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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 85 out of 8,753

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VAERS ID: 1840051 (history)  
Form: Version 2.0  
Age: 23.0  
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 FD0809 / 2 LA / IM

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

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

Write-up: The patient was administered a second dose of 0.3ml of Pfizer undiluted vaccine on the left arm intramuscularly on 10/27/21. The patient was notified and instructed to watch for symptoms (i.e fatigue, chills, sore arm) and seek medical attention if necessary.


VAERS ID: 1840148 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-03-09
Onset:2021-10-27
   Days after vaccination:232
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6198 / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal discomfort, COVID-19, Chills, Decreased appetite, Diarrhoea, Dysuria, Exposure to SARS-CoV-2, Fatigue, Hypoxia, Pain, Productive cough, Pyrexia, SARS-CoV-2 test positive, Sick relative
SMQs:, Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Noninfectious diarrhoea (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: HTN, HLD, asthma
Allergies:
Diagnostic Lab Data: 10/31/21 Covid-19 positive
CDC Split Type:

Write-up: 10/30/21 77 y.o. female with a past medical history noted below presents from ED with c/o body aches, fatigue, productive cough with white sputum x 2 weeks. Associated with poor appetite, subjective fevers, chills, abdominal discomfort. Had 2 episodes of diarrhea. Saw her PCP who advised her to come to the ED. Tested positive for COVID at Walgreens 3 days ago. Lives with son who also tested positive for COVID. Fully vaccinated against COVID x 2 doses. Reports dysuria x 1 week. Denies CP, SOB, sore throat, loss of smell/taste. On the unit, pt spiked fever of 102.9 and hypoxic at 90% on RA". Treatment: Rocephin IV, Remdesivir IV x 5 d, Decadron IV x 10 d. Pt is still hospitalized.


VAERS ID: 1840202 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-10-22
Onset:2021-10-27
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 3 RA / IM
FLU4: INFLUENZA (SEASONAL) (FLULAVAL QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS X4J94 / 1 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Deep vein thrombosis, Ultrasound Doppler abnormal
SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Cardiomyopathy (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: Albuterol, Meclizine, Duloxetine, Diflucan, Depo-Provera, Metaxalone, Naratriptan, Ondansetron, Lyrica, Propranolol, Topamax, Tramadol
Current Illness: None
Preexisting Conditions: Cervicalgia, cough, fibromyalgia, history DVT and PE, memory loss, low-back pain, GERD, obesity
Allergies: Tioconazole, Sulfa
Diagnostic Lab Data: Doppler ultrasound confirmed clot on 10/28/2021.
CDC Split Type:

Write-up: 5 days after vaccine given in right arm, patient developed DVT in right arm.


VAERS ID: 1840415 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: California  
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 (JANSSEN)) / JANSSEN - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Electrocardiogram, Headache, Hypertension, Laboratory test
SMQs:, Neuroleptic malignant syndrome (broad), Hypertension (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Wheat, avocado, banana
Diagnostic Lab Data: 10/29/2021: EKG and labs 11/02/2021: Oral blood pressure medicine
CDC Split Type:

Write-up: Headache, hypertension


VAERS ID: 1840503 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Washington  
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 939904 / 3 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Feeding disorder, Full blood count, Headache, Metabolic function test, Nausea, SARS-CoV-2 test, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: multi-vitamin po, calcuim1200 po
Current Illness: None
Preexisting Conditions: None
Allergies: Codeine Sulfate
Diagnostic Lab Data: Basic Metabolic Panel, CBC with Differential, Covid-19 NAAT
CDC Split Type:

Write-up: Extreme nausea & headache, Unable to eat or drink without vomiting for two days, Given IV fluids (sodium chloride o.9% (2 bags), Ondansetron (Zofran) , Ketorolac (Toradol) on 10/29/2021 starting at 6:07 pm


VAERS ID: 1840552 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Indiana  
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 012F21A / 3 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Chills, Fatigue, Feeling hot, Influenza like illness, Insomnia, 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: I AM DONE TOO MUCH
Other Medications: lisinopril; amlodipine; cetirizine hydrochloride; ibuprofen; acetaminophen.
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: FLU-LIKE SYMPTOMS, LIKE A FEVER, ACHES,SLEEPLESSNESS, CHILLS,FATIGUE


VAERS ID: 1840583 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
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 091D21A / UNK - / -

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

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

Write-up: expired vial 10/24 administered on 10/27


VAERS ID: 1840588 (history)  
Form: Version 2.0  
Age: 70.0  
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 091D21A / UNK - / -

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

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

Write-up: expired vial 10/24 administered on 10/27


VAERS ID: 1840594 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
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 091D21A / UNK - / -

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

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

Write-up: expired vial 10/24 administered on 10/27.


VAERS ID: 1840601 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Male  
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 091D21A / UNK - / -

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

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

Write-up: expired vial 10/24 administered on 10/27


VAERS ID: 1840604 (history)  
Form: Version 2.0  
Age: 59.0  
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 091D21A / UNK - / -

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

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

Write-up: expired vial 10/24 administered on 10/27


VAERS ID: 1840606 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
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 091D21A / UNK - / -

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

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

Write-up: expired vial 10/24 administered on 10/27.


VAERS ID: 1840610 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: California  
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 FE3590 / 3 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Diarrhoea, Dyspnoea, Fatigue, Injection site pain, Pyrexia, Rash, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: PFIZER - SECOND DOSE ONLY (NOT FIRST)
Other Medications: NONE
Current Illness:
Preexisting Conditions: CHF COPD OBESITY
Allergies: NONE
Diagnostic Lab Data:
CDC Split Type:

Write-up: WITH IN 24 HRS: SLIGHT FEVER (REOCCURRING OFF AND ON), FATIGUE, DIARRHEA, SORENESS AT SHOT AREA, HIVES/RASH ON BOTH ARMS, LEGS AND PARTS OF BACK. SHORTNESS OF BREATH. ALL SIDE EFFECTS HAVE BEEING GOING ON SINCE 10/27 - 11/3/2021, MOST HAVE STOPPED OR HAVE GONE DOWN IN LEVEL OF PAIN.


VAERS ID: 1840611 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
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 091D21A / UNK - / -

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

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

Write-up: Expired vial 10/24/2021 administered 10/27/2021.


VAERS ID: 1840617 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
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 091D21A / UNK - / -

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

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

Write-up: expired vial 10/24 administered on 10/27


VAERS ID: 1840621 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
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 091D21A / UNK - / -

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

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

Write-up: expired vial 10/24 administered on 10/27


VAERS ID: 1840623 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Ohio  
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 014-336 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Skin lesion, Skin oedema, Skin warm, 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: LNG-IUD
Current Illness: None
Preexisting Conditions: None
Allergies: Sulfa
Diagnostic Lab Data: None
CDC Split Type:

Write-up: 8x4cm swelling, edematous lesion with heat


VAERS ID: 1840625 (history)  
Form: Version 2.0  
Age: 52.0  
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 091D21A / UNK - / -

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

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

Write-up: expired vial 10/24 administered on 10/27


VAERS ID: 1840626 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
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 091D21A / UNK - / -

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

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

Write-up: expired vial 10/24 administered on 10/27


VAERS ID: 1840632 (history)  
Form: Version 2.0  
Age: 78.0  
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 091D21A / UNK - / -

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

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

Write-up: expired vial 10/24 administered on 10/27


VAERS ID: 1840636 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
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 091D21A / UNK - / -

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

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

Write-up: expired vial 10/24 administered on 10/27


VAERS ID: 1840641 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
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 091D21A / UNK - / -

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

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

Write-up: expired vial 10/24 administered on 10/27


VAERS ID: 1840649 (history)  
Form: Version 2.0  
Age: 81.0  
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 - / UNK - / -

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

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

Write-up: expired vial 10/24 administered on 10/27


VAERS ID: 1840709 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Indiana  
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 076D21A / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain, Bacterial infection, Decreased appetite, Dysuria, Fatigue, Headache, Myalgia, Pain, Pain in extremity, Pyrexia, Rash, Rash erythematous, Urinary tract infection, Urine analysis abnormal
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Covid Vaccine (2nd dose)- flu like symptoms, body aches, headache, no fever, but in bed all day. (March 5th 2021)
Other Medications: Aller-Zyr 10mg 1xday evening; Aspirin 325mg 1xday night; Turmeric 450mg 1xday morning; Probiotic 100 Million organicism 1xday morning; Vitamin D3 125mcg 1xday morning; B Complex morning; Sam-E 100mg 1xday morning; Airborne Vitamin 1 2xday m
Current Illness: none
Preexisting Conditions: none
Allergies: Capers; Environmental Allergies
Diagnostic Lab Data: Uranalysis- found UTI (10/30/2021)
CDC Split Type: vsafe

Write-up: After receiving the vaccine I experienced muscle aches, body aches, a fever of 101, a massive headache, and a bacterial infection. I had a red rash all over my neck and under my armpits and breast. I have not been my self since getting the vaccine. I can only do minimal things. I had loss of appetite, fatigue, and exhaustion. I had lower abdominal pain. It was painful prior urinating and after urination. On 10/30/2021 I went to see the doctor. I was prescribed phenazopyridine 200mg 3xday and Bactrim 800mg 2xday for the UTI. My thighs also hurt really badly. I have recovered from everything expect from the poor appetite and fatigue.


VAERS ID: 1840728 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Illinois  
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 FH8020 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Back pain, Headache, Impaired driving ability, Muscle spasms
SMQs:, Retroperitoneal fibrosis (broad), Dystonia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Flexerill 10 mg od vitamin C 500 mg od B-12 2400 mcg od vitamin D-3 5000 iu B-6 50 mg Biotin 5000 mcg od methyl folate 400 mcg magnesium glycinate 220 mg loratadine 10 mg od
Current Illness: no
Preexisting Conditions: fibromyalgia chronic menstrual migraines
Allergies: gluten
Diagnostic Lab Data: no
CDC Split Type: vsafe

Write-up: 30 hours post vaccination, the evening of 10/24/2021- my lower back hurt and I was getting a headache. On Saturday morning 10/30/2021, I was getting no relief from migraine medication. The intensity of the headache increased and it included very strong muscle spasms in my neck. I called the doctor on call, and he prescribed mephylprednisolone, a packet of 4 ml, 21 tablets over the course of 6 days. I will be finished with them 11/04/2021. He also told me to up my migraine, treximet, from 3 instead of 1 time a day. And I also take imatrix 25 mg ( I took that on Friday before I called the doctor) I have not recovered from the headaches and neck spasms. The intensity has decreased. I still can''t drive. I contacted the doctor because my symptoms have not resolved and they scheduled me an appointment for 11/04/2021 in the morning.


VAERS ID: 1840744 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: New York  
Vaccinated:2021-10-20
Onset:2021-10-27
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Burning sensation, Injection site erythema, Injection site pain, Injection site swelling, Pain, Pruritus, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Peripheral neuropathy (broad), Extravasation events (injections, infusions and implants) (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Had Moderna COVID 19 Vacc. 10/20/2021, reports since 10/27/2021 had redness, pain and swelling in left arm at injection site and now has swelling and pain and itching below injection site. "...feels like I got stung by a bee then I got burned...'' Reports no improvement with cortisone and aleve.


VAERS ID: 1840762 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Georgia  
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 012F21A / 3 LA / IM
VARZOS: ZOSTER (SHINGRIX) / GLAXOSMITHKLINE BIOLOGICALS E344C / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Contusion, Dyspnoea, Fatigue, Nausea, Pruritus, Pyrexia, Tachycardia, Urticaria, Vertigo
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Albuterol HFA, Chlorpromazine, Famotidine, Valacyclovir, Cetirizine, Ketoconazole 2% Cream, Furosemide, Atorvastatin, Buspirone, Topamax, Atrovent, Fluticasone Nasal Spray, Basaglar, Montelukast, Baclofen,
Current Illness: Herpesviral infection, Nausea, Candidiasis of skin and nail, Anxiety d/o, Acute sinusitis
Preexisting Conditions: Anxiety disorder, High cholesterol, Asthma, High Blood Pressure, Diabetes
Allergies: Metformin, Morphine & Related, Cyclobenzaprine, Duloxetine, Codeine, Fluoxetine, Clonidine, and Meperidine.
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Develop symptoms the second day after vaccinated. She had nausea, vertigo, fatigue, hives, itching, shortness of breath, chest pain/ tachycardia, bruising on arm, fever.


VAERS ID: 1840774 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Unknown  
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 037C21A / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Dizziness, Flushing, Hyperhidrosis, Immediate post-injection reaction, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (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: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies: Amoxicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt w/ previously known allergy to Amoxicillin. NO other PMH or Medications known to this writer. Immediately post vaccination, pt had a syncopal event associated w/ flushing/sweating and dizziness. Pt reports that she has a hx of vasovagal type rxn w/ previous vaccinations/ blood draws. Pt had requested to lie down for immunization today and this was done. Vitals: BP 85/58, HR 64, RR 16, SPO2 100% -- $g @17:30 103/62, 68, 16, 100% (supine -- $g 17:48 96/59, 72, 16, 100% (sitting) @17:48 pt states that she feels ok to leave, ambulated w/o difficulties. Advised to f/u w/ PCP, assure adequate hydration. Pt left the facility w/ roommate at her side. Pt stable and released from the vaccination site w/ roommate.


VAERS ID: 1840784 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: New York  
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 - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: pfizer covid 19: second shot
Other Medications: n/a
Current Illness: n/a
Preexisting Conditions: MS
Allergies: n/a
Diagnostic Lab Data: n/a. Viewed by Dr.
CDC Split Type:

Write-up: pain, swelling, redness and itching in left arm


VAERS ID: 1840827 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Unknown  
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 037C21A / 3 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Dizziness, Extra dose administered
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad), Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Pt w/ unknown PMH or Medications.
Current Illness:
Preexisting Conditions: Pt w/ unknown PMH or Medications.
Allergies: Known allergies to Phenergan.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt w/ unknown PMH or Medications. Known allergies to Phenergan. 2mins post vaccination pt reported dizziness. Pt has reported similar reactions to immunizations in the past. Vitals: @17:44 BP 109/81, HR 73, RR 18 -- $g @17:55 115/77, 66, 18, 100% O2 Sat Pt given apple juice. Pt''s symptoms resolved. Pt denies any dizziness or unusual symptoms. Pt stable and released from the vacciation site at 18:00.


VAERS ID: 1841187 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-10-23
Onset:2021-10-27
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 2 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Eye pain, Vertigo
SMQs:, Glaucoma (broad), Vestibular disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: allergies weeks before 2nd dose.
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Vertigo and eye pain when looking side-to-side.


VAERS ID: 1841534 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-02-17
Onset:2021-10-27
   Days after vaccination:252
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / 2 AR / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Atrial fibrillation, C-reactive protein increased, COVID-19, COVID-19 pneumonia, Chest X-ray abnormal, Condition aggravated, Cough, Cystitis, Dyspnoea, Dysuria, Fall, Fatigue, Full blood count normal, Hypoxia, Insulin therapy, International normalised ratio, Liver function test increased, Lung opacity, Mobility decreased, Oropharyngeal pain, Pyrexia, Tachypnoea
SMQs:, Liver related investigations, signs and symptoms (narrow), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Supraventricular tachyarrhythmias (narrow), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen (TYLENOL) 325 MG tablet amitriptyline (ELAVIL) 25 MG tablet amLODIPine (NORVASC) 10 MG tablet ascorbic acid (VITAMIN C) 1000 MG tablet atorvastatin (LIPITOR) 20 MG tablet cholecalciferol (D3 HIGH POTENCY) 10 MCG (400 UNIT) TAB
Current Illness: 10.28.2021 - ED visit - cough, sore throat, fever, shortness of breath 10.15.2021 - Outpatient visit - persistent atrial fibrillation 10.07.2021 - acute cystitis without hematuria; dysuria
Preexisting Conditions: Persistent atrial fibrillation Essential hypertension Type 2 diabetes mellitus without complication, without long-term current use of insulin Pneumonia due to COVID-19 virus Obesity Hyperlipidemia
Allergies: Altace [Ace Inhibitors]Swelling Ramipril
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospitalized (10.28.21); COVID-19 vaccine (10.27.21); fully vaccinated Admission Date: 10/28/2021 Discharge Date: 11/1/2021 PRESENTING PROBLEM: Pneumonia due to COVID-19 virus HOSPITAL COURSE: 74 y.o. female with known permanent atrial fibrillation on warfarin, chronic left bundle branch block, non-insulin-dependent diabetes mellitus type 2, obesity and essential hypertension who presented with a chief complaint of worsening COVID-19 symptoms. Symptoms started 2 days prior to admission with fevers and cough with associated fatigue and generalized weakness. Patient lives independently and had a fall the night before admission and unable to get up on her own. EMS was then called and patient was brought in to the hospital and was diagnosed with COVID-19 pneumonia at the time. Upon emergency department arrival patient was noted to be mildly tachypneic, hypoxic at 87% and requiring at least 2 L nasal cannula oxygen support to maintain saturations above 92%. Workups at emergency department, complete blood count unremarkable INR therapeutic, chest x-ray showed patchy nonspecific airspace opacities that can be seen with COVID-19 infection. Patient was then admitted to hospitalist service for further management. On admission, elemental oxygen support continued a 2 L nasal cannula. Patient was started on remdesivir IV with planned completion of 5 doses. She was started on Decadron as well. CRP were monitored and continued to have shown down trending throughout hospital stay. Patient subsequently weaned off oxygen on her 3rd hospital stay. With patient''s diabetes and her oral hypoglycemic medications were held, she was placed on insulin corrective. With patient''s respiratory status stability and CRP improved, Decadron had been discontinued. Patient continued to do well maintaining saturations at room air, without any fever episodes and liver function stable although elevated. Patient was discharged to home stable after last dose of remdesivir infusion.


VAERS ID: 1842108 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-10-27
Onset:2021-10-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014F21A / UNK - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Expired product administered, Product temperature excursion issue
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: 20 patients total who received the shot outside of temperature range; expired vaccine used; Based on the current case data, this case has been classified as invalid. This spontaneous case was reported by a nurse and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (expired vaccine used) and PRODUCT TEMPERATURE EXCURSION ISSUE (20 patients total who received the shot outside of temperature range) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 014F21A) for COVID-19 vaccination. No Medical History information was reported. On 27-Oct-2021, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 27-Oct-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (expired vaccine used). On an unknown date, the patient experienced PRODUCT TEMPERATURE EXCURSION ISSUE (20 patients total who received the shot outside of temperature range). On 27-Oct-2021, EXPIRED PRODUCT ADMINISTERED (expired vaccine used) had resolved. At the time of the report, PRODUCT TEMPERATURE EXCURSION ISSUE (20 patients total who received the shot outside of temperature range) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. Concomitant medications was not provided by the reporter. Treatment information was not provided. Maximum or minimum temperatures reached, is min -59C; max -75C and Excursion duration is of 6 days.


VAERS ID: 1842117 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Maine  
Vaccinated:2021-10-27
Onset:2021-10-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052E21A / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Maternal exposure during pregnancy
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: got the vaccine while pregnant; This spontaneous prospective pregnancy case was reported by a nurse and describes the occurrence of MATERNAL EXPOSURE DURING PREGNANCY (got the vaccine while pregnant) in a 41-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 052E21A) for COVID-19 vaccination. No Medical History information was reported. On 27-Oct-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. The patient''s last menstrual period was on an unknown date and the estimated date of delivery was 20-Feb-2022. On 27-Oct-2021, the patient experienced MATERNAL EXPOSURE DURING PREGNANCY (got the vaccine while pregnant). On 27-Oct-2021, MATERNAL EXPOSURE DURING PREGNANCY (got the vaccine while pregnant) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. No concomitant and treatment medications were reported. It was reported that the second shot was scheduled on 24-Nov-2021. Company comment: This is a case of Maternal exposure during pregnancy for this 41-year-old female patient. Reportedly, the patient received the first dose of Moderna COVID-19 Vaccine during pregnancy. The patient''s last menstrual period was not provided, and as per the estimated date of delivery, the patient received this first dose approximately during the sixth month of pregnancy (however, this information will be confirmed during follow up). No adverse events were reported at the time of this report. The company causality for the event of Maternal exposure during pregnancy is not applicable. The benefit-risk relationship of Moderna COVID-19 Vaccine is not affected by this report. Patient will continue to be contacted for further monitoring of AEs during the pregnancy.; Sender''s Comments: This is a case of Maternal exposure during pregnancy for this 41-year-old female patient. Reportedly, the patient received the first dose of Moderna COVID-19 Vaccine during pregnancy. The patient''s last menstrual period was not provided, and as per the estimated date of delivery, the patient received this first dose approximately during the sixth month of pregnancy (however, this information will be confirmed during follow up). No adverse events were reported at the time of this report. The company causality for the event of Maternal exposure during pregnancy is not applicable. The benefit-risk relationship of Moderna COVID-19 Vaccine is not affected by this report. Patient will continue to be contacted for further monitoring of AEs during the pregnancy.


VAERS ID: 1842232 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-10-27
Onset:2021-10-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Dermatitis allergic, Immunisation
SMQs:, Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: USPFIZER INC202101483111

Write-up: Allergic type rash on full body; A third (booster) dose of BNT162b2 was administered; This is a spontaneous report from a contactable healthcare professional. A 47-year-old male patient received the third dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: UNKNOWN) via intramuscular route of administration on 27Oct2021 (at the age of 47-years-old) as a single dose for COVID-19 immunisation. Medical history was not reported. The patient had no known allergies. Prior to the vaccination, the patient was not diagnosed with COVID-19. Concomitant medications were not reported. The patient previously received the first dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: UNKNOWN) via an unspecified route of administration on an unknown date, as a single dose for COVID-19 immunisation and received the second dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: UNKNOWN) via an unspecified route of administration on an unknown date, as a single dose for COVID-19 immunisation. On 29Oct2021, the patient experienced allergic type rash on full body. The event resulted in doctor/other health care professional office/clinic visit. Therapeutic measures were taken as a result of the event which included treatment with dexamethasone (MANUFACTURER UNKNOWN) and hydroxyzine hydrochloride (VISTARIL). Since the vaccination, the patient had not been tested for COVID-19. The clinical outcome of the event allergic type rash on full body was unknown at the time of this report. The lot number for BNT162b2 was not provided and will be requested during follow up.


VAERS ID: 1842240 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-10-27
Onset:2021-10-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 3 - / -

Administered by: Work       Purchased by: ?
Symptoms: Chills, Immunisation, Nausea, Vaccination site pain
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101483952

Write-up: Pain at injection site; Nausea; Chills; A third (booster) dose of BNT162b2 was administered; This is a spontaneous report from a contactable consumer, the patient. A 40-year-old non-pregnant female patient received the third dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: FF8839) via an unspecified route of administration on 27Oct2021 (at the age of 40-years-old) as a single dose for COVID-19 immunisation. Medical history and concomitant medications were not reported. The patient had no known allergies. Prior to the vaccination, the patient was not diagnosed with COVID-19. The patient previously received the first dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: EL3247) via an unspecified route of administration on an unknown date, as a single dose for COVID-19 immunisation and received the second dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: EL3247) via an unspecified route of administration on an unknown date, as a single dose for COVID-19 immunisation. The patient did not receive any other vaccines within four weeks prior to the COVID-19 vaccine. On 28Oct2021, the patient experienced nausea, chills and pain at injection site. The events did not result in doctor or other healthcare professional office/clinic visit, emergency room/department or urgent care. Therapeutic measures were not taken as a result of the events. Since the vaccination, the patient had not been tested for COVID-19. The clinical outcome of the events nausea, chills and pain at injection site was unknown at the time of this report.


VAERS ID: 1842244 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-10-27
Onset:2021-10-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 3 RA / -

Administered by: Work       Purchased by: ?
Symptoms: Chills, Diarrhoea, Immunisation, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ANASTROZOLE; CALCIUM; VITAMIN D NOS
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Breast cancer (Breast cancer diagnosed in 2019)
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101484064

Write-up: Chills; Muscle pain; Diarrhea; Administration date 27Oct2021 at 11:00, dose number=3; This is a spontaneous report from a contactable consumer, the patient. A 51-year-old non-pregnant female patient received the third dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: EW0196) via an unspecified route of administration in the right arm on 27Oct2021 at 11:00 (at the age of 51-years-old) as a single dose for COVID-19 immunisation. Medical history included breast cancer diagnosed in 2019. The patient had no known allergies. Prior to the vaccination, the patient was not diagnosed with COVID-19. Concomitant medications included anastrozole (MANUFACTURER UNKNOWN) and vitamin d nos (MANUFACTURER UNKNOWN) and calcium (MANUFACTURER UNKNOWN); all taken for unknown indication from an unknown date and unknown if ongoing. The patient previously received the first dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot number: EL3247) via an unspecified route of administration in the right arm on 24Feb2021 (at the age of 50-years-old) and also received the second dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot number: EL3247) via an unspecified route of administration in the right arm on 17Mar2021 (at the age of 50-years-old) as a single dose for COVID-19 immunisation. The patient previously received influenza vaccine (MANUFACTURER UNKNOWN) on 28Sep2021 (at the age of 50-years-old) for immunization. On 27Oct2021 at 11:00, the patient had "administration date 27Oct2021 at 11:00, dose number=3". On 28Oct2021 at 14:00, the patient experienced chills, muscle pain and diarrhea. The events did not result in doctor or other healthcare professional office/clinic visit, emergency room/department or urgent care. Therapeutic measures were taken as a result of events chills, muscle pain and diarrhea and included treatment with ibuprofen (ADVIL). Since the vaccination, the patient had not been tested for COVID-19. The clinical outcome of the events chills, muscle pain and diarrhea was resolved on an unknown date in Oct2021. The clinical outcome of the event "administration date 27Oct2021 at 11:00, dose number=3" was unknown at the time of this report.


VAERS ID: 1842246 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-10-27
Onset:2021-10-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH F63527 / 3 LA / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Blood pressure high (High B/P); COPD; Depression; Diastolic dysfunction; Neuropathy peripheral (Severe Neuropathy BLE); Stroke (Stroke Minor)
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101484223

Write-up: EXTREME MALAISE; WEAKNESS; DIZZYNESS; Booster dose taken on 27Oct2021 at 14:30; This is a spontaneous report from a contactable consumer, the patient. A 76-year-old non-pregnant female patient received third (BOOSTER) dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: F63527) via an unspecified route of administration in the left arm on 27Oct2021 at 14:30 (at the age of 76-years-old) as a single dose for COVID-19 immunisation. Medical history included chronic obstructive pulmonary disease (COPD), diastolic dysfunction, severe neuropathy bilateral lower extremities (BLE), depression, high blood pressure (B/P) and stroke minor. Prior to the vaccination, the patient was not diagnosed with COVID-19. The patient did not receive any other vaccines within four weeks prior to the vaccination. The patient received unspecified regular concomitant medications within two weeks of vaccination. The patient received second dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: ER8733) via an unspecified route of administration in the right arm on 30Mar2021 at 13:15 (at the age of 75-years-old) and first dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: EN6205) via an unspecified route of administration in the right arm on 05Mar2021 at 14:00 (at the age of 75-years-old) as a single dose for COVID-19 immunisation. The patient previously received simvastatin (MANUFACTURER UNKNOWN) on an unknown date for unknown indication and experienced drug allergy. On 28Oct2021 at 07:00, the patient experienced extreme malaise, weakness and dizziness. The events did not result in doctor or other healthcare professional office/clinic visit and emergency room/department or urgent care. Therapeutic measures were not taken as a result of events. Since the vaccination, the patient had not been tested for COVID-19. The clinical outcome of the events extreme malaise, weakness and dizziness were resolving at the time of this report.


VAERS ID: 1842254 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-10-27
Onset:2021-10-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Immunisation, Vaccination site erythema, Vaccination site swelling
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: Medical History/Concurrent Conditions: Allergy to NSAIDs (Known allergies: NSAIDS)
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101485036

Write-up: Redness, slightly distal (`2in)to site of injection.; swelling slightly distal (`2in) to site of injection; Booster dose taken on 27Oct2021; This is a spontaneous report from a contactable nurse. A 26-year-old non-pregnant female patient received third (BOOSTER) dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: UNKNOWN) via an intramuscular route of administration in the left arm on 27Oct2021 (at the age of 26-years-old) as a single dose for COVID-19 immunisation. Medical history included allergy to non-steroidal anti inflammatory drugs (NSAIDS). Prior to the vaccination, the patient was not diagnosed with COVID-19. The patient did not take any concomitant medications within 2 weeks of vaccination. The patient did not receive any other vaccines within four weeks prior to the vaccination. The patient previously received second dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: UNKNOWN) via an unspecified route of administration on an unknown date and also received first dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: UNKNOWN) via an unspecified route of administration on an unknown date as a single dose for COVID-19 immunisation. On 30Oct2021, the patient experienced redness and swelling slightly distal to 2 inches to the site of injection. The events did not result in doctor or other healthcare professional office/clinic visit, emergency room/department or urgent care. Therapeutic measures were not taken as a result of the events. Since the vaccination, the patient had not been tested for COVID-19. The clinical outcome of the events redness and swelling slightly distal to 2 inches to the site of injection were resolving at the time of this report. No follow-up attempts are possible; information about lot/batch number cannot be obtained. No further information is expected.


VAERS ID: 1842445 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-10-27
Onset:2021-10-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034C21A / 2 - / OT

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Expired vaccine administered beyond 12 hours post puncture for booster dose; This spontaneous case was reported by an other health care professional and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (Expired vaccine administered beyond 12 hours post puncture for booster dose) in a 64-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 034C21A) for COVID-19 vaccination. Previously administered products included for COVID-19 vaccination: Johnson and Johnson COVID-19 Vaccine (First dose administered using Johnson and Johnson COVID-19 vaccine) on 27-Mar-2021. Past adverse reactions to the above products included No adverse event with Johnson and Johnson COVID-19 Vaccine. On 27-Oct-2021 at 9:30 AM, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On an unknown date, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 27-Oct-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (Expired vaccine administered beyond 12 hours post puncture for booster dose). On 27-Oct-2021, EXPIRED PRODUCT ADMINISTERED (Expired vaccine administered beyond 12 hours post puncture for booster dose) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No concomitant medication was reported. No treatment medication was reported. The vial was in the refrigerator for 24 hours after punctured and didn''t undergo any temperature excursions.


VAERS ID: 1842450 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-08-26
Onset:2021-10-27
   Days after vaccination:62
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022C21A / 1 RA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Accidental underdose, Inappropriate schedule of product administration, Wrong technique in device usage process
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: OMEPRAZOLE; CETIRIZINE [CETIRIZINE HYDROCHLORIDE.]
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Allergy NOS; Comments: No medical history was provided by the reporter.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: 2nd dose beyond approved interval; Pt may be got 0.1ml; gave a 2nd dose with faulty syringe and needle came off; This spontaneous case was reported by a nurse and describes the occurrence of INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (2nd dose beyond approved interval), ACCIDENTAL UNDERDOSE (Pt may be got 0.1ml) and WRONG TECHNIQUE IN DEVICE USAGE PROCESS (gave a 2nd dose with faulty syringe and needle came off) in a 46-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 012S21A and 022C21A) for COVID-19 vaccination. No medical history was provided by the reporter. Concurrent medical conditions included Allergy NOS. Concomitant products included CETIRIZINE HYDROCHLORIDE (CETIRIZINE [CETIRIZINE HYDROCHLORIDE]) for Allergy NOS, OMEPRAZOLE for an unknown indication. On 26-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 27-Oct-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On 27-Oct-2021, the patient experienced INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (2nd dose beyond approved interval), ACCIDENTAL UNDERDOSE (Pt may be got 0.1ml) and WRONG TECHNIQUE IN DEVICE USAGE PROCESS (gave a 2nd dose with faulty syringe and needle came off). On 27-Oct-2021, INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (2nd dose beyond approved interval), ACCIDENTAL UNDERDOSE (Pt may be got 0.1ml) and WRONG TECHNIQUE IN DEVICE USAGE PROCESS (gave a 2nd dose with faulty syringe and needle came off) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. No treatment information was provided.


VAERS ID: 1842453 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Male  
Location: Mississippi  
Vaccinated:2021-10-26
Onset:2021-10-27
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011F21A / 3 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Body temperature, Chills, Influenza like illness, Pain, Pyrexia, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20211027; Test Name: BODY TEMPERATURE; Result Unstructured Data: a fever a little over 99 degrees
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Shaky; Flu like symptoms; Achy; Bad chills; Had a fever a little over 99 degrees; This spontaneous case was reported by a consumer and describes the occurrence of TREMOR (Shaky), INFLUENZA LIKE ILLNESS (Flu like symptoms), PAIN (Achy), CHILLS (Bad chills) and PYREXIA (Had a fever a little over 99 degrees) in an 89-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 011F21A) for COVID-19 vaccination. No Medical History information was reported. On 26-Oct-2021, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 27-Oct-2021, the patient experienced TREMOR (Shaky), INFLUENZA LIKE ILLNESS (Flu like symptoms), PAIN (Achy), CHILLS (Bad chills) and PYREXIA (Had a fever a little over 99 degrees). At the time of the report, TREMOR (Shaky), INFLUENZA LIKE ILLNESS (Flu like symptoms), PAIN (Achy), CHILLS (Bad chills) and PYREXIA (Had a fever a little over 99 degrees) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 27-Oct-2021, Body temperature: 99 (High) a fever a little over 99 degrees. No concomitant medications reported. No treatment information was provided.


VAERS ID: 1842570 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Texas  
Vaccinated:2021-10-27
Onset:2021-10-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 023C21A / UNK - / OT

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Expired dose administered; Based on the current case data, this case has been classified as invalid. This spontaneous case was reported by a nurse and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (Expired dose administered) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 023C21A) for COVID-19 vaccination. No Medical History information was reported. On 27-Oct-2021, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 27-Oct-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (Expired dose administered). On 27-Oct-2021, EXPIRED PRODUCT ADMINISTERED (Expired dose administered) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No relevant concomitant medications were reported. Treatment medication was not provided by the reporter. Reporter did not allow further contact


VAERS ID: 1842572 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-10-27
Onset:2021-10-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Limb discomfort, Pain in extremity
SMQs:, 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: opposite arm (left) started to hurt in the upper area/ pain moved all the way the down to her wrist/ collar bone down now/felt like someone punched me; could not even activate the turn signal in their car/not lift their left arm/could not lift boxes at work; Based on the current case data, this case has been classified as invalid. This spontaneous case was reported by a consumer and describes the occurrence of PAIN IN EXTREMITY (opposite arm (left) started to hurt in the upper area/ pain moved all the way the down to her wrist/ collar bone down now/felt like someone punched me) and LIMB DISCOMFORT (could not even activate the turn signal in their car/not lift their left arm/could not lift boxes at work) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On 27-Oct-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 27-Oct-2021, the patient experienced PAIN IN EXTREMITY (opposite arm (left) started to hurt in the upper area/ pain moved all the way the down to her wrist/ collar bone down now/felt like someone punched me) and LIMB DISCOMFORT (could not even activate the turn signal in their car/not lift their left arm/could not lift boxes at work). At the time of the report, PAIN IN EXTREMITY (opposite arm (left) started to hurt in the upper area/ pain moved all the way the down to her wrist/ collar bone down now/felt like someone punched me) and LIMB DISCOMFORT (could not even activate the turn signal in their car/not lift their left arm/could not lift boxes at work) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. No concomitant medications reported. No treatment reported.


VAERS ID: 1842580 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-10-27
Onset:2021-10-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 076C21A / 3 - / OT

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Expired vaccine given to patient; This spontaneous case was reported by a pharmacist and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (Expired vaccine given to patient) in an 88-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 076C21A) for COVID-19 vaccination. No Medical History information was reported. On 27-Oct-2021, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 27-Oct-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (Expired vaccine given to patient). On 27-Oct-2021, EXPIRED PRODUCT ADMINISTERED (Expired vaccine given to patient) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. The concomitant medications on use were not provided. No treatment information was provided. The vial was punctured on 26-oct-2021 at 3 PM and returned to the refrigerator after administering to a couple of patients on 26 Oct 2021 and then on 27 Oct 2021 at 9:30 AM, the punctured vial was used to administer booster doses to 4 patients. No adverse reactions was reported so far. This case was linked to MOD-2021-365967, MOD-2021-365848, MOD-2021-366345 (Patient Link).


VAERS ID: 1842585 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-10-27
Onset:2021-10-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 076C21A / UNK - / OT

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: expired vaccine given to patient; This spontaneous case was reported by an other health care professional and describes the occurrence of EXPIRED PRODUCT ADMINISTERED in a 68-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 076C21A) for COVID-19 vaccination. No Medical History information was reported. On 27-Oct-2021 at 9:30 AM, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 27-Oct-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED. On 27-Oct-2021, EXPIRED PRODUCT ADMINISTERED had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. Concomitant medications details were not reported by the reporter. Treatment details was not reported by the reporter. This case was linked to MOD-2021-365967, MOD-2021-365701 (Patient Link).


VAERS ID: 1842591 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-10-27
Onset:2021-10-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 076C21A / 3 - / OT

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: expired vaccine given to patient; This spontaneous case was reported by an other health care professional and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (expired vaccine given to patient) in an 85-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 076C21A) for COVID-19 vaccination. No Medical History information was reported. On 27-Oct-2021, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 27-Oct-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (expired vaccine given to patient). On 27-Oct-2021, EXPIRED PRODUCT ADMINISTERED (expired vaccine given to patient) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. Patient was administered with vaccine which was punctured the day before 26-oct-2021 at 3 pm. No adverse reactions were reported as far. Concomitant medications were not provided. Treatment information was not provided.


VAERS ID: 1842593 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Arizona  
Vaccinated:2021-10-27
Onset:2021-10-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 076C21A / UNK - / OT

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: USMODERNATX, INC.MOD20213

Write-up: vaccine was administered to 1 patient past the 30-day refrigeration date; Product storage error; Based on the current case data, this case has been classified as invalid. This spontaneous case was reported by a pharmacist and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (vaccine was administered to 1 patient past the 30-day refrigeration date) and PRODUCT STORAGE ERROR (Product storage error) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 076C21A) for COVID-19 vaccination. No Medical History information was reported. On 27-Oct-2021, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 27-Oct-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (vaccine was administered to 1 patient past the 30-day refrigeration date) and PRODUCT STORAGE ERROR (Product storage error). On 27-Oct-2021, EXPIRED PRODUCT ADMINISTERED (vaccine was administered to 1 patient past the 30-day refrigeration date) and PRODUCT STORAGE ERROR (Product storage error) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No concomitant medications were reported. No treatment information was provided.


VAERS ID: 1842601 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-27
Onset:2021-10-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006C21A / 3 - / OT

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Administered vaccine past the published expiration date; This spontaneous case was reported by a health care professional and describes the occurrence of EXPIRED PRODUCT ADMINISTERED in a 57-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 006C21A) for COVID-19 vaccination. No Medical History information was reported. On 27-Oct-2021, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 27-Oct-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED. On 27-Oct-2021, EXPIRED PRODUCT ADMINISTERED had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No concomitant medications were reported. It was reported that the vial was initially stored in the refrigerator on 30September2021. No treatment medications were reported.


VAERS ID: 1842620 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-01-27
Onset:2021-10-27
   Days after vaccination:273
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029L20A / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Biopsy, Erythema, Feeling hot, Swelling face
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Asthma; Blood pressure; Breast cancer; Cholesterol
Preexisting Conditions: Medical History/Concurrent Conditions: Heart attack
Allergies:
Diagnostic Lab Data: Test Name: Biopsy; Result Unstructured Data: Cancer
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: red/never ever had fillers or Botox, or anything like that; warm; Cheek swelling; This spontaneous case was reported by a consumer and describes the occurrence of ERYTHEMA (red/never ever had fillers or Botox, or anything like that), FEELING HOT (warm) and SWELLING FACE (Cheek swelling) in an 82-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 038C21A, 025A21A and 029L20A) for COVID-19 vaccination. The patient''s past medical history included Heart attack. Concurrent medical conditions included Blood pressure, Breast cancer, Cholesterol and Asthma. On 27-Jan-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 03-Mar-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 25-Oct-2021, received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 27-Oct-2021, the patient experienced ERYTHEMA (red/never ever had fillers or Botox, or anything like that), FEELING HOT (warm) and SWELLING FACE (Cheek swelling). At the time of the report, ERYTHEMA (red/never ever had fillers or Botox, or anything like that), FEELING HOT (warm) and SWELLING FACE (Cheek swelling) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On an unknown date, Biopsy: cancer (abnormal) Cancer. Concomitant products included 9 prescription medications, Blood thinners, Blood pressure pills, Cholesterol thing, and Inhaler in the morning for asthma. Patient has a surgery scheduled for November 6th. No treatment medication details was reported. This case was linked to MOD-2021-366737 (Patient Link).


VAERS ID: 1842653 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-10-27
Onset:2021-10-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-04
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: 1842787 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-10-26
Onset:2021-10-27
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017F21A / 3 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Chills, Extra dose administered, Eye pain, Fatigue, Feeling abnormal, Malaise, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Glaucoma (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: Calcium, Vitamin D3, lutein, CO-Q10, Centrum Silver multivitamin, fish oil, simvastatin 20 mg, probiotic
Current Illness: None
Preexisting Conditions: None
Allergies: Ceclor
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Besides the usual fever, chills, malaise, body aches and fatigue, I had pain behind my left eye. It felt like a "headache" behind my left eye and it hurt when I moved my eyeball up, down or side-to-side.


VAERS ID: 1842844 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-04-14
Onset:2021-10-27
   Days after vaccination:196
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8731 / 1 RA / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Cough, Rhinorrhoea, SARS-CoV-2 test positive, Transient ischaemic attack
SMQs:, Anaphylactic reaction (broad), Ischaemic central nervous system vascular conditions (narrow), Embolic and thrombotic events, arterial (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 10/27/2021 0116 COVID-19 (SARS CoV-2,RNA Molecular Amplification) Collected: 10/27/21 0116 | Final result | Specimen: Swab from Nasopharynx COVID-19 SARS-CoV-2 Overall Result Det
CDC Split Type:

Write-up: ED to Hosp-Admission Discharged 10/27/2021 - 11/2/2021 (6 days) TIA (transient ischemic attack) #COVID-19 infection (initial positive date 10/27) -only symptoms were cough and rhinorrhea -Tested +10/27. Test was negative on 10/20 during previous admission. Patient was immunized with Pfizer x2 doses in April/May -Completed remdesivir ?Continue dexamethasone (day 5/10) -did not require supplemental oxygen during admission


VAERS ID: 1842884 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-10-26
Onset:2021-10-27
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012F21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: COVID-19, Chest discomfort, Dysphonia, Extra dose administered, Fatigue, Nasal congestion, Nasopharyngitis, Respiratory tract congestion, Rhinorrhoea, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Parkinson-like events (broad), Medication errors (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Levothyroxine, Multivitamin, CoQ10, Vit. D3, Turmeric, B12, Omega 3, Resveratrol
Current Illness: no
Preexisting Conditions: Hypothyroidism
Allergies: Ibuprofen, Statins
Diagnostic Lab Data: COVID-19-positive
CDC Split Type: vsafe

Write-up: A next days after the vaccine late in the evening an extreme tired feeling just came over me. I sleep real good. The next day was ok but later that day that same extreme tired feeling came over me again. 10/29 I got a runny nose and developed various cold like symptoms. I started feeling a little congested. 10/30 while working outside I was fine, but later in the afternoon while talking I noticed I had a developed a bronchial crackly voice sound. My upper chest began feeling funny of a congested like feeling. 10/31 I reached out to my PCP and advised I thought I had bronchitis due to the symptoms I was having, but I got no response so I called the Urgent care and advised of my symptoms and was advised to come in. I went to the Urgent Care where a COVID test was performed. That Monday following my Dr''s office finally reached back out to me later and did hear the crackly sound of my voice and advised if the symptoms got worse to seek additional care. On 11/3 the Urgent Care''s office and my Dr''s office received the COVID positive test results and called me and now wants to do the Monoclonal Antibodies injection for the COVID positive status. I still have a lot of nasal stuffiness in the back upper throat chest area.


VAERS ID: 1842922 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-03-18
Onset:2021-10-27
   Days after vaccination:223
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7534 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Anaemia, Angiogram abnormal, Asymptomatic COVID-19, Bronchiectasis, COVID-19, Colonoscopy normal, Diverticulum intestinal, Gastrointestinal haemorrhage, Haemoglobin decreased, Intervertebral disc degeneration, Mesenteric artery stenosis, Nephrolithiasis, Pulmonary fibrosis, Rectal haemorrhage, Renal artery arteriosclerosis, Renal artery stenosis, Renal atrophy, SARS-CoV-2 test positive, Scan with contrast abnormal, Vertebral foraminal stenosis
SMQs:, Haematopoietic erythropenia (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (broad), Interstitial lung disease (narrow), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Gastrointestinal haemorrhage (narrow), Gastrointestinal nonspecific dysfunction (broad), Ischaemic colitis (broad), Renovascular disorders (narrow), Chronic kidney disease (broad), Tubulointerstitial diseases (broad), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: albuterol HFA (PROVENTIL;VENTOLIN) 90 mcg/actuation inhaler amLODIPine (NORVASC) 10 mg tablet aspirin 81 mg tablet atorvastatin (LIPITOR) 10 mg tablet azelastine 205.5 mcg (0.15 %) spray,non-aerosol budesonide-formoterol (SYMBICORT) 16
Current Illness:
Preexisting Conditions: Nervous Type 2 diabetes mellitus with neurologic complication Benign paroxysmal positional vertigo due to bilateral vestibular disorder Cervicalgia Respiratory Asthma, mild persistent Circulatory CAD (coronary artery disease) Cardiomyopathy Benign essential hypertension Digestive Gastrointestinal hemorrhage associated with anorectal source Genitourinary Chronic kidney disease, stage 3 Musculoskeletal Primary osteoarthritis of right knee Endocrine/Metabolic Hyperlipidemia Infectious/Inflammatory COVID-19 virus infection Other Other contact with and (suspected) exposures hazardous to health Dependent edema
Allergies: PenicillinsHives / Urticaria, Rash, Other (document details in comments) Sulfa (Sulfonamide Antibiotics)Hives / Urticaria, Rash MoldOther (document details in comments)
Diagnostic Lab Data: 10/27/2021 2159 COVID-19 (SARS CoV-2,RNA Molecular Amplification) Collected: 10/27/21 2159 | Final result | Specimen: Swab from Nasopharynx COVID-19 SARS-CoV-2 Overall Result Detected Critical 10/27/2021 2159 COVID-19 PCR - Asymptomatic screening for admission Collected: 10/27/21 2159 | Final result | Specimen: Swab from Nasopharynx CT angiogram abdomen pelvis with and without contrast for bleeding Resulted: 10/31/21 0646 Order Status: Completed Updated: 10/31/21 0646 Narrative: CT ANGIOGRAM ABDOMEN PELVIS W WO CONTRAST FOR BLEEDING IMPRESSION: No evidence of active GI hemorrhage. No acute findings. Chronic findings as noted in the report. END OF IMPRESSION: INDICATION: Rectal Bleeding, GI bleed. TECHNIQUE: Contiguous collimation 1 mm axial images. 3D volume acquisition was performed through the abdomen and pelvis. Images obtained with contrast including noncontrast images. 3D shaded surface display, maximum curved intensity projection (MIP) and multiplanar reconstructions were performed and permanently recorded. CONTRAST: 80mL of IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION administered INTRAVENOUS. COMPARISON: None available. FINDINGS: There is no evidence of active GI hemorrhage. There is extensive diffuse colonic diverticulosis without evidence of diverticulitis. The normal-sized appendix is identified. The aortoiliac vessels are normal in size. The celiac artery is preserved. There is moderate plaque and moderate stenosis at the SMA origin. There is moderate plaque at the renal artery origins with moderate stenosis bilaterally. There are duplicated right renal arteries. The IMA is preserved. The liver, gallbladder, spleen, pancreas, adrenal glands, bladder, and prostate gland are unremarkable. There is bilateral renal atrophy. There are small nonobstructive left renal calculi. No free fluid is present. No large lymph nodes are apparent. The heart is normal in size. There is mild scarring and bronchiectasis in the lung bases. There are no acute findings in the bones. There is moderate degenerative change at L2-L3 with bilateral bony neural foraminal narrowing.
CDC Split Type:

Write-up: ED to Hosp-Admission Discharged 10/27/2021 - 10/29/2021 (2 days) HPI: Very pleasant 84-year-old gentleman with a past medical history of coronary artery disease with last intervention several years ago, previous CABG, previous stenting, CKD stage III who presented to Hospital with bright red blood per rectum and significant drop in hemoglobin resulting in anemia. Hospital Course: Patient was hospitalized for GI bleed but incidentally tested positive for COVID-19 in the setting of vaccinations x2. Patient underwent colonoscopy which did not reveal source for bleeding. He does have underlying diverticula so it is quite possible that a self-limited diverticular bleed might have been the etiology of the bleed. He can follow-up with gastroenterology as an outpatient if needed. Please recheck hemoglobin in 3 to 5days. Due to bleeding as above, he has been recommended to avoid NSAIDs. Furthermore, I am going to stop Brilinta and recommend that PCP evaluate the need for dual antiplatelet therapy. I do not see an indication. Patient is asymptomatic from COVID-19 and I do not think he warrants further hospitalization in regards to this. Would recommend quarantine time of 10 days for asymptomatic patient


VAERS ID: 1842987 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-10-27
Onset:2021-10-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FG3257 / 3 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Breath sounds abnormal, Cardiomegaly, Chest X-ray, Chest pain, Computerised tomogram thorax, Dyspnoea, Electrocardiogram, Immunodeficiency, Troponin
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Respiratory failure (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: Ferrous Sulfate, Novolog insulin, Pyridoxine, Cyanocobalamin, Venlafaxine, OxyContin, Omeprazole, Oxycodone, Levemir Flextouch Insulin, Aripiprazole, Aspirin, Proventil inhaler, Donepezil, Simvastatin, Sorbitol, Symbicort, Fentanyl, Norvas
Current Illness: Recent changes in her Mental Health treatment.
Preexisting Conditions: Kidney Disease Toxic metabolic encephalopathy, chronic UTI, Heart Failure, preserved Ejection Fracture, Hyperlipademia DM Hypercalcemia SIRS, acute Resp failure , hypertension, anemia, Vit D deficiency, depression, glaucoma, dyspnea, thrombosis COPD, chronic pain, cardiomegaly, dysphagia Bipolar Dementia
Allergies: PCN
Diagnostic Lab Data: see above
CDC Split Type:

Write-up: 11:45 PM c/o SOB, 10/10 chest pain, diminished bilateral breath sounds T 101, HR 120, 20 O2Sat 88-89% RA. 3L O2 applied, sat went up to 95%. BP 160/80 Tylenol given transferred to ER. CXR done patchy infiltrates seen , CT of chest showed Cardiomegaly, Cardiac Troponin and EKG were negative. DX on admission was Acute Respiratory Failure with hypoxia. Sinus Tach. Suspected due to Covid Vaccine Booster. FYI Resident was Covid + in March of 2020.


VAERS ID: 1843002 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-10-27
Onset:2021-10-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012F21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Decreased appetite, Dizziness postural, Dysphonia, Fatigue, Feeling abnormal, Feeling drunk, Impaired driving ability, Impaired work ability, Injection site pain, Nausea, Oropharyngeal pain, Productive cough, Pulmonary pain, Swelling face, Vision blurred
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (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: Effexor XR, Ativan, Abilify, vistaril, creastor, trazadone and B12
Current Illness: 0
Preexisting Conditions: Bipolar type 1, anxiety, high cholesterol, insomnia
Allergies: Adhesive tape
Diagnostic Lab Data: None to date. Will be Covid tested
CDC Split Type:

Write-up: injection site was pain nauseous Appetite lost Day 2 All above plus fatigue extreme Day 3 Uneventful Day 4 Tiredness and above sxs Day 5 Sore throat Hoarseness Weakness Blurry vision Brain fog Unable to work or drive Felt drunk but wasn?t Positional dizziness Productive cough Pain in lungs Decreased appetite Facial swelling


VAERS ID: 1843108 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-03-29
Onset:2021-10-27
   Days after vaccination:212
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8734 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, Anticoagulant therapy, Asymptomatic COVID-19, Computerised tomogram abdomen abnormal, Explorative laparotomy, Gastrointestinal wall thickening, Intestinal perforation, Intestinal resection, Leukopenia, Peritonitis, Pneumoperitoneum, Pyrexia, SARS-CoV-2 test positive, Tachycardia, Tenderness
SMQs:, Acute pancreatitis (broad), Haematopoietic leukopenia (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Malignancy related therapeutic and diagnostic procedures (narrow), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal perforation (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 8 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: allopurinoL (ZYLOPRIM) 300 mg tablet aspirin 81 mg tablet atorvastatin (LIPITOR) 80 mg tablet clopidogreL (PLAVIX) 75 mg tablet dexAMETHasone (DECADRON) 4 mg tablet nitroglycerin (NITROSTAT) 0.4 mg SL tablet prochlorperazine (COMPAZIN
Current Illness:
Preexisting Conditions: Non-Hospital Cerebrovascular accident (CVA), unspecified mechanism Bilateral carotid artery stenosis Hyperlipidemia Arthritis Atherosclerosis of native coronary artery of native heart without angina pectoris Cigarette smoker Alcohol abuse Lymphoproliferative disorder
Allergies: NKA
Diagnostic Lab Data: Collected Procedure 10/27/2021 1525 COVID-19 (SARS CoV-2,RNA Molecular Amplification) Collected: 10/27/21 1525 | Final result | Specimen: Swab from Nasopharynx COVID-19 SARS-CoV-2 Overall Result Detected Critical 10/27/2021 1525 COVID-19 PCR - Asymptomatic screening for admission Collected: 10/27/21 1525 | Final result | Specimen: Swab from Nasopharynx
CDC Split Type:

Write-up: Asymptomatic screening for admission ED to Hosp-Admission Current 10/27/2021 - present (8 days) Hospital SURGERY PROGRESS NOTE Background: The patient is a 75 year old male with history of follicular lymphoma with imaging-proven cancer involvement of the abdomen, who presented to the ED with one day of severe abdominal pain. Patient was febrile and tachycardic, with peritonitis noted on physical exam. A CT scan of the abdomen and pelvis revealed findings of foci of free air in the right lower quadrant, and diffuse bowel thickening, raising concern for viscus perforation. Patient now s/p laparotomy with 30 cm small bowel resection. Subjective NAEON. Pain is well controlled. Objective Temperature: [36.9 ?C (98.4 ?F)-37.5 ?C (99.5 ?F)] 37.5 ?C (99.5 ?F) Heart Rate: [84-119] 109 Resp: [16-18] 18 BP: (110-114)/(66-72) 110/68 Body mass index is 27.55 kg/m?. 11/03 0701 - 11/04 0700 In: 540 [P.O.:360] Out: 950 [Urine:950] Physical Exam: General - awake, alert, NAD Respiratory - non-labored CV - RRR GI -abdomen soft, minimally tender to palpation. Midline incision OTA with no drainage. Ext - WWP Labs & Images reviewed. Assessment/Plan 75 y.o. male with small bowel perforation secondary to lymphoma status post exploratory laparotomy with resection of 30 cm of distal ileum and primary anastomosis, now 8 Days Post-Op. o Home medications including aspirin and PO plavix restarted. o PRN Oxy and ATC Tylenol o Continued Leukopenia. o Oncology consult- Patient will resume chemotherapy as an outpatient, no need to treat leukopenia unless ANC less than 1 o PT/OT: Recommending discharge to facility, 24/7 care cannot be provided at home. o DVT prophylaxis: SCDs, Lovenox o Adult diet Regular; Yes o Dispo: Will require hospitalization until 14 days after his COVID diagnosis and can then be discharged to facility MD 11/4/2021 7:27 AM MD at 11/3/2021 7:48 AM


VAERS ID: 1843170 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-10-21
Onset:2021-10-27
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8020 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Condition aggravated, Cough, Culture urine negative, Dyspnoea, Lung disorder, Malaise, Platelet count increased, SARS-CoV-2 test negative, Thrombocytosis
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: tylenol, proair, azithromycin 3/week, pulmicort, coreg bid, vitamin D, plavix, colace, repatha, flonas, asix, bevespi, hydroxyurea, atrovent neb, protonix, prednisone 10, trazodone
Current Illness: 1. Hypertension. 2. Carotid stenosis- followed by vascular surgery 3. Hyperlipidemia 4. Allergic rhinitis 5. Tobacco abuse, quit 3/15 6. Hyperparathyroidism 7. COPD 8. Osteopenia 9. Anxiety 10. CAD, followed by cards (RCA stent 03/2015. NSTEMI. Subsequent cath demonstrated left main and circumflex mild nonobstructive CAD, LAD mid 50 and RCA had a proximal 70 that had a drug-eluting stent.) 11. PAD (4/15- LE ABI''s) 12. Polycythemia rubra vera, followed by heme 13. Adrenal insufficieny with Long-term steroid use. 14. GERD with h/o UGIB 15. CKD 16 .Diabetes
Preexisting Conditions: see above
Allergies: ace inhibitors, codeine
Diagnostic Lab Data: see above
CDC Split Type:

Write-up: patient with h/o polycythemia rubra vera, followed by heme and has monitoring CBC almost weekly to q2weeks. day prior to pfizer #2, platelets increased to 757. previous value 10/12/21 at 95. ranges low with high of 1176. h/o thrombocytosis when she is ill with COPD/pneumonia in past. started on hydroxyurea 9/21 and had complaints of diarrhea, but improved. then 10/27, platelets were 1558. minimal symptoms. urine culture negative. seen in my office 10/29/21 and just started with worsening SOB and cough. RLL lung findings and started on augmentin. covid test negative. Seen 11/4/21 for f/u and plt now down to 511. Thrombocytosis could be due to infection, resolving with antibiotics, but just wanted to report for possible link with pfizer vaccine. thanks


VAERS ID: 1843282 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-10-22
Onset:2021-10-27
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH 8020 / 3 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Balance disorder, Feeling abnormal, Headache, Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre 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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Hives, Severe hypersensitivity to smell, odors, which caused hives and dizziness
Other Medications: Compounded HRT Ducosate Calcium Metamucil
Current Illness: none
Preexisting Conditions:
Allergies: Aspirin Cortico steroids Compazine Adverse reactions to: all antibiotics lisinopril
Diagnostic Lab Data: saw MD 11/2/21 no tests
CDC Split Type:

Write-up: Nausea, Vomiting, initially Frontal headache Loss of balance, Feeling off balance this has continued for more than 8 days


VAERS ID: 1843304 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: Kansas  
Vaccinated:2021-10-27
Onset:2021-10-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939905 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain upper, Axillary pain, Bradyphrenia, Fatigue, Feeling abnormal, Injection site pain, Mental impairment, Pain, Pain in extremity
SMQs:, Acute pancreatitis (broad), Dementia (broad), Parkinson-like events (broad), Psychosis and psychotic disorders (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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: VAERS ID: 1798411; E-report number 684557
Other Medications: N/A
Current Illness: None
Preexisting Conditions: Seasonal allergies
Allergies: Unknown
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Extreme arm soreness where injected. Sharp stabbing pains would suddenly come and go throughout my body. The sharp stabbing pains were most painful in my right kidney area and just below my sternum. The pain below my sternum was so bad I would have to buckle over. I also had pain in right arm that mirrored the pain in the left arm where I was injected even though I had not been injected in my right arm. The right arm pain was a constant pain and did not come and go like the other sharp stabbing pains. I also had fatigue and slight brain fog. I had trouble thinking clearly at times and was told my reaction times were noticeably slower. This lasted about two days. The injection area pain was the last to subside. It lasted four days. I was extremely sore under my left arm and putting deodorant on was very painful all four days.


VAERS ID: 1843392 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-10-27
Onset:2021-10-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Erythema, Flushing, Pharyngeal erythema, Throat irritation
SMQs:, Anaphylactic reaction (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: On exam by the provider results were as follows: face was somewhat flushed, little bit of patchy redness over her chest and neck area. Oropharynx was clear, posterior pharynx is minimally erythematous left posterior pharynx. Patient reported itchy throat. These symptoms occurred 15 minutes after her COVID 19 injection was administered. After being examined by Dr. the order was given to administer Benadryl 25mg IM in the right deltoid. This was administered by the CMA.


VAERS ID: 1843451 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-10-26
Onset:2021-10-27
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 091D21A / 3 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chills, Feeling cold
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: Rosuvastatin 10MG 1 WEEK Mirtazapine 15MG @ NIGHT Ambien 10MG @ BED TIME Naproxen 220 MG Allergy pill Cetirizine 10 MG Aspirin 81MG Prolocet Mens vitamins Calcium 1200 Vitamin D 2000 Trimeric 500 Flaxseed oil 1000 Fish oil
Current Illness: NO
Preexisting Conditions: Arthritis
Allergies: Only outdoor allergies
Diagnostic Lab Data: NO
CDC Split Type: vsafe

Write-up: I experience some chills after I received my booster, I just was very very cold. Nothing really worked for it, That evening I was fine.


VAERS ID: 1843479 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-10-27
Onset:2021-10-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2593 / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chills, Cough, Fatigue, Headache, Influenza like illness, Muscular weakness, Nausea, Pain, SARS-CoV-2 test negative
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), COVID-19 (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: Mirena (IUD)
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: Egg component IgE raw and cooked eggs , milk, gluten, alcohol, ceclor, contrast penicillins, cephalexin,
Diagnostic Lab Data: i received a rapid covid/flu/ rsv test which had came back negitive this was done on 11/02/21 at 2:30pm
CDC Split Type:

Write-up: On the day I received my shot around 7:30 I started to get a pounding headache, followed by muscle weakness and the and nausea. The following date 11/28/21 I woke up with a pounding headache, followed by body ache, tiredness, nausea, chills, flu like symptoms, these symptoms didn''t get better they only got worse as the days went on. as of 11/02/21 i had called my drs office and they had stated that my symptoms sounded like covid. they scheduled me to go in to get a rapid test done, which came back negative. an hour later i had an appointment with the dr over the phone due to my symptoms and he prescribed me medication to help, i have now been taking this medication for a few days now and symptoms are not getting any better, if anything it is making my cough worse and i am starting to have pain due to coughing so much


VAERS ID: 1843557 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Delaware  
Vaccinated:2021-10-27
Onset:2021-10-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache, Intermenstrual bleeding, Migraine, Urine analysis, Vaginal haemorrhage
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: I generally have issues with the flu vaccine. I would feel sick and have been put in the hospital with flu like symptoms.
Other Medications: I was taking Trilogy.
Current Illness: I was not experiencing any illness.
Preexisting Conditions: I have asthma/COPD.
Allergies: I am allergic to Phenergan and cipro.
Diagnostic Lab Data: The doctor performed a urine analysis. My urine came back clear.
CDC Split Type: vsafe

Write-up: Almost instantly after receiving both of my doses, I experienced an instant headache which turned into a migraine. I''m still experiencing headaches but they are not migraines. Within an hour, I also experienced vaginal bleeding (full like a period) that lasted 24 hours and the next day I spotted, but the then it was gone. I would like say that I am very skeptical about receiving this vaccine. I do not think that people should be forced to get the vaccine because it reacts differently with everyone''s bodies.


VAERS ID: 1843568 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-10-27
Onset:2021-10-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2593 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test, Chest X-ray, Chest discomfort, Chest pain, Computerised tomogram, Dyspnoea, Electrocardiogram normal, Loss of consciousness, Palpitations, Pericarditis
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Flu shot, 1998, I ended up feeling like I had the flu, fever and chills. But never a heart issue.
Other Medications: No
Current Illness: No
Preexisting Conditions: No
Allergies: Lortab; Macrobid; sensitive to all nuts I don''t go into anaphylaxis
Diagnostic Lab Data: A lot of blood test, EKG-fine, blood pressure-fine, chest x-rays, CAT scan of my chest
CDC Split Type: vsafe

Write-up: On 10/27/2021, 7 mins after the injection, I blackout, passed out cold. I finally came through. My heart was racing and palpitating. Someone drove me home. The next day and all that day, my heart palpitations, and my heart was racing. On Saturday along with the heart issues. I was also starting to get shortness of breath. I started getting pressure in my chest. Then I started getting pain in my chest. On, Tuesday, 11/02/2021, Everything kept getting worse I had shortness of breath. I passed out again. On Tuesday, My husband took me to the ER room. We were there for like 10 to 11 hours. The doctor ruled out myocarditis and blood clot in the lungs. The ER doctor said my symptoms fit pericarditis. But he wants me to confirm with a cardiologist. Right now I am working on an appointment with a cardiologist.


VAERS ID: 1843576 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-10-26
Onset:2021-10-27
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026D21A / 3 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Erythema, Induration, Mobility decreased, Pain, Peripheral swelling, Pruritus, Rash
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Parkinson-like events (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), 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? No
Previous Vaccinations: Shingles 02/25/2008
Other Medications: Tylenol 500mg
Current Illness: 0
Preexisting Conditions: Atrial fib; hypertension; high blood pressure; GERD; osteoarthritis
Allergies: Neomycin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Swelling of arm to twice the size; redness; rash; itching; soreness; unable to lift arm above shoulder; hard to touch


VAERS ID: 1843584 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-10-27
Onset:2021-10-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / 1 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Blood urine present, Dizziness, Fibrin D dimer increased, Headache, Magnetic resonance imaging, Pain in extremity, SARS-CoV-2 test negative, Vomiting
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (narrow), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad), COVID-19 (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: Received first dose of PFIZER 10/27/21. Within five minutes of first dose she was vomiting. States she then became dizzy on the way home and vomited again. She has had severe headaches since the vaccine as well. Was seen at Clinic 10/29/21 due to vomiting, headache, blood in urine, and right leg pain. Urine testing was negative for UTI and kidney stone. Leg ultrasound was negative for clot. D dimer was elevated. COVID test was negative. Was seen again in clinic 11/3/21. Given steroids and a Toradol injection for ongoing headache. Has follow up appointment 11/5/21 and will likely do MRI due to ongoing headache. May do ABI due to ongoing leg pain as well. States today is the first day since being vaccinated that she has not had a headache.


VAERS ID: 1843653 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-10-27
Onset:2021-10-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 058E21A / 3 LA / IM

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

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

Write-up: NURSE ADMINISTERING VACCINE ADMINISTERED SOME DOSES AS 0.5ML INSTEAD OF 0.25ML FOR BOOSTER. WHEN ERROR WAS REALIZED SHE WAS UNSURE WHICH PATIENT RECEIVED THE 0.5ML VS 0.25ML. THIS PATIENT MAY HAVE RECEIVED 0.5ML INSTEAD OF 0.25ML.


VAERS ID: 1843662 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-10-27
Onset:2021-10-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 058E21A / 3 LA / IM

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

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

Write-up: NURSE ADMINISTERING VACCINE ADMINISTERED SOME DOSES AS 0.5ML INSTEAD OF 0.25ML FOR BOOSTER. WHEN ERROR WAS REALIZED SHE WAS UNSURE WHICH PATIENT RECEIVED THE 0.5ML VS 0.25ML. THIS PATIENT MAY HAVE RECEIVED 0.5ML INSTEAD OF 0.25ML.


VAERS ID: 1843666 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-10-27
Onset:2021-10-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 058E21A / 3 RA / IM

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

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

Write-up: NURSE ADMINISTERING VACCINE ADMINISTERED SOME DOSES AS 0.5ML INSTEAD OF 0.25ML FOR BOOSTER. WHEN ERROR WAS REALIZED SHE WAS UNSURE WHICH PATIENT RECEIVED THE 0.5ML VS 0.25ML. THIS PATIENT MAY HAVE RECEIVED 0.5ML INSTEAD OF 0.25ML.


VAERS ID: 1843668 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-10-27
Onset:2021-10-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 058E21A / 3 LA / IM

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

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

Write-up: Nurse administered some doses as 0.5mL instead of 0.25mL for booster vaccine. When error was realized, she was unsure which patient received the 0.5mL vs 0.25mL. This patient may have received 0.5mL instead of 0.25mL.


VAERS ID: 1843673 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-10-27
Onset:2021-10-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 058E21A / 3 LA / IM

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

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

Write-up: Nurse administered some doses as 0.5mL instead of 0.25mL for booster vaccine. When error was realized, she was unsure which patient received the 0.5mL vs 0.25mL. This patient may have received 0.5mL instead of 0.25mL.


VAERS ID: 1843678 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-10-27
Onset:2021-10-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 058E21A / 3 LA / IM

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

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

Write-up: NURSE ADMINISTERING VACCINE ADMINISTERED SOME DOSES AS 0.5ML INSTEAD OF 0.25ML FOR BOOSTER. WHEN ERROR WAS REALIZED SHE WAS UNSURE WHICH PATIENT RECEIVED THE 0.5ML VS 0.25ML. THIS PATIENT MAY HAVE RECEIVED 0.5ML INSTEAD OF 0.25ML.


VAERS ID: 1843682 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-10-27
Onset:2021-10-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 058E21A / 3 LA / IM

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

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

Write-up: NURSE ADMINISTERING VACCINE ADMINISTERED SOME DOSES AS 0.5ML INSTEAD OF 0.25ML FOR BOOSTER. WHEN ERROR WAS REALIZED SHE WAS UNSURE WHICH PATIENT RECEIVED THE 0.5ML VS 0.25ML. THIS PATIENT MAY HAVE RECEIVED 0.5ML INSTEAD OF 0.25ML.


VAERS ID: 1843685 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-10-27
Onset:2021-10-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 058E21A / 3 RA / IM

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

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

Write-up: NURSE ADMINISTERING VACCINE ADMINISTERED SOME DOSES AS 0.5ML INSTEAD OF 0.25ML FOR BOOSTER. WHEN ERROR WAS REALIZED SHE WAS UNSURE WHICH PATIENT RECEIVED THE 0.5ML VS 0.25ML. THIS PATIENT MAY HAVE RECEIVED 0.5ML INSTEAD OF 0.25ML.


VAERS ID: 1843688 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-10-27
Onset:2021-10-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 058E21A / 3 LA / IM

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

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

Write-up: NURSE ADMINISTERING VACCINE ADMINISTERED SOME DOSES AS 0.5ML INSTEAD OF 0.25ML FOR BOOSTER. WHEN ERROR WAS REALIZED SHE WAS UNSURE WHICH PATIENT RECEIVED THE 0.5ML VS 0.25ML. THIS PATIENT MAY HAVE RECEIVED 0.5ML INSTEAD OF 0.25ML.


VAERS ID: 1843695 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-10-27
Onset:2021-10-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 058E21A / 3 RA / IM

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

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

Write-up: NURSE ADMINISTERING VACCINE ADMINISTERED SOME DOSES AS 0.5ML INSTEAD OF 0.25ML FOR BOOSTER. WHEN ERROR WAS REALIZED SHE WAS UNSURE WHICH PATIENT RECEIVED THE 0.5ML VS 0.25ML. THIS PATIENT MAY HAVE RECEIVED 0.5ML INSTEAD OF 0.25ML.


VAERS ID: 1843698 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-10-26
Onset:2021-10-27
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012F21A / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Bone pain
SMQs:, Osteonecrosis (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: I didnt feel great with the second Moderna vaccine.
Other Medications: NP Thyroid 120mg 2 per day once a day Lecartin 50mg once a day Atnolol 50mg once a day Desvenlasaxine Subsanat ER 100mg a day, Calcium 15mg once a day Niacin ER 500mg two at night Medformin 1000mgs twice a day Jardias 25mg once a day
Current Illness: None
Preexisting Conditions: High blood pressure, Type 2 Diabetes , Thyroids and Small cholesterol issue . Anxiety and Depression.
Allergies: Sulfa drugs , augmenton and Nailtrexone
Diagnostic Lab Data: None
CDC Split Type: vsafe

Write-up: I had a pain in my skeleton, my neck my jaw and shoulders and wrist hurt. It felt more skeletal than anything. They provided my Tylenol. I took Advil and the prescription ibuprofen I was given. I spoke to the doctor on the phone, on the 27th of October. I had an appointment with the endocronologist on 28th. He ask that I don''t take the new drug to avoid any complication from Vescepa.


VAERS ID: 1843703 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-10-27
Onset:2021-10-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 058E21A / 3 LA / IM

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

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

Write-up: NURSE ADMINISTERING VACCINE ADMINISTERED SOME DOSES AS 0.5ML INSTEAD OF 0.25ML FOR BOOSTER. WHEN ERROR WAS REALIZED SHE WAS UNSURE WHICH PATIENT RECEIVED THE 0.5ML VS 0.25ML. THIS PATIENT MAY HAVE RECEIVED 0.5ML INSTEAD OF 0.25ML.


VAERS ID: 1843707 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-10-27
Onset:2021-10-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 058E21A / 3 LA / IM

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

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

Write-up: NURSE ADMINISTERING VACCINE ADMINISTERED SOME DOSES AS 0.5ML INSTEAD OF 0.25ML FOR BOOSTER. WHEN ERROR WAS REALIZED SHE WAS UNSURE WHICH PATIENT RECEIVED THE 0.5ML VS 0.25ML. THIS PATIENT MAY HAVE RECEIVED 0.5ML INSTEAD OF 0.25ML.


VAERS ID: 1843719 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-10-27
Onset:2021-10-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 058E21A / 3 RA / IM

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

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

Write-up: NURSE ADMINISTERING VACCINE ADMINISTERED SOME DOSES AS INSTEAD OF FOR BOOSTER. WHEN ERROR WAS REALIZED SHE WAS UNSURE WHICH PATIENT RECEIVED THE WRONG DOSE. THIS PATIENT MAY HAVE RECEIVED WRONG DOSAGE.


VAERS ID: 1843764 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: California  
Vaccinated:2021-10-27
Onset:2021-10-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 32030BD / 4 LA / IM

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

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

Write-up: The patient was scheduled to receive a flu vaccination but was accidentally given a Covid 19 Pfizer shot instead. It was the patient''s 4 th dose . They had received their booster previously because the patient is immunocompromised. As of today no adverse effects according to the mother of the patient.


VAERS ID: 1843799 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-10-27
Onset:2021-10-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: There was no adverse event. The vaccine had gone through one freeze thaw excursion. After speaking with Pfizer and reading the information they provided, the safety and efficacy of the vaccine was not affected.


VAERS ID: 1843816 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-10-27
Onset:2021-10-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2590 / 1 RA / IM

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

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

Write-up: There was no adverse event. The dose that the patient received had gone through one freeze thaw excursion. After talking with Pfizer and reviewing the information provided, the safety and efficacy of the vaccine was not jeopardized.


VAERS ID: 1843825 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-10-27
Onset:2021-10-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2590 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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 did not experience any adverse events. The vaccine that the patient received had gone through one freeze thaw excursion. After speaking with Pfizer and reviewing information provided by them, we were able to determine that the safety and efficacy of the vaccine was not compromized.


VAERS ID: 1843836 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-10-27
Onset:2021-10-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2590 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: The patient did not experience and adverse effects. The vaccine had undergone one freeze thaw excursion. After speaking with Pfizer and reviewing the information provided by them , it was determined that the safety and efficacy of the vaccine was not compromised.


VAERS ID: 1843870 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-10-27
Onset:2021-10-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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 did not experience an adverse event. The vaccine had undergone one freeze thaw excursion. Upon speaking to Pfizer and reviewing information provided by them, it was determined that the safety and efficacy of the vaccine had not been compromised.


VAERS ID: 1843879 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-10-27
Onset:2021-10-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2590 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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 did not experience an adverse reaction. The product had undergone one freeze thaw excursion. After discussing the situation with Pfizer and reviewing information provided by them, it was determined that the safety and efficacy of the vaccine was not compromised.


VAERS ID: 1843903 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-10-26
Onset:2021-10-27
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2593 / 3 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Synthroid Multi vitamin
Current Illness: None
Preexisting Conditions: Hypothyroidism
Allergies: Penicillin, Avelox, Bactrim, Z Pack
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Body aches, especially left arm. Swollen arm. Big red patch on arm. Lymph nodes in right armpit swollen and tender to the touch. Lymph nodes were swollen for 4 days


VAERS ID: 1844059 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-10-24
Onset:2021-10-27
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 019F21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Anticoagulant therapy, Atrial fibrillation, Electrocardiogram abnormal, Full blood count abnormal, Haemoglobin increased, Palpitations
SMQs:, Haematopoietic leukopenia (broad), Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Amlodipine; allopurinol; Pravastatin
Current Illness: No
Preexisting Conditions: Hypertension; High Cholesterol
Allergies: Penicillin; ADVIL
Diagnostic Lab Data: EKG - Showed signs of A-Fib initially/2nd one was normal; Blood Work - Slightly high on Hemoglobin and CBC
CDC Split Type: vsafe

Write-up: I experienced heart palpitations (heat rate was 170) and went to Urgent Care on 10/27/2021 where they diagnosed me with A-Fib and sent me to the hospital. EKG and blood work was performed by Urgent Care and then again at the hospital. The Doctors prescribed Eliquis and Cardizem.


VAERS ID: 1844724 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-10-25
Onset:2021-10-27
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822811 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Erythema, Fungal infection, Pruritus, Rash, Rash papular, Rash pruritic, Rash vesicular, Skin discolouration, Skin weeping
SMQs:, Anaphylactic reaction (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Losartan 100mg qd, HCTZ 25mg qd, Amlodipine 10mg qd
Current Illness: None
Preexisting Conditions: HTN
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Pruritic rash on arms, legs, torso, face, scalp. Consists of vesicles and pustules, raised papules, erythema, intense pruritis. A previously healed area on the right lower leg that had superficial fungal infection erupted in intense erythema to purple with straw colored weeping.


VAERS ID: 1845283 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-02-04
Onset:2021-10-27
   Days after vaccination:265
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010A21A / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Vaccination site erythema, Vaccination site mass, Vaccination site swelling
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: USMODERNATX, INC.MOD20213

Write-up: hard lump on the injection site; he was noted to have redness; swelling; This spontaneous case was reported by a consumer and describes the occurrence of VACCINATION SITE MASS (hard lump on the injection site), VACCINATION SITE ERYTHEMA (he was noted to have redness) and VACCINATION SITE SWELLING (swelling) in a 66-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 017F21A and 010A21A) for COVID-19 vaccination. No Medical History information was reported. On 04-Feb-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 04-Mar-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 26-Oct-2021, received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 27-Oct-2021, the patient experienced VACCINATION SITE MASS (hard lump on the injection site), VACCINATION SITE ERYTHEMA (he was noted to have redness) and VACCINATION SITE SWELLING (swelling). At the time of the report, VACCINATION SITE MASS (hard lump on the injection site), VACCINATION SITE ERYTHEMA (he was noted to have redness) and VACCINATION SITE SWELLING (swelling) outcome was unknown. No concomitant medications were reported. No treatment details were reported.


VAERS ID: 1845287 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-10-27
Onset:2021-10-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003C21A / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Headache, Product administered to patient of inappropriate age, Somnolence, Vaccination site pain, Vomiting
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Medication errors (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Slept most of the day; Vaccination site pain; threw up; Headache; gave a shot of the Moderna first shot to a 16 year old patient; This spontaneous case was reported by an other health care professional and describes the occurrence of PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE (gave a shot of the Moderna first shot to a 16 year old patient), SOMNOLENCE (Slept most of the day), HEADACHE (Headache), VACCINATION SITE PAIN (Vaccination site pain) and VOMITING (threw up) in a 16-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 003C21A) for COVID-19 vaccination. No Medical History information was reported. On 27-Oct-2021 at 11:10 AM, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 27-Oct-2021, the patient experienced PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE (gave a shot of the Moderna first shot to a 16 year old patient) and HEADACHE (Headache). On 28-Oct-2021, the patient experienced SOMNOLENCE (Slept most of the day), VACCINATION SITE PAIN (Vaccination site pain) and VOMITING (threw up). The patient was treated with PARACETAMOL (TYLENOL [PARACETAMOL]) for Adverse event, at an unspecified dose and frequency. On 27-Oct-2021, PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE (gave a shot of the Moderna first shot to a 16 year old patient) had resolved. On 29-Oct-2021, SOMNOLENCE (Slept most of the day), HEADACHE (Headache), VACCINATION SITE PAIN (Vaccination site pain) and VOMITING (threw up) had resolved. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter considered SOMNOLENCE (Slept most of the day), HEADACHE (Headache), VACCINATION SITE PAIN (Vaccination site pain) and VOMITING (threw up) to be possibly related. No further causality assessment was provided for PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE (gave a shot of the Moderna first shot to a 16 year old patient). Concomitant product use was not provided by the reporter. The patient had no allergies. The patient had never been diagnosed with COVID-19. The patient had no acute illness at the time of vaccination and up to one month before. The patient had no chronic or long-standing health conditions. No prescriptions, over-the-counter medications, dietary supplements, or herbal remedies were taken at the time of vaccination. Most recent FOLLOW-UP information incorporated above includes: On 29-Oct-2021: Follow-up contains additional events, updated patient demographics, vaccination start time, anatomical location, action taken and treatment product.


VAERS ID: 1845306 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-10-27
Onset:2021-10-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 076C21A / 3 - / OT

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Expired vaccine given to patient; This spontaneous case was reported by an other health care professional and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (Expired vaccine given to patient) in a 75-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 076C21A) for COVID-19 vaccination. No Medical History information was reported. On 27-Oct-2021, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 27-Oct-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (Expired vaccine given to patient). On 27-Oct-2021, EXPIRED PRODUCT ADMINISTERED (Expired vaccine given to patient) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No Concomitant medications were reported. No Treatment medications were reported. This case was linked to MOD-2021-365967, MOD-2021-365701 (Patient Link).


VAERS ID: 1845413 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-27
Onset:2021-10-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2590 / 3 LA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Immunisation, Lymph node pain, Lymphadenopathy
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? 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: USPFIZER INC202101484860

Write-up: Swollen and painful lymph nodes armpit; Painful lymph nodes armpit; Booster dose; This is a spontaneous report from a contactable consumer, the patient. A 46-year-old non pregnant female patient received third dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: FF2590) via an unspecified route of administration in the left arm on 27Oct2021 at 15:30 (at the age of 46-years-old) as a single dose for COVID-19 immunisation. Medical history was not reported. The patient had no known allergies. Prior to the vaccination, the patient was not diagnosed with COVID-19. Concomitant medications were not reported. It was not reported if the patient received any other vaccines within four weeks prior to the vaccination. The patient previously received first dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: ER8730) via an unspecified route of administration in the left arm on 22Mar2021 (at the age of 46-years-old) as a single dose for COVID-19 immunisation and also the second dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: EW0158) via an unspecified route of administration in the left arm on 12Apr2021 (at the age of 46-years-old) as a single dose for COVID-19 immunisation. On 28Oct2021 at 04:00, the patient experienced swollen and painful lymph nodes in armpit. The events did not result in doctor or other healthcare professional office/clinic visit, and emergency room/department or urgent care. Since the vaccination, the patient had not been tested for COVID-19. Therapeutic measures were not taken as a result of the events. The clinical outcome of the events swollen and painful lymph nodes armpit was not resolved at the time of this report.


VAERS ID: 1845582 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: New York  
Vaccinated:2021-02-17
Onset:2021-10-27
   Days after vaccination:252
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Myalgia, Pyrexia, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: USMODERNATX, INC.MOD20213

Write-up: full body aches; I got my Moderna Covid-19 booster in the afternoon. I''ve been throwing up; fever; chills; This spontaneous case was reported by a consumer and describes the occurrence of MYALGIA (full body aches), VOMITING (I got my Moderna Covid-19 booster in the afternoon. I''ve been throwing up), PYREXIA (fever) and CHILLS (chills) in a 55-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On 17-Feb-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 17-Mar-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 27-Oct-2021, received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 27-Oct-2021, the patient experienced MYALGIA (full body aches), VOMITING (I got my Moderna Covid-19 booster in the afternoon. I''ve been throwing up), PYREXIA (fever) and CHILLS (chills). At the time of the report, MYALGIA (full body aches), VOMITING (I got my Moderna Covid-19 booster in the afternoon. I''ve been throwing up), PYREXIA (fever) and CHILLS (chills) outcome was unknown. No concomitant medication details was provided. No treatment medication details was provided. This case was linked to MOD-2021-368946 (Patient Link).


VAERS ID: 1845589 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-10-26
Onset:2021-10-27
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025D21A / UNK LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Breast pain, Contusion, Erythema, Headache, Lymph node pain, Lymphadenopathy, Pain, Skin discolouration
SMQs:, Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Accidents and injuries (narrow), Lipodystrophy (broad), Hypotonic-hyporesponsive episode (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? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Redness; soreness; headache; sore/swollen lymph nodes under left arm pit; left side of left breast was sore and was purple and looked bruised.


VAERS ID: 1845963 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-10-13
Onset:2021-10-27
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 - / IM

Administered by: Private       Purchased by: ?
Symptoms: CSF protein increased, Guillain-Barre syndrome, Magnetic resonance imaging spinal abnormal, Muscular weakness, Paraesthesia
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (narrow), Guillain-Barre syndrome (narrow), Noninfectious encephalopathy/delirium (broad), Demyelination (narrow), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Vitamin D3 25mcg BID
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: NKDA
Diagnostic Lab Data: MRI C-spine, L-spine, T-spine: diffuse smooth thin enhancement along cauda equivalent nerve roots most suggestive of Guillian-Berra Lumbar puncture: protein 121
CDC Split Type:

Write-up: Ascending parasthesias and weakness in bilateral upper and lower extremities.


VAERS ID: 1845998 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-10-21
Onset:2021-10-27
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8020 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Arthritis viral, Peripheral swelling
SMQs:, Cardiac failure (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (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: Hashimoto?s, migraines, IBS
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Viral arthritis- left hand swollen and severe joint pain


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