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

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



Case Details (Reverse Sorted by Onset Date)

This is page 89 out of 4,799

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VAERS ID: 1413110 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-06-19
Onset:2021-06-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Tongue pruritus
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (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: Spironolactone Estradiol
Current Illness:
Preexisting Conditions: Tachycardia (POTS)
Allergies: Z pack
Diagnostic Lab Data:
CDC Split Type:

Write-up: Mild itching on the tip of the tongue


VAERS ID: 1413115 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-06-18
Onset:2021-06-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / UNK LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / UNK LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Dehydration, Discomfort, Dizziness, Fatigue, Feeling hot, Nausea, Palpitations, Pyrexia
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (narrow)

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

Write-up: Had a night fever at 3am on June 19. Felt hot, dehydrated, and weak. Took 200mg ibuprofen pill with water and slept again but was uncomfortable. Also felt dizzy and fatigue at night. My heart was also beating fast. When I woke up at 10am the symptoms seem to be less intense and better. I didn''t feel hot. However, I still felt weak in my body. At 1pm when I started earing lunch I felt hot, tired and dizzy again, I was really sleepy, didn''t feel like eating, and felt like vomiting. I drank coke soda instead and slept until 4pm and I took another 200mg ibuprofen pill with water, after which I felt better.


VAERS ID: 1413116 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-06-19
Onset:2021-06-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No current medications on file
Current Illness: No known illnesses
Preexisting Conditions: No known health conditions
Allergies: No known drug allergy, no known food allergy
Diagnostic Lab Data: None
CDC Split Type:

Write-up: COVID-19 (Pfizer-BioNTech) was administered to patient for 2nd dose. Patient received COVID-19 ( Moderna) for 1st dose. No reported adverse reactions at this time.


VAERS ID: 1413120 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-06-19
Onset:2021-06-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: guardian says she has fainted before with shots
Other Medications: no known
Current Illness: no known
Preexisting Conditions: no known
Allergies: no known
Diagnostic Lab Data: no known
CDC Split Type:

Write-up: following patients injection, during the post vaccination wait time, patient fainted. Her guardians were with her, and said she frequently faints with immunizations. She came to quickly. Her caregiver went to get her some food and drink, as they said she had not eaten yet today. They stayed 30 minutes longer to make sure she was ok, then left.


VAERS ID: 1413122 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-19
Onset:2021-06-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009D21A / 1 LA / IM

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

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

Write-up: the patient presented her sisters id . Due to communication issues and pt looking slimiar to id we assumed the id was hers. After patient immunized they brought back the imz card stating we had the wrong date of birth. I paged patient and she stated that infact she presented an id with the dob that we thought was hers. So it was a 14 yo getting the imz.


VAERS ID: 1413123 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-06-19
Onset:2021-06-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Feeling hot, Hyperhidrosis, Presyncope, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: PATIENT WALKED TO OBSERVATION AREA AND SAT DOWN. AFTER 1-2 MINUTES PER MOM HE SAID HE FELT LIKE HE WAS GOING TO PASS OUT AND BECAME UNRESPONSIVE. I RAN OVER. AND PATIENT WAS STARTING TO BECOME RESPONSIVE. I ASKED IF HE WAS OK, HE SAID HE WAS VERY HOT AND SWEATY. I ASKED IF THEY (PATIENT/MOM) WANTED US TO CALL 911. PT WAS COMING OUT OF IT AND BECAME FULLY AWARE OF WHAT WAS HAPPENING. BP WAS 78/56 AND PULSE WAS 70. HE ASKED FOR WATER, ASST STORE MGR BROUGHT HIM A COLD WATER AND HE STARTED TO FEEL BETTER. WHEN ASKED, PATIENT HADN''T EATEN IN AWHILE; WE GAVE HIM A CANDY BAR PER HIS REQ. HE FELT MUCH BETTER. RETOOK BP - 123/79 AND P-67 (VASOVAGAL REACTION) BUT WAS STILL A LITTLE SWEATY. HE STAYED FOR 30 MINUTES AND FELT MUCH BETTER. HE LEFT WITH HIS MOM (AND BROTHER?). 911 WAS NOT CALLED.


VAERS ID: 1413126 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: West Virginia  
Vaccinated:2021-06-19
Onset:2021-06-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022C21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood pressure increased, Dizziness, Fatigue, Headache
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypertension (narrow), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: patient has does not have any prescriptions at this pharmacy. Patient did say he drank 2 monsters and had 2 cups of coffee.
Current Illness: unknown
Preexisting Conditions:
Allergies: unknown
Diagnostic Lab Data: unknown
CDC Split Type:

Write-up: on 6/19/21 Patient came to store for his 2nd Moderna shot. After the shot was given I had staff observe the patient. In a few minutes the patient felt tired and dizzy. His wife said this did not happen with the first shot. I then had staff call for a code white and I went to assist the patient. Immunization cart was brought out and I took the patient''s BP 167/122 HR 76. I asked the patient did he have any problems breathing, he said no. I did inform him that his blood pressure was high and that can contribute to him feeling dizzy. I continued to ask the patient if he was breathing ok and he said yes. There was no need for an epi-pen as the patient was conscious and responsive to all my questions. Where his blood pressure was still high I continued to take his blood pressure. Blood Pressure remained high at recorded times: 4:06 pm 176/114 hr 73 4:16 pm 151/110 hr 76 4:18 pm 153/102 hr 76 4:19 pm patient said he tests his sugar twice a day and complains of a headache straight across his forehead 4:26 pm 153/104 HR 74 at this time I was wanting to see if the cuff size played a role in the high blood pressure. Staff was able to find a meter with a larger cuff size 4:30 pm 159/103 HR 79 wife stated that his BP was on the lower end at home 4:34 pm patient stated that he''s feeling a bit better . BP still elevated. 4:35 PM 147/103 HR 77 4;36 pm patient said bottom # rarely goes over 100 but has saw top # the same or higher 4:37 pm patient said he''s able to walk and go on about his day. I was asking about him eating/drinking anything and this is when he mentioned that he drank 2 monsters and had 2 cups of coffee. I told the patient that this can contribute to him having high blood pressure at this time and asked his wife to monitor his BP when he got home. I will call them in the morning to make sure he is doing ok. Note: patient does not have a PCP verified by his wife. However standing order doctor will be notified.


VAERS ID: 1413130 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: West Virginia  
Vaccinated:2021-06-19
Onset:2021-06-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cold sweat, Dizziness, Hyperhidrosis, Pallor, Skin warm
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Mom stated pt has felt dizzy but never fainted on previous vaccines or during blood draws at dr''s office.
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: EMS responded and took patient''s blood pressure along with her blood sugar. She was transported to local hospital for further monitoring after EMS found her blood pressure to be 80/40.
CDC Split Type:

Write-up: Pt began to feel dizzy, warm and faint within 10 minutes of her second pfizer vaccine. Pt did not lose consciousness but was dizzy, clammy, sweaty, pale, faint feeling. Pt responded to commands but felt faint.


VAERS ID: 1413142 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-06-18
Onset:2021-06-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 0217 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Mouth haemorrhage
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow)

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

Write-up: Blood in mouth, suspected from the back of throat area


VAERS ID: 1413145 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-19
Onset:2021-06-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / UNK LA / IM

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

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

Write-up: FEEL DIZZINESS AND TIRED


VAERS ID: 1413160 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-06-18
Onset:2021-06-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / SYR

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

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

Write-up: The injection site is a itchy raised bump. I didn?t experience this with the first injection.


VAERS ID: 1413161 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-02-05
Onset:2021-06-19
   Days after vaccination:134
Submitted: 0000-00-00
Entered: 2021-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1283 / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Heart medications blood thinners
Current Illness: Heart, Cancer
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Husband and wife both vaccinated on 02/05/2021 test positive for Covid 19. Both had two doses of Pfizer lot EL128


VAERS ID: 1413174 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-06-18
Onset:2021-06-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Feeling hot, Headache, Hyperhidrosis, Pain in extremity
SMQs:, Neuroleptic malignant syndrome (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Wixela, flonase, iron (65mg), vitamin
Current Illness:
Preexisting Conditions: Asthma, seasonal allergies, headaches
Allergies: Albuterol, cinnamon
Diagnostic Lab Data: Not applicable
CDC Split Type:

Write-up: Very sore arm, headache, hot sweats Acetaminophen, water


VAERS ID: 1413177 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-18
Onset:2021-06-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009D21A / 2 RA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache, Lethargy, Myalgia, Pain in extremity
SMQs:, Rhabdomyolysis/myopathy (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vyvanse, Estradial, NP Thyroid, Valtrex, Atorvastatin
Current Illness: None
Preexisting Conditions: Hashimoto Thyroiditis
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Woke up day after shot around 9:30am with a localized pain, left of center, on my left glute muscle. Other side effects are normal... arm very sore shortly after shot and still sore the next day, by 8pm on the following day, feeling lethargic with upper body muscle aches and a headache.


VAERS ID: 1413192 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-18
Onset:2021-06-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Paranasal sinus discomfort, Toothache
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: Levothyroxine, Necon
Current Illness: N/A
Preexisting Conditions: hypothyroid
Allergies: N/A
Diagnostic Lab Data:
CDC Split Type:

Write-up: sinus pressure causing moderate nerve pain in teeth


VAERS ID: 1413198 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-19
Onset:2021-06-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036C21A / UNK LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain, Arthralgia, Flatulence, Muscle spasms, Musculoskeletal stiffness, Nausea, Pain in extremity, Peripheral swelling
SMQs:, Cardiac failure (broad), Acute pancreatitis (broad), Angioedema (broad), Retroperitoneal fibrosis (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Zoloft Wellbutrin XL Buspirone Propranolol Vitamin D supplements Vitamin B-12 supplements
Current Illness: None that I know of
Preexisting Conditions: Autoimmune disorder: SLE Endometriosis Fibromyalgia
Allergies: None that I know of
Diagnostic Lab Data: None
CDC Split Type:

Write-up: I am having major stomach pains, it''s like very painful gas and cramps. I am too nauseous to eat or move, really. My arm hurts so much it feels like if I pick anything up (like my phone, or a blanket) with my left arm, I get this shooting, tearing pain all through my upper arm. All the joints in my left arm have sharp shooting pains along with just general stiffness. I also had tingling in my fingertips & some major swelling all through my upper arm and shoulder.


VAERS ID: 1413207 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-19
Onset:2021-06-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 LA / IM

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

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

Write-up: Systemic: Dizziness / Lightheadness-Medium, Systemic: Fainting / Unresponsive-Medium, Additional Details: pt was sitting and than fainted 911 arrived and helped pt recover


VAERS ID: 1413208 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-06-19
Onset:2021-06-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 049C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Dizziness, Hyperventilation, Nausea
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Asthma/bronchospasm (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Systemic: Chills-Severe, Systemic: Dizziness / Lightheadness-Severe, Systemic: Hyperventilation-Severe, Systemic: Nausea-Severe


VAERS ID: 1413209 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-06-19
Onset:2021-06-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 049C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Dizziness, Hyperventilation, Nausea
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Asthma/bronchospasm (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Systemic: Chills-Severe, Systemic: Dizziness / Lightheadness-Severe, Systemic: Hyperventilation-Severe, Systemic: Nausea-Severe


VAERS ID: 1413213 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-06-19
Onset:2021-06-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Confusional state, Dizziness, Loss of consciousness, Nausea, Pallor, Syncope, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Confusion-Severe, Systemic: Dizziness / Lightheadness-Severe, Systemic: Fainting / Unresponsive-Severe, Systemic: face was pale---consiousness was on and off-Severe, Systemic: Nausea-Severe, Additional Details: after recieving 1 st dose of pfizer vaccine--patient was in the observation area for 15 minutes,during that time frame patient started feeling nauseous and then she felt dizzy..her skin was turning pale.. her consiousness was on and off.. she would respond one time and then another second she would freeze..at one point she lost consiousness. then we called 911 (EMS) right away...before even ems arrived patient regained consiousness. when EMS arrived patient was responsive & went to hospital.


VAERS ID: 1413214 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-06-19
Onset:2021-06-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Loss of consciousness, Nausea, Pallor, Syncope, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Confusion-Severe, Systemic: Dizziness / Lightheadness-Severe, Systemic: Fainting / Unresponsive-Severe, Systemic: face was pale---consiousness was on and off-Severe, Systemic: Nausea-Severe, Additional Details: after recieving 1 st dose of pfizer vaccine--patient was in the observation area for 15 minutes,during that time frame patient started feeling nauseous and then she felt dizzy..her skin was turning pale.. her consiousness was on and off.. she would respond one time and then another second she would freeze..at one point she lost consiousness. then we called 911 (EMS) right away...before even ems arrived patient regained consiousness. when EMS arrived patient was responsive & went to hospital.


VAERS ID: 1413215 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-19
Onset:2021-06-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Headache, Hypertension, Syncope, Tachycardia
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Hypertension (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Dehydration (broad)

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

Write-up: Systemic: Dizziness / Lightheadness-Severe, Systemic: Headache-Medium, Systemic: Hypertension-Medium, Systemic: Tachycardia-Medium, Additional Details: patient experienced syncope about 15 minutes after vaccine given...lasted around 30 minutes


VAERS ID: 1413218 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-19
Onset:2021-06-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 054C21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Fatigue, Flushing, Hyperhidrosis, Lethargy
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Hypersensitivity (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Dizziness / Lightheadness-Medium, Systemic: Exhaustion / Lethargy-Medium, Systemic: Flushed / Sweating-Severe


VAERS ID: 1413219 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-06-19
Onset:2021-06-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Chills, Dizziness, Fatigue, Flushing, Hyperhidrosis, Hypotension, Lethargy, Syncope, Tremor, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

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

Write-up: Systemic: Chills-Severe, Systemic: Dizziness / Lightheadness-Severe, Systemic: Exhaustion / Lethargy-Severe, Systemic: Fainting / Unresponsive-Severe, Systemic: Flushed / Sweating-Severe, Systemic: Hypotension-Severe, Systemic: Shakiness-Severe, Systemic: Weakness-Severe


VAERS ID: 1413224 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-06-19
Onset:2021-06-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood glucose normal, Dizziness, Flushing, Hyperhidrosis, Injection site pain, Syncope, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Hypoglycaemia (broad)

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

Write-up: Site: Pain at Injection Site-Mild, Systemic: Dizziness / Lightheadness-Mild, Systemic: Fainting / Unresponsive-Mild, Systemic: Felt light-headed, and fell unresponsive for less then 1 minute-Mild, Systemic: Flushed / Sweating-Mild, Additional Details: called 911, EMT/paramedics came, checked vitals (all were fine), Blood glucose 100.


VAERS ID: 1413225 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-06-19
Onset:2021-06-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 1 LA / IM

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

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

Write-up: Systemic: Dizziness / Lightheadness-Medium, Systemic: Fainting / Unresponsive-Medium, Systemic: Flushed / Sweating-Medium, Systemic: Hypotension-Medium, Systemic: Weakness-Medium, Additional Details: PATIENT STARTED FEELING WEAK AFTER A FEW MINUTES OF SITTING DOWN, HE THEN FAINTED/UNRESPONSIVE SO I LAYED THE PATIENT DOWN AND RAISED HIS LEGS, PATIENT CAME CONSCIOUS IN LESS THAN A MINUTE. I STAYED BY PATIENTS SIDE UNTIL HE WAS FEELING WELL AND CONFIDENT ABOUT LEAVING THE PHARMACY. PATIENT RECOVERED PRETTY WELL.


VAERS ID: 1413231 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-06-19
Onset:2021-06-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037C21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Confusional state, Diarrhoea, Dizziness
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Pseudomembranous colitis (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Noninfectious diarrhoea (narrow), Hypoglycaemia (broad)

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

Write-up: Systemic: Chills-Medium, Systemic: Confusion-Medium, Systemic: Diarrhea-Medium, Systemic: Dizziness / Lightheadness-Medium


VAERS ID: 1413237 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-06-18
Onset:2021-06-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Muscle twitching
SMQs:, Dyskinesia (broad), Dystonia (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: Unithroid, flonase, omeprazole, allegra, probiotic
Current Illness: None
Preexisting Conditions: Hashimotos, seasonal allergies
Allergies: Phenergan
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Facial twitching of upper lip and right cheek for approx 20 seconds.


VAERS ID: 1413239 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-17
Onset:2021-06-19
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Fatigue, Heavy menstrual bleeding, Menstruation irregular, Muscle spasms
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Dystonia (broad), Fertility disorders (broad)

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

Write-up: Irregular period- no period on my birth control and after my 2nd dose, I am now experiencing a heavy flow period with cramps and fatigue.


VAERS ID: 1413242 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-06-11
Onset:2021-06-19
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-06-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050C21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Erythema, Fatigue, Feeling abnormal, Feeling hot, Hypoaesthesia, Induration, Nausea, Pain in extremity, Peripheral swelling, Pruritus, Urticaria
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Peripheral neuropathy (broad), Dementia (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Synthroid Cytomel Losartan
Current Illness: NA
Preexisting Conditions: NA
Allergies: None
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: Had expected symptoms of nausea and arm pain on first evening. Arm was hot and had hard bump for two days and returned to normal. On day nine, was on a flight, at 7pm, arm became hot, itchy, large round red area emerged again, was very hard. Instant fatigue, and head felt numb/fuzzy, had chills throughout night. Researched symptoms online and appears to be COVID ARM, typical with Moderna vaccine.. Watching for infection, no red streaking at this time.


VAERS ID: 1413260 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-06-18
Onset:2021-06-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Headache, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Extreme headache from temples all the way down to base of skull Muscle soreness in back and neck


VAERS ID: 1413261 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-06-18
Onset:2021-06-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0175 / UNK LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Blood test, Chest pain, Computerised tomogram, Dyspnoea
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Sotalol, Lisinopril, Symbicort, Omeprazole
Current Illness: None
Preexisting Conditions: COPD, Afib
Allergies: None
Diagnostic Lab Data: CT scan, anti inflammatory injection, pain medication, breathing treatment, blood work
CDC Split Type:

Write-up: Very sharp pain in middle of chest, shortness of breath, difficulty breathing,


VAERS ID: 1413267 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-29
Onset:2021-06-19
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-06-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

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

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

Write-up: PATIENT STATED SHE HAS HAD A SMALL BUMP WHERE SHE RECEIVED HER FIRST DOSE. SHE ASKED TO FEEL THE BUMP AND IT WAS HARD. PATIENT DIDN''T MENTION OF ANY PAIN. NO REDNESS. SHE DID NOT MENTION WHEN THE BUMP APPEARED


VAERS ID: 1413268 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-18
Onset:2021-06-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Work       Purchased by: ?
Symptoms: Asthenia, Chills, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Weak. Chills. Fever. Body aches.


VAERS ID: 1413274 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-19
Onset:2021-06-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / IM

Administered by: Other       Purchased by: ?
Symptoms: Chills, Influenza like illness, Injection site pain, Lymphadenopathy, Myalgia, Nasopharyngitis, Oral herpes, Oropharyngeal pain, Pharyngitis, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Agranulocytosis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal infections (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Extravasation events (injections, infusions and implants) (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: 20mg citalopram/day 25/25mg Opipramol/day
Current Illness: None
Preexisting Conditions: Currently under medical investigation: Infectious myopathies
Allergies: Unknown
Diagnostic Lab Data:
CDC Split Type:

Write-up: May 8th 2021, 14:00h, first vaccination: May 9th: Severe pain in vaccinated arm Night form 9th to 10th of May: Cold chills, fever (38,5?C), continued pain in vaccinated arm, very severe muscle pain going beyond existing chronic myopathy, throughout neck, back, both arms, hips and legs. It felt like I had a severe flu. May 10th: Fever dropping back to normal by the evening. Rest of symptoms remain. Severe myalgia. May 11th: symptoms remain. Myalgia. May 12th: slightly feeling better, but cold sore on both sides of mouth manifest May 13th: Doing much better May 14th: symptoms gone, except for cold sores that lasted an unusual 2 weeks June 19th, 15:30h, 2nd vaccination: Sore throat starting in late evening Night form 19th to 20th of June: Cold chills, fever (38,5?C), continued pain in vaccinated arm, very severe muscle pain going beyond existing chronic myopathy, throughout neck, back, both arms, hips and legs. Throat infection with swollen lymphs. It feels like I have a severe flu. June 20th: Fever dropping back to normal by afternoon. Rest of symptoms remain. Severe myalgia.


VAERS ID: 1413283 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-06-19
Onset:2021-06-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dyskinesia, Eye movement disorder, Fatigue, Immediate post-injection reaction, Nausea, Seizure, Unresponsive to stimuli
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Dyskinesia (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: None
Allergies: Hummus, chickpeas
Diagnostic Lab Data: Unknown- patient was taken to ER by ambulance once paramedics arrived.
CDC Split Type:

Write-up: Approximately 2-3 minutes after vaccine administration patient began having a seizure (convulsing/uncontrolled movements, random eye movements, unresponsive but conscious) in observation area chair. The paramedics were called immediately. The seizure lasted about a minute. The father was insistent that he get up and walk around. After 2-3 minutes he returned to his seat. Pharmacist attempted to take blood pressure reading. During blood pressure check the patient complained of fatigue and nausea and then began having another seizure. This also lasted about 1 minute. About 2 minutes later the paramedics arrived and took patient to ER.


VAERS ID: 1413291 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-06-01
Onset:2021-06-19
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-06-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Fatigue, Hypersomnia
SMQs:, Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Depression (excl suicide and self injury) (broad)

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

Write-up: Periodic chills and tiredness. I had the shot at 12:33 PM and slept the entire day and didn?t wake up until 9:30AM the next day


VAERS ID: 1413297 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-06-01
Onset:2021-06-19
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-06-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chills, Lethargy, Pain
SMQs:, Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypoglycaemia (broad)

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

Write-up: 12 hours after injection severe chills. Body aches. 102.0 fever. Very lethargic. Symptoms lasted 24 hours.


VAERS ID: 1413310 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-06-18
Onset:2021-06-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / -

Administered by: Public       Purchased by: ?
Symptoms: Fatigue, Headache, Injection site pain, Nausea, Pain
SMQs:, Acute pancreatitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Flu shot hives
Other Medications: Lorazepam Wellbutrin Multivitamin Melatonin Fiber Prilosec Flexaril
Current Illness: None
Preexisting Conditions: Migraine Anxiety
Allergies: Hives with flu vaccine Intolerance to codeine and hydrocodeine, albuterol
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Headache- severe frontal h/a starting 6/18 afternoon through 6/20 AM. Nausea 6/19 Site pain 6/18 PM through 6/20 AM Muscle aches 6/18 late PM though 6/20 AM Fatigue 6/19 all day


VAERS ID: 1413322 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-06-17
Onset:2021-06-19
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039B21A / 1 RA / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017B21A / 2 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Contusion, Pruritus, Vaccination complication
SMQs:, Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Accidents and injuries (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: UTI
Preexisting Conditions: Postural Orthostatic Tachycardia Syndrome
Allergies: Penicillin, Compazine, Codeine, Bee Stingds
Diagnostic Lab Data:
CDC Split Type:

Write-up: 1st dose: Itching all over body and then COVID arm Benadryl and ice helped eventually went away 2nd dose: Itching all over Then underneath arm opposite side of injection long line of dark bruising from near armpit to elbow also small bruise near arm pit crease front. Still ongoing not sure if should be checked out


VAERS ID: 1413337 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-06-17
Onset:2021-06-19
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Migraine
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: Ibuprofen
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/a
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Migraine started 11 hours after 2nd dose. Migraine has only gotten worse now 60 hours later. Ibuprofen is the only treatment used thus far to combat the migraines.


VAERS ID: 1413352 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-06-19
Onset:2021-06-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Hypotension, 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), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: BP and BS reading performed by first responders. BP was on the low side. BS was normal
CDC Split Type:

Write-up: Patient after the injection in the waiting area started to complain of dizziness, lightheadedness, feeling faint shortly after the injection. Asked for iced water (was given to the patient), also asked if it would be ok to call 911. She said yes because she did not know why she was feeling that way, called 911, first responders answered the call, and checked out the patient in the pharmacy waiting area. Told her that her BP was on the low side and her BS was normal. Patient started feeling better shortly before they arrived and decline to go with them for medical treatment. Left the pharmacy waiting area after first responders left, shortly around 7:30 p.m. with boyfriend walked out of the store.


VAERS ID: 1413362 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-06-19
Onset:2021-06-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Flushing, Hyperhidrosis, Injection site haemorrhage, Pallor, Paraesthesia, Paraesthesia oral
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Dizziness / Lightheadness-Medium, Systemic: Flushed / Sweating-Medium, Systemic: Tingling (specify: facial area, extemities)-Mild, Additional Details: After vaccine, pt bled slightly at injection site. She saw the blood and started to feel faint, tingly lips, flushed and then lost color in her face. I instructed her to deep breath and elevated her feet since she felt she couldn''t move to be laid down. Finally she was able to stand up, I assisted her to the floor the pharmacy, elevated her feet, and she improved immediately in the supine position w/ feet elevated. She recovered 100 percent without fainting or losing consciousness.


VAERS ID: 1413367 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-06-19
Onset:2021-06-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Chest pain, Dizziness, Dysphagia, Dyspnoea, Headache, Nausea, Throat tightness
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypersensitivity (broad)

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

Write-up: Systemic: Allergic: Difficulty Breathing-Mild, Systemic: Allergic: Difficulty Swallowing, Throat Tightness-Mild, Systemic: Chest Tightness / Heaviness / Pain-Mild, Systemic: Dizziness / Lightheadness-Mild, Systemic: Headache-Mild, Systemic: Nausea-Mild, Additional Details: patient was given vaccine around 5:00 pm. after 15 minutes patient complaiend of lightheadidness, 15 minutes later developed slight difficulty breathing followed up throat tightness. after another 15 minutes of no improvement, benadryl was given. after 15-20 minutes, patient began to recover. after another 15 minutes patient was well enough to leave on her own with no further issues.


VAERS ID: 1413368 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-19
Onset:2021-06-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 LA / IM

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

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

Write-up: Pt was administered Janssen vaccine at age 16


VAERS ID: 1413372 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-19
Onset:2021-06-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8737 / 2 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: information not available
Current Illness: information not available
Preexisting Conditions: information not available
Allergies: amoxicillin and erythromycin
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Vaccine Lot # ER8737 was adminstered after 22 hours past of initial dilution time. No adverse reaction was reported at 15 minutes mark. Will continue to monitor for next 2-3 days., and their extended physical and chemical stability test, the integrity of vaccine was not comproised up to 24 hours after dilution in terms of physical and chemical properties


VAERS ID: 1413389 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-06-09
Onset:2021-06-19
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-06-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038C21A / UNK - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Fatigue, Headache, Influenza like illness, Injection site erythema, Injection site pain, Injection site swelling, Nausea, Pain
SMQs:, Acute pancreatitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Shingrex vaccine, age 66, general mailaise, fever, chills, large localized reaction with both injections, nausea
Other Medications: Advair, Hydrochlorothiazide, Armour Thyroid, Synthroid, Fish oil, Calcium, Black Seed oil, Glutathione, Vitamin D3, Turmeric, Glucosamine/Chondroitin/MSM, MVI, Magnesium, Wellbutrin (tapering off)
Current Illness: None
Preexisting Conditions: Asthma, hypothyroid (total thyroidectomy), hypertension
Allergies: Biaxin, Compazine, Inderal, Mycardis, Lisinopril, Amlodipine
Diagnostic Lab Data: None at this time
CDC Split Type:

Write-up: Moderna COVID-19 Vaccine EUA. Initial reaction of redness at the injection site with swelling and tenderness. This lasted about 5 days, lessening every day. Some fatigue and headache for about 24 -36 hours. Ten days after the vaccine, nausea, headache, all over body aches, chills but no fever. I feel like I have the flu but I have not left my house in more than a week and have not been around any other people. These symptoms have now been present for about 36 hours and are very similar to my first positive COVID experience.


VAERS ID: 1413405 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-17
Onset:2021-06-19
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Catheterisation cardiac normal, Chest pain, Echocardiogram, Echocardiogram abnormal, Ejection fraction decreased, Electrocardiogram ST segment elevation, Hyperhidrosis, Muscle spasms, Myocarditis, Troponin increased, Ventricular hypokinesia
SMQs:, Cardiac failure (narrow), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Dystonia (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (narrow), 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: HTN, daily etoh use
Allergies:
Diagnostic Lab Data: All on 6/19 EKG ST elevations anterolateral leads Trop elevation peak of 9.35 L heart cath no CAD TTE global hypokinesis, EF 40-45% PENDING a cardiac MR 6/21
CDC Split Type:

Write-up: On 6/19/21, while in ED noted to be diaphoretic with crushing substernal chest pain. Noted to have ST elevations on anterolateral leads and trop elevation that peaked at 9.35. Patient taken to cath lab without evidence of coronary artery disease. ECHO with global hypokinesis with estimated EF 40-45%. Our top differentials at this time being myocarditis vs. spasm. He is going for cardiac mri 6/21.


VAERS ID: 1413408 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-06-19
Onset:2021-06-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Back pain, Chest pain, Dizziness, Dyspnoea, Limb discomfort, Paraesthesia
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Oregano oil, Vitamin C, Vitamin D, Probiotic
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: Gluten, Dairy
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Lightheadedness, dizziness, legs feeling heavy and tingly, chest pain (this started one day after receiving my dose), shortness of breath, back pain


VAERS ID: 1413409 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-06-18
Onset:2021-06-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048C21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Discomfort, Induration, Pain, Pain in extremity, Paraesthesia, Peripheral swelling
SMQs:, Cardiac failure (broad), Angioedema (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A per patient no current meds
Current Illness: No recent illness
Preexisting Conditions: No chronic conditions
Allergies: No known allergies
Diagnostic Lab Data: N/A patient on nurse help line no tests run yet
CDC Split Type:

Write-up: Patient states symptoms started evening of 6/19 with right sided tingling/pain of lower leg/calf and arm and increased swelling that is firm to the touch but not warm on the right lower calf. Patient also notes pain/discomfort that feels like it moves or travels around the body as if fluid


VAERS ID: 1413419 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-06-19
Onset:2021-06-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Back pain, Cyanosis, Dizziness, Eye movement disorder, Hypoacusis, Loss of consciousness, Muscle rigidity, Nausea, Pallor, Paraesthesia
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Parkinson-like events (narrow), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hearing impairment (narrow), Vestibular disorders (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

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

Write-up: Within a few minutes after receiving my first COVID vaccine I started feeling lightheaded/nausea and then lost consciousness. My wife was with me during this time and stated that I lost consciousness for about a minute. My wife stated that my eyes rolled back in my head, my back arched, and I became rigid. Upon waking up my ears were muffled and my wife stated my lips were blue and my face/arms/legs were very pale in color. Both of my legs and both of my hands were also tingling upon waking up. 911 was called by my wife.


VAERS ID: 1413421 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-06-19
Onset:2021-06-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 5 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NOT KNOW
Current Illness: NO
Preexisting Conditions: NOT KNOWN
Allergies: NO KNOWN ALLERGY
Diagnostic Lab Data:
CDC Split Type:

Write-up: AFTER GETTING SHOT , PATIENT WAS WAITING FOR 15 MINUTES. PATIENT FAINTED AND FELL ON FACE . CALLED 911 AND AMBULNACE CAME OVER, SHE WAS AWAKE AND RESPONDING. NEXT DAY ON DUTY RPH CALLED BOYFRIEND ( HE WAS WITH HER ON 06/19/20 VACCINATION TIME) AND FOUND OUT THAT SHE HAD ANXIETY FROM VACCINE


VAERS ID: 1413433 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-06-17
Onset:2021-06-19
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test, Condition aggravated, Dizziness, Electroencephalogram, Epileptic aura, Seizure
SMQs:, Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lamotrigine 100MG
Current Illness: none
Preexisting Conditions: Epilepsy
Allergies: no
Diagnostic Lab Data: EEG 6/20/21. Blood tests standard. Observation in emergency ward and observation ward.
CDC Split Type:

Write-up: Daughter suffered 3 "auras". She also seized during those auras. Neurologist stated the vaccine could have had an adverse effect. She reported after 2nd injection that she felt somewhat dizzy. She spent overnight in the observation wing of the hospital. She also received an EEG. Her meds will be increased. It is highly probable that the vaccine had an adverse effect on her.


VAERS ID: 1413454 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-06-01
Onset:2021-06-19
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-06-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / SYR

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

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

Write-up: High fever that peaked above 104 degrees the morning after


VAERS ID: 1413469 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-06-18
Onset:2021-06-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Angina pectoris, Pain
SMQs:, Other ischaemic heart disease (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Nothing
Current Illness: Nothing
Preexisting Conditions: Nothing
Allergies: Nothing
Diagnostic Lab Data:
CDC Split Type:

Write-up: Outside of my heart started hurting after 38 hours of getting the vaccine. I wake up from the pain it was very sharp pain where my heart it. But my heartbeat was normal and not pounding. I don''t think it was my heart that was hurting. It was kind of outside of my heart. It was hurting a lot for 10 minutes. I tried to deep breath and it made it hurting more. Whenever i tried to move it hurted a lot. After 10 mins it was getting better enough for me to go back to sleep. But for the 10 minutes I thought i was going to die.


VAERS ID: 1413471 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-06-19
Onset:2021-06-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypoaesthesia, Pain
SMQs:, Peripheral neuropathy (broad), Guillain-Barre 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: Few mins after receiving the shot, the pt started having shooting pain down his hands and numbness that was also extending to his head . Offered to call EMS . But they did not want me to . Asked to go to ER/UC if it does not go away or gets worse . Double checked inj site and it was on the correct spot on his deltoid muscle . He said his mom was also very sensitive this way to certain vaccines


VAERS ID: 1413489 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-06-18
Onset:2021-06-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

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

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

Write-up: Headache, fatigue, nausea, muscle soreness Lasted about 20 hours Took Tylenol and rested


VAERS ID: 1413493 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-06-19
Onset:2021-06-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site erythema, Injection site rash, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (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: Prilosec, benadryl
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None as of today
CDC Split Type:

Write-up: Swelling, red rash approximately 3 inch radius around injection site


VAERS ID: 1413495 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Hawaii  
Vaccinated:2021-06-19
Onset:2021-06-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Diarrhoea, Fatigue, Headache, Oropharyngeal pain
SMQs:, Pseudomembranous colitis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)

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

Write-up: fatigue, diarrhea, headache, sore throat for 24 hours


VAERS ID: 1413502 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-06-19
Onset:2021-06-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Feeling cold, Hyperhidrosis, Hypoaesthesia, Pyrexia
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (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:
CDC Split Type:

Write-up: My fingertips went numb for 3 hours and then cold sweats fever hot sweats continuing all the way through the next day.


VAERS ID: 1413536 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-06-19
Onset:2021-06-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

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

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

Write-up: High fever, headache, aches, fatigue.


VAERS ID: 1413560 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-19
Onset:2021-06-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037C21A / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Fatigue, Loss of consciousness, Myalgia, Pain, Pyrexia, Syncope, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Pain, fever, two syncope spells, blacking out, vomiting, extreme fatigue, 101 degree fever, muscle pain and aches.


VAERS ID: 1413568 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-06-15
Onset:2021-06-19
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-06-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Fibromyalgia, Injection site mass, Injection site rash, Pain in extremity
SMQs:, Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Fibromyalgia
Allergies: Nkda or food allergies. Allergic to betadine and medical tape
Diagnostic Lab Data:
CDC Split Type:

Write-up: 5 days later developed rash and still lump at injection site. In day or 2 following injection, arm was sore, some flare up in systemic fibromyalgia pain.


VAERS ID: 1413578 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-06-18
Onset:2021-06-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO181 / 1 LA / IM

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

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

Write-up: Fever, cold chills, body aches, headache, swelling in lymph nodes.


VAERS ID: 1413584 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-19
Onset:2021-06-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 2 RA / IM

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

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

Write-up: Patient came in to receive 2nd dose of Moderna. Instead, Pfizer vaccine was given in error.


VAERS ID: 1413589 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-06-18
Onset:2021-06-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Activated partial thromboplastin time, Asthenia, Blood culture, Blood lactic acid normal, Brain natriuretic peptide normal, C-reactive protein increased, Chest X-ray normal, Computerised tomogram head normal, Drooling, Eye movement disorder, Full blood count normal, International normalised ratio normal, Metabolic function test normal, Prothrombin time normal, Pyrexia, Seizure like phenomena, Tremor, Troponin normal
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Ocular motility disorders (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Fish oil, multivitamin with fluoride, Nasonex nasal spray
Current Illness: N/A
Preexisting Conditions: Autism and remote history of asthma
Allergies: Dog Hair, Peanut Butter Flavor, Tree Nuts
Diagnostic Lab Data: Patient had a chest x-ray which was negative and a head CT which was negative for any intracranial pathology. His CBC, CMP, BNP, troponin, lactate, PT, PTT, INR were unremarkable, blood culture was drawn, CRP elevated to 12.2. He did not receive any abortive medications and did not have any further seizure-like activity. He was transported to ED for further work-up and hydration.
CDC Split Type:

Write-up: On 06/19/2021 was noted to have decreased energy and temp was ~100, tylenol given. A few hours later after completing his morning therapies he showered and went to take a nap. At this time he was febrile to 103.6. At 1600 he had seizure-like activity with trunk and upper extremity shaking as well as eyes rolling back and drooling. Parents put him in car and transported him to an outside hospital. He did stop seizing prior to getting to that hospital. Parents reported seizure lasted approximately 15 minutes with no loss of bowel or bladder control. By time he arrived at local emergency room he was back at his neurological baseline. At the outside hospital our PICU was consulted and he was given ceftriaxone and vancomycin in meningitic dosing.


VAERS ID: 1413605 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-06-18
Onset:2021-06-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Fatigue, Injection site erythema, Injection site induration, Injection site pain, Injection site swelling, Myalgia, Pyrexia, Thirst
SMQs:, Rhabdomyolysis/myopathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

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

Write-up: Thirst; Chills; Fever; Generalized muscle aches (with greater intensity in legs and back); tiredness; and pain, swelling, redness, and hardening in the arm (injection area).


VAERS ID: 1413606 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Utah  
Vaccinated:2021-06-17
Onset:2021-06-19
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Myocardial infarction
SMQs:, Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow)

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

Write-up: Heart attack


VAERS ID: 1413614 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-18
Onset:2021-06-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Angina pectoris, Arthralgia, Diplopia, Eye pain, Headache, Myalgia, Pain, Pyrexia, Renal pain, SARS-CoV-2 antibody test, Vision blurred
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Glaucoma (broad), Lens disorders (broad), Eosinophilic pneumonia (broad), Retinal disorders (broad), Other ischaemic heart disease (narrow), Ocular motility disorders (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Glaucoma suspect
Allergies:
Diagnostic Lab Data: 06/17/2021- antibodies test. Showed robust immunity to Covid, however recommendations were to get the shot.
CDC Split Type:

Write-up: High fever 103 unrelieved by tylenol, explosive headache, piercing eye pain, blurry vision, double vision, heart pain, kidney pain, muscle and joint pain.


VAERS ID: 1413811 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-18
Onset:2021-06-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA URN:UVCI:01DE/I / 2 LA / -

Administered by: Other       Purchased by: ?
Symptoms: Body temperature increased, Chills, Orthostatic heart rate response increased, Rash, SARS-CoV-2 test, Tachycardia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Losartan 50, 1/2 tablet morning and night Mometa Cortisone Nasal spray 2 sprays per nostril morning and night Budiair, 100 microgramm cortisone asthma spray 1 inhalation morning and night Aspirin 100 mg 1/night Tromcardin, 2 tablets morning
Current Illness:
Preexisting Conditions: hypertension, autoimmune thyroid disorder, asthma and allergies
Allergies: Pollen allergies, mold allergies, allergic to penicillins and cephalosporins. Antihistamine intolerant (react with high blood pressure and rapid pulse)
Diagnostic Lab Data: Covid quick test on June 21, 2021
CDC Split Type:

Write-up: Started at 1 am with chills, followed by 38.3 temperature. At 3 AM, fever sank to 37.4 and tachycardia with up to 125 bpm began. Blood pressure 160/74. Rash covered face and neck. Treated with Aconitum D30 (homeopathic medicine), lowered pulse rate to the 90''s. Still suffered orthostatic peaks of 125. With stable higher blood pressures of 145/80, at 6 AM took 1,25 mg bisoprolol. This took the pulse down to the 80''s. Orthostatic elevated pulse continued throughout the day and into the evening. In the evening, normal blood pressure, pulse and temperature. Rash was gone.


VAERS ID: 1413814 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-06-18
Onset:2021-06-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 005C21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Hyperhidrosis, Migraine, Nausea, Pain in extremity
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Levothyroxine 100mcg Famotidine 40mg
Current Illness: N/A
Preexisting Conditions: Hypothyroidism GERD
Allergies: N/A
Diagnostic Lab Data:
CDC Split Type:

Write-up: Migrane: Started next day around 2pm. Took extra strength Tylenol and slept. Sore arm: started later the same day as vaccination. Slight nausea: took promethazine as needed for nausea. Sweaty: tried to keep cool with air conditioning and fans.


VAERS ID: 1413817 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-06-18
Onset:2021-06-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / SYR

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

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

Write-up: Achey, fever of 102 at highest


VAERS ID: 1413853 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-06-18
Onset:2021-06-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051D21A / 2 AR / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Joint swelling, Peripheral swelling
SMQs:, Cardiac failure (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: feet ankle and legs are very swollen. patient states foot is too swollen to war a show.


VAERS ID: 1414174 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-03-03
Onset:2021-06-19
   Days after vaccination:108
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Abbott ID NOW 6/19/21
CDC Split Type:

Write-up: Breakthrough COVID


VAERS ID: 1414406 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-06-19
Onset:2021-06-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 1 - / IM

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

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

Write-up: Patient wated at pharmacy for required 15 minutes. Went home and eyes started to swell. Went to the urgent care in town and was administered a shot for allergic reaction and the swelling subsided.


VAERS ID: 1414415 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-19
Onset:2021-06-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Pruritus, Rash, Swollen tongue
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Pt received 1st dose Covid vaccine at 4:28pm on 6/19/21. During observation, patient reported a skin rash/itchiness on the right side of neck and swelling of the tip of her tongue. Two capsules of Benadryl 25mg were given to patient. She consented to leave afterwards.


VAERS ID: 1414429 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-06-10
Onset:2021-06-19
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036C21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Pain, Tinnitus
SMQs:, Hearing impairment (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: Vitamins, Olive Leaf Extract, Fish Oil with Vitamin D3, Bitter Mellon Extract.
Current Illness: None
Preexisting Conditions: Numular Eczema which occurs when I eat food with presevatives from canned goods and preserved meats.
Allergies: Allergic to food with presevatives
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: On the 9th day after receiving Dose 1 of the Moderna mRNA vaccine shot, I had a ring in my left ear followed by a sting much like a bee sting. The ring was like a phone ring.


VAERS ID: 1414570 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-01
Onset:2021-06-19
   Days after vaccination:138
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Acute myocardial infarction, Acute respiratory failure, Endotracheal intubation
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Myocardial infarction (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (narrow), Hypersensitivity (broad), Respiratory failure (narrow)

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

Write-up: Acute respiratory failure requiring intubation; Non-ST segment elevation MI


VAERS ID: 1414625 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-19
Onset:2021-06-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 1 LA / IM

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

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

Write-up: PATIENT WAS NOT 12 YEARS OLD AND I GAVE HIM THE PFIZER SHOT AND REALISED IF AFTERWARD


VAERS ID: 1414663 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-19
Onset:2021-06-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Dizziness, Hyperhidrosis
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Zoloft
Current Illness:
Preexisting Conditions: Pt w/ PMH Depression, Anxiety. No PSH.
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: "Pt w/ PMH Depression, Anxiety. No PSH. Current Medications: Zoloft. NKDA At approximately 1400, pt in observation, post-vaccination of Johnson and Johnson (received at 1353), was brought to triage area by TRN, d/t complaints of sweating and dizziness. Pt denied experiencing any other abnormal sxs. On-site NP and clinic lead ANM notified. On-site NP provided further eval with pt. V/S taken at 1405: BP - 101/47, HR - 81, RR - 18, T - 97.8 V/S taken at 1408: BP - 111/66. HR - 74, RR - 20 Fluids encouraged and given. Pt placed on recliner chair. Per NP, after additional 15 min observation (and if pt is stable), pt is okay to be released from vaccination site. Pt expressed improvement to sxs, stable gait, AxOx4. Pt stable to go home."


VAERS ID: 1414954 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Louisiana  
Vaccinated:2021-06-18
Onset:2021-06-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036C1A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Sertraline 25mg
Current Illness: Runny nose
Preexisting Conditions: none
Allergies: NKDA/NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever, chills, nausea, migraine


VAERS ID: 1415017 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-06-18
Onset:2021-06-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050C21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Rash on arms, age 43, May 21, 2021, Moderna COVID
Other Medications: Geodon , serazone
Current Illness:
Preexisting Conditions:
Allergies: Sudafed
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Rash and welts all over legs, arms & crotch. Redness, heat and swelling of left arm. Prescribed prednisone and Benadryl.


VAERS ID: 1415029 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-19
Onset:2021-06-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: No adverse event
SMQs:

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

Write-up: Skin itchiness w/o rash within 1 hr of receiving the vaccine. Unknown duration. Pt denies swelling, SOB at that time. Reported by pt when arrived for second dose on 6/19. Pt was pre-medicated with Benadryl for second dose and asked to stay for 30 mins observation. No reaction to second dose noted at the time of discharge. Second dose was same Pfizer EW0173 IM Left Deltoid.


VAERS ID: 1415040 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-06-19
Onset:2021-06-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cold sweat, Dizziness, Immediate post-injection reaction, Nausea, Pallor
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Hypoglycaemia (broad)

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

Write-up: Patient started to feel light headed , cold sweat, pale and nauseated about a minute after the injection. I had patient lay down on the floor with her feet up on the chair for about 15 to 20 minutes. After 20 minutes patient feels better.


VAERS ID: 1415049 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-15
Onset:2021-06-19
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050C21H / UNK RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Alanine aminotransferase normal, Angiogram, Aspartate aminotransferase normal, Basophil count decreased, Basophil percentage decreased, Blood albumin decreased, Blood alkaline phosphatase normal, Blood bilirubin normal, Blood calcium decreased, Blood chloride increased, Blood creatinine normal, Blood glucose normal, Blood potassium normal, Blood sodium normal, Blood urea nitrogen/creatinine ratio, Blood urea normal, C-reactive protein increased, Carbon dioxide decreased, Chest X-ray normal, Chest discomfort, Crying, Diarrhoea, Dyspnoea, Electrocardiogram abnormal, Eosinophil count decreased, Eosinophil percentage, Fibrin D dimer increased, Glomerular filtration rate normal, Haematocrit normal, Haemoglobin normal, Lymphocyte count normal, Lymphocyte percentage, Mean cell haemoglobin concentration normal, Mean cell haemoglobin decreased, Mean cell volume normal, Mean platelet volume normal, Metabolic function test, Monocyte count decreased, Monocyte percentage, Musculoskeletal discomfort, Nausea, Neutrophil count normal, Neutrophil percentage, Pain, Platelet count normal, Protein total normal, Red blood cell count normal, Red cell distribution width normal, SARS-CoV-2 test negative, Sinus tachycardia, Streptococcus test negative, Troponin I increased, Vomiting, White blood cell count normal
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Haematopoietic leukopenia (narrow), Haemorrhage laboratory terms (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Depression (excl suicide and self injury) (broad), Chronic kidney disease (broad), Noninfectious diarrhoea (narrow), Tumour lysis syndrome (broad), Tubulointerstitial diseases (broad), Dehydration (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: bifidobacterium-lactobacillus oral tablet, 1 Tab, PO, qDay buPROPion 150 mg/24 hours (XL) oral tablet, extended release, 150 mg= 1 Tab, PO, every 24 hours, 3 refills dicyclomine 10 mg oral capsule, See Instructions, take 1 to 2 capsul
Current Illness: None.
Preexisting Conditions: None.
Allergies: Keflex Reaction: Rash, Itch Norco Reaction: Rash
Diagnostic Lab Data: Diagnostic Results EKG: Sinus tachycardia. Mild NSSTTWA V4-V6. No ischemic changes or changes of pericarditis. Radiology - Full Interpretation, Last 24 hrs Result Date: 06/19/21 08:52 Report : CT Angio Chest w Con History: Chest pain, tachycardia, elevated d-dimer TECHNIQUE: Axial tomographic images of chest performed after administration of 80 cc of Isovue-370 following CT angiography protocol. Multiplanar reconstructed images as well as 3-D reconstructions reviewed in remote workstation. Representative images added to patient''s file. Visualized portions of thyroid gland appear unremarkable. Normal take off of supra aortic vessels. The left vertebral artery origin is directly from the arch. Normal dimensions of the thoracic aorta and main pulmonary artery. Cardiac chambers appear unremarkable. No pericardial effusion. Trachea and proximal bronchi are normal. No central filling defects in the pulmonary arterial system to suggest the presence of pulmonary embolism. No mediastinal masses or adenopathy. No hiatal hernia or retrocrural adenopathy. Review of lung fields show no areas of consolidation or interstitial disease. No pulmonary nodules or focal areas of groundglass attenuation. Mild dependent atelectasis in lung bases. No pleural effusion. Visualized portions of abdomen appear unremarkable. Review bone windows show no vertebral body compression or dislocation. IMPRESSION: No evidence of pulmonary embolism or acute process in chest. Dose: CTDIvol: 29.76 mGy DLP: 903.54 mGy- centimeter One or more of the following dose reduction techniques were used: Automated exposure control, adjustment of the mA and or kV according to patient''s size. 06/19/21 08:58 +++++++++++++++++++++++++++++++++++++++++++++++++++++++ Result Date: 06/19/21 07:21 Report : XR Chest 1 View Portable Clinical history: Chest pain. Portable frontal view of chest submitted for evaluation. No prior exams available for comparison. Cardiomediastinal silhouette appears normal in dimension. The lung fields show no definite area of infiltrate, effusion or pneumothorax. No signs of failure. No gross bony abnormalities. Impression: No acute cardiopulmonary process. 06/19/21 08:04 Basic Metabolic Panel: Hematology: Sodium: 141 (06/19/21) Hgb: 12.4 (06/19/21) Potassium: 4.6 (06/19/21) HgbA1c: ------ Phosphorus: ------ WBC: 7.5 (06/19/21) Mg: ------ Plt: 257 (06/19/21) BUN: 11.0 (06/19/21) INR: ------ Creatinine.: 0.8 (06/19/21) Creatinine Clearance: ------ Additional - Last Month ABS Baso: 0.0 (06/19/21) ABS Eos: 0.2 (06/19/21) ABS Lymph: 2.4 (06/19/21) ABS Mono: 0.6 (06/19/21) ABS Neut: 4.3 (06/19/21) Albumin: 3.2 (06/19/21) Alkphos: 102 (06/19/21) ALT: 21 (06/19/21) AST: 21 (06/19/21) Baso%: 0.3 (06/19/21) Bili Total: 0.3 (06/19/21) BUN/Cr Ratio: 13.8 (06/19/21) Calcium: 8.5 (06/19/21) Chloride: 110 (06/19/21) CO2: 22 (06/19/21) COVID19 Source: Nasal Swab (06/19/21) COVID19/SARS-CoV-2 POCT Result: Negative (05/25/21) COVID19/SARS-CoV-2 Result: Negative (06/19/21) D-Dimer, Quant.: 812 (06/19/21) eGFR Afr/Am: $g60 (06/19/21) eGFR NonAfr/Am: $g60 (06/19/21) Eos%: 2.6 (06/19/21) Glucose Level: 92 (06/19/21) Hct: 37.8 (06/19/21) hsCRP: 37.7 (06/19/21) Lymph%: 32.2 (06/19/21) MCH: 26.7 (06/19/21) MCHC: 32.9 (06/19/21) MCV: 81.2 (06/19/21) Mono%: 7.9 (06/19/21) MPV: 7.9 (06/19/21) Neut%: 57.0 (06/19/21) nRBC Auto: 0.1 (06/19/21) POCT-Strep Result: Negative (05/25/21) Protein, Total: 7.10 (06/19/21) RBC: 4.65 (06/19/21) RDW: 14.2 (06/19/21) SARS CoV2 (COVID19) RNA, RT PCR: Not Detected (05/26/21) SARS-CoV-2, LDT: Performed (05/26/21) Troponin I: 1.11 (06/19/21) Cardiac Enzymes - This Encounter, All Results, Last 48 hours Cardiac Enzymes Troponin I: 1.11 ng/mL Critical Troponin I: 0.91 ng/mL Critical
CDC Split Type:

Write-up: 27-year-old female without significant past medical history who presents to the ER with 9/10 substernal chest pressure that awoke the patient from sleep at 4 AM and radiated to her left chest and neck. She has never had symptoms like this before. She reports nausea and one episode of vomiting with the pain around 430 AM. Did not feel better after. She called her mother crying due to the severity of the symptoms. She reports some shortness of breath but reports that taking a deep inspiration makes the discomfort better. She denies abdominal pain. She denies cough, rhinorrhea, fevers, or chills. She also denies arm pain, leg pain, back pain, numbness, weakness, tingling, dysuria, dysuria, constipation. No history of hyper-mobility. No trauma. He has frequent lose stool, but this is not new. On arrival to the ED, her pain was a 7 or 8 out of 10 and had been constant since onset. She reports that she had her second Moderna COVID vaccine on Tuesday 6/15/21 and wonders if it may be related. She had a breast reduction surgery in January 2021. No complications from that and no symptoms related to the surgery. No new medications. She got a GI cocktail with viscous lidocaine and Maalox in the ER and the pain has completely resolved. She walks for exercise with her dog. No symptoms with that.


VAERS ID: 1415057 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-06-18
Onset:2021-06-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0150 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Body temperature increased, Chest pain, Chills, Decreased appetite, Dizziness, Headache, Nausea, Painful respiration
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Patient is a 12 yr/o child with a history of mobility, pots, factor VII deficiency, scoliosis who presents with chest pain and headache after receiving the second Covid vaccine. Mom reports patient got the second Pfizer Covid vaccine yesterday. After the vaccine the patient had some nausea and dizziness which he occasionally has at baseline. This morning when the patient woke up he was having chest pain with deep breathing and complaining of burning in the chest. Mom reports the patient had a temperature to 100.7 at home. Mom endorses decreased activity level and mom noted the patient to have a heart rate to the 130s at home. Patient endorses chills and nausea without vomiting, no diarrhea. Patient also endorses a poor appetite today. the patient has difficulty describing the exact location of the chest pain, mom reports that the patient has always had difficulty with pinpointing the exact location of pain.


VAERS ID: 1415077 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-06-17
Onset:2021-06-19
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0158 / 2 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Head discomfort, Headache, Musculoskeletal stiffness, Nausea, Photophobia, Tension headache
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Corneal disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Arthritis (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: albuterol HFA 108 mcg/act, ergocalciferol 50,000 units once a week, fluticasone 50 mcg/act nasal spray 2 sprays daily, lidocaine-hydrocortisone Ace 3-0.5% Cream 1 application rectally 2 times daily prn, loratadine 10 mg 1 daily prn allergie
Current Illness:
Preexisting Conditions: seasonal allergies, hemorrhoids, wheezing
Allergies: Ibuprofen, penicillins
Diagnostic Lab Data:
CDC Split Type:

Write-up: 27 yo M presents to the ICC c/o a headache and dizziness. States that he has neck muscle stiffness and a squeezing, pressure-type headache that is affecting the top of his head and both sides of his forehead. The lights are bothering him and he is nauseated. Received COVID vaccination 4 days ago. Had a headache yesterday, which was worse than the one he has today. Has not taken any medications for symptom relief because he did not want to mess with the vaccine. Symptom duration == 5 hours. Not worsening. Diagnosed with a tension headache. Treated with acetaminophen 1000 mg. Rated 8-9/10 before taking acetaminophen and 3-4/10 after acetaminophen.


VAERS ID: 1415091 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-04-23
Onset:2021-06-19
   Days after vaccination:57
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH N/A / 2 UN / UN

Administered by: Unknown       Purchased by: ?
Symptoms: Asthma, Blood alkaline phosphatase increased, Blood bilirubin normal, Chemotherapy, Chest X-ray normal, Condition aggravated, Differential white blood cell count abnormal, Dysphagia, Dyspnoea, Immunodeficiency, Neutrophil toxic granulation present, Odynophagia, Renal function test normal, SARS-CoV-2 test positive, White blood cell count increased
SMQs:, Liver related investigations, signs and symptoms (broad), Anaphylactic reaction (broad), Asthma/bronchospasm (narrow), Haematopoietic leukopenia (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Malignancy related therapeutic and diagnostic procedures (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Biliary system related investigations, signs and symptoms (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Myelodysplastic syndrome (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, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: amLODIPine (NORVASC) tablet 5 mg 5 mg Oral DAILY ? aspirin chew tab 81 mg 81 mg Oral DAILY ? atorvastatin (LIPITOR) tablet 80 mg 80 mg Oral Q HS ? enoxaparin (LOVENOX) injection 40 mg 40 mg Subcutaneous Q 24 H ? metoprolol (LOPRESSOR)
Current Illness: CAD in native artery remote stent placed. ? Chronic back pain ? Chronic obstructive pulmonary disease (COPD) (CMS/HCC) ? Colon cancer (CMS/HCC) 2018 metastatic cancer 2020 ? COVID-19 ? Diabetes mellitus, type II (CMS/HCC) ? Dyslipidemia ? Essential hypertension ? Glaucoma ? Headache ? Prostate cancer 2006 ? Pulmonary nodule
Preexisting Conditions: CAD in native artery remote stent placed. ? Chronic back pain ? Chronic obstructive pulmonary disease (COPD) (CMS/HCC) ? Colon cancer (CMS/HCC) 2018 metastatic cancer 2020 ? COVID-19 ? Diabetes mellitus, type II (CMS/HCC) ? Dyslipidemia ? Essential hypertension ? Glaucoma ? Headache ? Prostate cancer 2006 ? Pulmonary nodule
Allergies: No Known Allergies
Diagnostic Lab Data: Specimen Information: Nasopharyngeal; Swab 0 Result Notes Ref Range & Units SARS-CoV-2 (COVID-19) by NAA, Micro Not Detected DetectedAbnormal Narrative The SARS-CoV-2 (COVID-19) by NAA test is for in vitro diagnostic use under the FDA Emergency Use Authorization (EUA) for US laboratories certified under CLIA to perform high complexity testing. This test has not been FDA cleared or approved. Methodology: Nucleic Acid Amplification (NAA)/Polymerase Chain Reaction (PCR). Specimen Collected: 06/19/21 1:22 PM Last Resulted: 06/19/21 2:33 PM
CDC Split Type:

Write-up: Patient is a very pleasant 75y.o. year old male with a known history of metastatic colon carcinoma currently receiving chemotherapy, presenting to the hospital with complaints of odynophagia and dysphagia with both liquids and solids over the past 2-3 days. Additional complaints included intermittent shortness of breath related to "asthma" - unchanged in character or severity from previously.. He denies any cough, chest pain, fever, chills, sweats. At presentation he was afebrile with stable vital signs and was maintaining an O2 sat of 100% breathing room air. Laboratory revealed a WBC of 40.4 with a predominance of neutrophils on the differential as well as toxic granulation (patient had just recently received Neulasta on 6/17), mild elevation of his alkaline phosphatase of 199 with a normal bilirubin, and normal renal function. CXR was negative for any acute pathology. For reasons that are unclear, testing for SARS CoV 2 by NAA was performed and was positive. The patient has a history of having had Covid in November 2020, and also received vaccination for Covid with 2 doses of the Pfizer vaccine in April of this year. His any recent contact with anyone with Covid 19, and states that he has severely limited travel outside of his apartment to avoid social contact during the pandemic. ID is consulted regarding the above presentation. Significance unclear. This patient has little in the way of symptomatology to support a diagnosis of Covid 19. He had symptomatic infection with SARS CoV 2 in November 2020. Prolonged positive testing for SARS CoV 2 by NAA as been noted for months following Covid 19. In addition, prolonged shedding has been noted in patient''s who are immunocompromised, although I would doubt that is the situation here as he is asymptomatic for Covid 19 (intermittent shortness of breath likely related to his underlying asthma as she is maintaining an excellent O2 sat breathing room air at this time and has a negative CXR). I do not think any therapy for Covid 19 is indicated at this time. Would doubt he is shedding infectious virus, but will continue isolation for now


VAERS ID: 1415092 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Mississippi  
Vaccinated:2021-06-17
Onset:2021-06-19
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: C-reactive protein increased, Cardiac imaging procedure abnormal, Chest pain, Electrocardiogram ST segment elevation, Pericarditis, Red blood cell sedimentation rate increased, Troponin
SMQs:, Systemic lupus erythematosus (broad), Myocardial infarction (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: 6/20/21 Troponin: 1.39 6/20/21 EKG with diffuse ST segment elevation (by report) 6/20/21 CRP: 4.62 6/20/21 ESR: 21 6/21/21 Cardiac MRI: Pericarditis, no evidence of myocarditis
CDC Split Type:

Write-up: He developed chest pain two days after vaccination. The chest pain was worse with laying flat.


VAERS ID: 1415174 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-19
Onset:2021-06-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site extravasation, Underdose
SMQs:, Extravasation events (injections, infusions and implants) (narrow), Medication errors (broad)

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

Write-up: upon administration after needed retracted vaccine spilled out of patient''s arm


VAERS ID: 1415211 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-06-18
Onset:2021-06-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dizziness, Dyspepsia, Fatigue, Headache, Nausea
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific dysfunction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Metformin 500mg, tadalafil 20mg, Lisonopril 25mg, steglujan 15/100mg, fish oil, krill oil, multivitsmin, berberine, aged garlic, co-q10
Current Illness: No
Preexisting Conditions: High Blood Pressure, adult onset diabetic
Allergies: No
Diagnostic Lab Data:
CDC Split Type:

Write-up: Nausea, heartburn, tiredness, dizzyness, urge to lay down, slight headache


VAERS ID: 1415244 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-06-10
Onset:2021-06-19
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204AZ1A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: 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: Klonpin 25mg twice a day
Current Illness: no
Preexisting Conditions: no
Allergies: Sulphur
Diagnostic Lab Data: no
CDC Split Type:

Write-up: Lymph nodes in neck became painfully swollen


VAERS ID: 1415260 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-06-19
Onset:2021-06-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0202 / 3 LA / IM

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

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

Write-up: Patient came in for a shingles shot and was mistakenly given a Pfizer covid vaccine. this is patients 3rd dose


VAERS ID: 1415263 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-05-18
Onset:2021-06-19
   Days after vaccination:32
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 2 - / SYR

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Computerised tomogram abdomen abnormal, Groin pain, Hepatic mass, Hepatocellular carcinoma, Portal vein occlusion, Renal mass, SARS-CoV-2 test positive, Scan with contrast
SMQs:, Liver related investigations, signs and symptoms (narrow), Retroperitoneal fibrosis (broad), Embolic and thrombotic events, venous (narrow), Osteonecrosis (broad), Liver malignant tumours (narrow), Non-haematological malignant tumours (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: benzoyl peroxide 10% wash, carvedilol, clindamycin lotion, furosemide, losartan, omeprazole
Current Illness: presented to ED with erythematous, painful hernia mass
Preexisting Conditions: liver cancer, alcohol abuse, hepatitis C infection, portal hypertension, varices
Allergies: none known
Diagnostic Lab Data: COVID positive on 6/19/2021 but no respiratory symptoms
CDC Split Type:

Write-up: Received Pfizer-COVID-19 vaccine on 5/18/2021 and 4/27/2021 (lot number EW01562). Presented to ED 6/19/2021 with painful mass in inguinal area thought to be a hernia. CT scan with contrast showed occluded main portal vein, masses throughout liver and kidney suggested of spreading hepatocellular carcinoma, no inguinal hernia.


VAERS ID: 1415275 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-06-19
Onset:2021-06-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0202 / 3 LA / IM

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

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

Write-up: Patient came in for a shingles shot and was accidently given a covid Pfizer vaccine instead.


VAERS ID: 1415281 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-16
Onset:2021-06-19
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 2 RA / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None Asthma in childhood, no albuterol needed after age 8
Allergies: None
Diagnostic Lab Data: elevated troponin over two days, 24,000 at admission and 221 at time of discharge
CDC Split Type:

Write-up: chest pain 2/2 myocarditis


VAERS ID: 1415293 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-18
Onset:2021-06-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Blood test normal, Chest X-ray normal, Chest pain, Dyspnoea, Electrocardiogram normal, Headache, Musculoskeletal chest pain, Pain in extremity
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: rainbow light Multivitamin for kids
Current Illness: none
Preexisting Conditions: Migraines,
Allergies: none
Diagnostic Lab Data: EKG tested at ER, came back normal. Chest X-RAY at ER doctor didn''t see anything. Blood work done at ER, hasn''t shown anything yet
CDC Split Type:

Write-up: She had chest pain in her middle chest and to the left of middle. At first the pain was moving, it was up higher and down to ribs and is not upper chest, center chest and left of center of chest. hurts when breathing. She went to ER hour and half after pain started and then her leg, upper thigh, started hurting. elevating her leg helped the leg pain. The leg pain has gotten better. She also had a bad headache the first night and the night after the vaccine but the headaches have gotten better since.


VAERS ID: 1415306 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-06-18
Onset:2021-06-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Lymphadenopathy, Pain in extremity
SMQs:, Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: pain in left arm and leg


VAERS ID: 1415331 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-19
Onset:2021-06-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypoaesthesia oral, Rash
SMQs:, Anaphylactic reaction (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: phentermine; women''s hair skin vitamin;
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt returned to pharmacy counter after 15 minutes to pick up her vaccination card, and at that time showed us the rash on her arm. Pt was asked to remain in the pharmacy for an additional 15 minutes for observation. Pt stayed a total of 40 minutes after vaccination. Pt had no difficulty breathing, and rash/itchiness did not spread beyond affected limb. Pt was instructed to take diphenhydramine 50mg and to seek immediate medical assistance if symptoms worsened or had any difficulty breathing. Followed up with pt a day later, and pt''s rash has resolved, but stated that she has slight numbness on tip and sides of tongue. Pt advised to follow up with primary healthcare provider


VAERS ID: 1415355 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-06
Onset:2021-06-19
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Imuran Plaquenil Eutirox 88
Current Illness:
Preexisting Conditions: Systemic lupus; erythematosus; Hypothyroidism Hashimoto
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Herpes Zoster on left side of neck


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