension, Obesity
Allergies: Bactrim
Diagnostic Lab Data: Covid-19 Positive 10/31/2021
CDC Split Type: vsafe

Write-up: On the third day after I got the third dose of the vaccine I felt flushed and I had pain in my sides. I had no appetite, and my sense of taste was gone. I developed a dry cough and congestion. I tested Positive on the fifth day after the vaccine when I went to the hospital. My sense of taste has returned a little. My cough was constant until about a week later. Cough drops are helping. I got a fever of 38 degrees Celsius for several days. I do have autoimmune so I am not sure if I am the road to recovery. I am in quarantine in a Hotel currently.


VAERS ID: 1837651 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-10-27
Onset:2021-10-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939902 / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Expired product administered, No adverse event
SMQs:, Medication errors (narrow)

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

Write-up: NO ADVERSE EVENT OCCURED. VACCINE ADMINSTERED PAST BUD


VAERS ID: 1837653 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-10-27
Onset:2021-10-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939902 / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Expired product administered, No adverse event
SMQs:, Medication errors (narrow)

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

Write-up: NO ADVERSE EVENT OCCURED. VACCINE ADMINSTERED PAST BUD


VAERS ID: 1837654 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-10-27
Onset:2021-10-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939902 / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Expired product administered, No adverse event
SMQs:, Medication errors (narrow)

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

Write-up: NO ADVERSE EVENT OCCURED. VACCINE ADMINSTERED PAST BUD


VAERS ID: 1837657 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-10-27
Onset:2021-10-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939902 / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Expired product administered, No adverse event
SMQs:, Medication errors (narrow)

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

Write-up: NO ADVERSE EVENT OCCURED. VACCINE ADMINSTERED PAST BUD


VAERS ID: 1838050 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-26
Onset:2021-10-27
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039D21A / 3 LA / IM

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

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

Write-up: Patient got 3rd dose of Moderna. She has redness and swelling of the arm at injection site and was concerned. She is going to follow-up with her doctor.


VAERS ID: 1838070 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-10-22
Onset:2021-10-27
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 2 - / SYR

Administered by: Private       Purchased by: ?
Symptoms: Alanine aminotransferase increased, Blood creatine phosphokinase increased, Myalgia, Rash, Rash erythematous, Rash pruritic
SMQs:, Rhabdomyolysis/myopathy (broad), Liver related investigations, signs and symptoms (narrow), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Lo Loestrin FE 1mg-10mcg (24)/10mcg (2) - take 1 tab PO daily
Current Illness: None
Preexisting Conditions: Alopecia History of COVID 19 infection (11/2020)
Allergies: NKDA
Diagnostic Lab Data: See Item 18
CDC Split Type:

Write-up: Five days following vaccine administration patient developed severe muscles aches in her lower extremities bilaterally, right greater than left. She also noted the development of a rash consistent of two small raised erythematous and pruritic lesions located over her right inner thigh, followed by the development of two similar lesions over her right gluteal region and then one underneath her right breast. She was seen by her primary care physician at which time labs were performed results of which revealed CPK in the 6000s. She was directed to Hospital ER at which time repeat labs showed a CPK of 6271. Mild ALT elevation was also noted. Patient was admitted and initiated on IVFs with rapid decline in CPK and resolution of muscle aches. Rash however persisted and work-up remains ongoing. Patient is currently scheduled to follow-up with Dermatology on 11/5/21 for further evaluation and potential skin biopsy.


VAERS ID: 1839618 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-10-27
Onset:2021-10-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8020 / 1 LA / IM

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

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

Write-up: Systemic: Dizziness / Lightheadness-Mild


VAERS ID: 1839882 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-10-26
Onset:2021-10-27
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939905 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Body temperature increased, Headache, Injection site discomfort, Insomnia, Pain
SMQs:, Neuroleptic malignant 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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No
Current Illness: No
Preexisting Conditions: High blood pressure, High Cholesterol, Fibromyalgia, Had Breast Cancer
Allergies: Prozac, Taxol
Diagnostic Lab Data: No
CDC Split Type: vsafe

Write-up: I exp severe headaches, body aches, didn''t ease up until 11/2/2021. I also exp temp of 101 and discomfort at the injection site very uncomfortable to sleep. I contacted my doctor she told me to take Tylenol and make sure I was hydrated.


VAERS ID: 1839910 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-10-25
Onset:2021-10-27
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 061E21A / 3 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Acoustic stimulation tests, 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: Unisom 25mg at bedtime, Celecoxib 400mg at bedtime
Current Illness: None
Preexisting Conditions: Chronic back pain
Allergies: None
Diagnostic Lab Data: Hearing test 11/2/21
CDC Split Type:

Write-up: Tinnitus in left ear, started on Weds 10/27/21, tinnitus is constant in left ear


VAERS ID: 1839931 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-04-30
Onset:2021-10-27
   Days after vaccination:180
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0169 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 2 RA / IM

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

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

Write-up: Breakthrough Covid-19 positive


VAERS ID: 1839972 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-10-27
Onset:2021-10-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 023C21A / 3 RA / IM

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

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

Write-up: Instructed by Moderna to fill out a VAERS. No adverse outcome occurred. This patient received a vaccine that was removed from deep freeze beyond the date of recommended use. The Beyond use date is 10/24/2021 and vaccine was given to patient on 10/27/2021.


VAERS ID: 1839999 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-10-27
Onset:2021-10-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939902 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Contusion, Nodule, Pain in extremity, Peripheral swelling, Pyrexia
SMQs:, Cardiac failure (broad), Angioedema (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Accidents and injuries (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Patient reports swelling of the arm and a knot directly under the armpit happening about 6 hours after vaccine. She now has bruising down her side and at ribcage to bra level. She also had a mild fever after shot. Patient is reporting this 6 days later and still has moderate bruising as well as pain and swelling of the arm.


VAERS ID: 1840000 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-10-26
Onset:2021-10-27
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2590 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Fatigue, Headache, Menstruation delayed, Myalgia, Nausea
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Fertility disorders (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Advil-200mg, multi-vitamin
Current Illness: None
Preexisting Conditions: Chronic neck and jaw pain-TMD
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: On 10/27/2021, around 5pm I started having chills, muscle aches, headache and extreme fatigue. I also experienced nausea. I was supposed to start my period a few days later but it never came and I am not pregnant. My cycle is always regular and never late and I still have not started.


VAERS ID: 1840006 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: West Virginia  
Vaccinated:2021-05-25
Onset:2021-10-27
   Days after vaccination:155
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19 pneumonia, Malaise
SMQs:, 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? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient vaccinated with Covid vaccine and was admitted to hospital with Covid symptoms. She was admitted with right lower lobe pneumonia due to Covid.


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