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From the 10/15/2021 release of VAERS data:

Found 800,916 cases where Vaccine is COVID19 and Patient Did Not Die



Case Details (Reverse Sorted by Onset Date)

This is page 89 out of 8,010

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VAERS ID: 1744537 (history)  
Form: Version 2.0  
Age: 97.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-04-06
Onset:2021-09-27
   Days after vaccination:174
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Hypertension, anxiety, macular degeneration, cholesterol
Allergies:
Diagnostic Lab Data: PCR collected on 9-27-2021, resulted positive
CDC Split Type:

Write-up: unknown


VAERS ID: 1744579 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-09-27
Onset:2021-09-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Back pain, Extra dose administered, Injection site pain
SMQs:, Retroperitoneal fibrosis (broad), Extravasation events (injections, infusions and implants) (broad), Arthritis (broad), 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: Arthritis, obesity
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: After receiving the Pfizer COVID-19 booster, I experienced soreness of the vax site. After one day I began to have soreness in my back and knees, which at this writing is ongoing.


VAERS ID: 1744613 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-27
Onset:2021-09-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808986 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Malaise, Mobility decreased, Vomiting, Wheezing
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Asthma/bronchospasm (broad), Parkinson-like events (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (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: Childhood Vaccinations: Unsure of which ones
Other Medications: Synthroid 75mg (once daily)
Current Illness: None
Preexisting Conditions: Thyroidectomy
Allergies: Unknown
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Started feeling ill, starting vomiting for 27 straight hours, wheezing, was unable to keep food or water down. Unable to sit up .


VAERS ID: 1744630 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-02-26
Onset:2021-09-27
   Days after vaccination:213
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9266 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: PCR collected on 9-27-2021, positive
CDC Split Type:

Write-up: unknown


VAERS ID: 1744743 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-09-09
Onset:2021-09-27
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045C21A / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Bell's palsy, Facial paralysis, Speech disorder
SMQs:, Dementia (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hearing impairment (broad)

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

Write-up: Developed Bells Palsy facial dropping and difficulty speaking started on 9/22/2021


VAERS ID: 1744748 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-09-27
Onset:2021-09-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Confusional state, Dizziness, Electrocardiogram, Fatigue, Headache, Pain, SARS-CoV-2 test negative, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Adderall
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Went to walk-in clinic 09/29/21 0900 , they tested my blood pressure , O2 levels 100% , tested me for covid - negative . Preformed an EKG and a more depth blood pressure test , can?t remember what they called it . Everything came back fine , they said it was most likely adverse side effects from the vaccine .
CDC Split Type:

Write-up: That night a headache , next day same headache with slight aches and pains fatigue , next morning 0400 exhaustion , lightheaded , dizziness , confusion , and fainting .


VAERS ID: 1744750 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-09-18
Onset:2021-09-27
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cerebral infarction, Hypoaesthesia, Hypoaesthesia oral, Magnetic resonance imaging head abnormal, Myalgia, Salivary hypersecretion
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Ischaemic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none known
Allergies: Naproxen Prednisone
Diagnostic Lab Data: 9/28/2021 MRI brain?embolic appearing infarcts in the distal left MCA territory.
CDC Split Type:

Write-up: concerns of right-sided facial and upper extremity numbness. 09/27/202110 AM she noted acute right-sided lip and cheek numbness and right upper extremity numbness. This lasted for about several minutes but currently she still has residual numbness to her right fourth and fifth digit. Also had increased salivation and some myalgias since receiving the vaccine.


VAERS ID: 1744774 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-04-12
Onset:2021-09-27
   Days after vaccination:168
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040B21A / 2 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Atelectasis, Blood glucose decreased, COVID-19, Chest X-ray abnormal, Cough, Dyspnoea, Lung infiltration, Respiratory symptom, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Interstitial lung disease (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: chest xray wih minimal infiltrate on 9/27/21 SARS-COV-2 (COVID-19), Micro detected on 9/28/21
CDC Split Type:

Write-up: Patient developed upper respiratory symptoms, and also experienced multiple episodes of very low blood sugar, presented to the Emergency dept. She was tested for COVID and tested positive on 9/28/21. Symptoms included cough and shortness of breath with chest xray showing minimal left basilar infiltrate or atelectasis on 9/27.


VAERS ID: 1744961 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-27
Onset:2021-09-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chest discomfort, Muscle tightness
SMQs:, Anaphylactic reaction (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: Lisinopril and Synthroid
Current Illness: No
Preexisting Conditions: None
Allergies: No
Diagnostic Lab Data: No
CDC Split Type:

Write-up: Shortly after getting the shot, while driving home, started to feel chest tightness on my left side. It?s been there for three days now. Feels like a muscle tightness. Gets more intense if I take deep breaths.


VAERS ID: 1744964 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-09-27
Onset:2021-09-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Back pain, Burning sensation, Chapped lips, Chest discomfort, Chest pain, Cough, Eye irritation, Eyelid margin crusting, Fatigue, Feeling abnormal, Feeling of body temperature change, Headache, Hyperhidrosis, Impaired work ability, Lacrimation increased, Neck pain, Oral discomfort, Pain, Pain in extremity, Pain of skin, Paraesthesia, Paranasal sinus discomfort, Peripheral coldness, Pruritus, Pyrexia, Sinus pain, Sleep disorder, Taste disorder
SMQs:, Anaphylactic reaction (narrow), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Corneal disorders (broad), Lacrimal disorders (narrow), Periorbital and eyelid disorders (narrow), Hypersensitivity (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Multi-vitamin Fish oil Vitamin d Collagen Zyrtec Mirena
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Side effects from vaccine 9/27/2021 Our family had covid back in March 2021. Demonstrated antibodies. Felt pressure to give vaccine to family. 9/27/2021 - Afternoon - pain in arm. 4 pm - arm started hurting more 515 pm - feeling tired 615 pm - bad taste in mouth 8 pm - exhaustion 9pm - body aches - from feet to legs and back 10 pm - went to bed - very restless sleep until 12 30 am - waking and feeling pain and aches - Jabbing pains throughout body Bad taste in mouth 9/28/2021 1 am - aches in lower back Can?t sleep Arm hurts - don?t want to even move it. Miserable. Pains in legs continuing Chest feeling gross Itchy head Cracking joints 426 am - kept waking up. Hurting and aching badly. Feels like Covid is coming back. How awful. Lower back pain. Terrible taste in mouth Sinuses tight and painful. Burning. Arm is throbbing. Lips cracked and burning. Even my toes hurt. Shooting pains through lower back. Hot pain in leg. Pains in neck, shoulders, back of head Still awake 535 am Took more Advil 630 am Up again 632 am broke into hot sweat. 10 am woke up Overly Crusty eyes Lower back pain Can?t see to type on my phone. Chest tight and hurts. Cough. Skin hurts. Prickly to the touch. 1140 pm - feel like crying. The aches hurt. Lowe back and hips. Shooting pains in my legs. Waves of Hot and cold. Itchy head - hair hurts to scratch it. 1215 pm fever 99.9 even though taking Advil Talked to doctor - took Advil again and aspirin 145 pm - achy 2 pm - Shoulders - headache Sweaty chest - cold feet 304 pm eyes burning and tearing 424 pm bad lower back pain 630 took 3 Advil for pain Dinner Broke into hot sweat 812 pm - another wave of more severe lower back pain Taking aspirin Sinus pressure 930 continual sweat outbreaks 1030 3 Advil bedtime Lower back hurts bad - 9/29/2021 Woke up 130 am foggy back hurt Woke up 630 with kids - took Advil Slept til 1030 Exhausted still! Back starting to hurt. 1220 pm Arm still hurts Still fatigued. Still missing work.


VAERS ID: 1745003 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-09-27
Onset:2021-09-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest X-ray normal, Chest discomfort, Dyspnoea, Fatigue, Influenza A virus test negative, Nausea, Respiratory syncytial virus test negative, SARS-CoV-2 test negative, Tremor
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypoglycaemia (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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unk
Current Illness: na
Preexisting Conditions: na
Allergies: nka
Diagnostic Lab Data: COVID-19 PCR, negative RSV, negative Influenza, negative chest xray, congestion albuterol neb given with decrease in symptoms
CDC Split Type:

Write-up: Pt c/o chest tightness and difficulty breathing after received 2nd dose Pfizer Covid vaccine last night. Appears fatigued but it alert and oriented, awakens easily. Reports some nausea and feeling shaky.


VAERS ID: 1745011 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-09-01
Onset:2021-09-27
   Days after vaccination:26
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH BOOSTER / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chills, Diarrhoea, Dyspnoea, Malaise
SMQs:, Anaphylactic reaction (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), 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: Zimvastatin Calcium Magnesium Vitamin D
Current Illness: None
Preexisting Conditions: Pre diabetes Cancer survivor High cholesterol
Allergies: Sentsitive
Diagnostic Lab Data:
CDC Split Type:

Write-up: At midnight of the same day of booster shot, I woke up with chills, diarrhea and my blood pressure was 150/90. I had shortness of breath and felt ill all night. Did not have this reaction with the other Pfizer shots, except for tiredness and headache.


VAERS ID: 1745036 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-01-28
Onset:2021-09-27
   Days after vaccination:242
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / 2 LA / IM

Administered by: Work       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: 9/28/21 SARS/COV-2, NAAT, Positive
CDC Split Type:

Write-up: Breakthrough COVID


VAERS ID: 1745050 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-09-27
Onset:2021-09-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048F21A / 2 RA / IM

Administered by: Work       Purchased by: ?
Symptoms: Injected limb mobility decreased, Injection site erythema, Injection site pain, Injection site swelling, Injection site warmth
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: levorhyroxine paroxetine
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: A few hours after Vaccination my upper arm swelled up and was unable to move my arm. Took ibuprofen and iced my arm. Two days later my arm is still swelling, red, and warm and severely tender to the touch


VAERS ID: 1745058 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-09-27
Onset:2021-09-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 088D21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Patient states she has a polycystic liver disease.
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient states that after patient received COVID shot on Monday, 09/27/2021, around 8:30am that later on in the day around 2:30 pm the patient started to break out. As of Wednesday, 09/29/2021 around 12:45 pm, when patient came to pharmacy that she had been itching since ~2:30pm on Monday and was still itching and had been broken out in welps since Monday afternoon.


VAERS ID: 1745059 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Idaho  
Vaccinated:2021-09-25
Onset:2021-09-27
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain upper, Laboratory test, Ultrasound scan
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Severe headache from 1st Covid shot 9/4/21
Other Medications: none
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Labs, Ultrasound
CDC Split Type:

Write-up: Severe RUQ pain


VAERS ID: 1745065 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-09-26
Onset:2021-09-27
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW017Y / UNK RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chills, Decreased appetite, Frequent bowel movements, Headache, Malaise, Nausea, Pain, Pyrexia, Respiratory tract congestion
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Micardis 40 mg. Once daily Vitamin D. 1000 mcg Once daily
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Nausea, fever (102), chills, loss of appetite, achy, congestion, Frequent bowl movement (6 times in two hours, malaise, headache.


VAERS ID: 1745083 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-27
Onset:2021-09-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 1 RA / IM

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

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

Write-up: Patient was 11 years old when she received the Covid vaccine, no known symptoms or side effects


VAERS ID: 1745086 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-09-26
Onset:2021-09-27
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025C21A / 2 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dizziness, Headache, Myalgia, Oropharyngeal pain, Pyrexia, Respiratory disorder
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Respiratory failure (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: 8/24/2021 Moderna Shot 1 had Headache for 3 days following
Other Medications: Metoprolol
Current Illness: None
Preexisting Conditions: None
Allergies: Hayfever and Wheat/Gluten
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever of 103.1, Respiratory difficulty, muscle aches, dizziness, Headache and sore throat. Took Advil to relieve fever which broke around noon on Tuesday. Rest and lots of fluids.


VAERS ID: 1745098 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-09-27
Onset:2021-09-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA O78C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Headache, Pain in extremity
SMQs:, Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Levothyroxine, Venlafaxine, Nortriptyline; Multivitamin-mineral, Liposomal Vitamin C, Ubiquinol, Quercetin, Eye Support, NAC/Glutathione, DIM, Vitamin B Complex, Magnesium L-Theonate, Vitamins D & K
Current Illness:
Preexisting Conditions: Fibromyalgia, depression, hypothyroidism
Allergies: Sulfa, erythromycin, pollens
Diagnostic Lab Data: None
CDC Split Type:

Write-up: About 15 minutes after shot, fatigue and feeling wiped out. Painful sore arm seven hours later. Headaches ever since. Two days later and headaches, fatigue, wiped-out and painful sore arm are no better.


VAERS ID: 1745107 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-01-28
Onset:2021-09-27
   Days after vaccination:242
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: Admitted to Hospital on Date of Adverse Event [recorded in VAERS] for treatment of Covid-19 Positive following completion of Covid Vaccine Series


VAERS ID: 1745123 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-04-10
Onset:2021-09-27
   Days after vaccination:170
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805029 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: COVID-19
SMQs:, Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: Vaccinated patient hospitalized with COVID-19


VAERS ID: 1745137 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-09-25
Onset:2021-09-27
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Lymphadenopathy, Pain, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (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: Wellbutrin
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: I am a physician and received my 3rd shot Pfizer - did well but developed LAD about 48 hours later - quite significant under my axilla and down my lateral chest wall. Was uncomfortable for 48 hours requiring NSAIDs and now I am still quite swollen but pain is subsiding.


VAERS ID: 1745164 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-02-11
Onset:2021-09-27
   Days after vaccination:228
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL8982 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9269 / 2 LA / IM

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

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

Write-up: Fully Vaccinated patient hospitalized with COVID-19.


VAERS ID: 1745170 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-09-27
Onset:2021-09-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301558A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Hypoaesthesia, Immediate post-injection reaction, Injection site pain, Pain in extremity, Pain in jaw
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Vestibular disorders (broad), Osteonecrosis (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Sexual dysfunction (broad)

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

Write-up: Numbness in fingers and dizziness immediately after shot. Pain in left arm and right jaw for 2 days, numbness in fingers and toes, tenderness and pain at injection site 2 days later that does not go away even with ibuprofen. Still experiencing symptoms now.


VAERS ID: 1745172 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-24
Onset:2021-09-27
   Days after vaccination:187
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: Admitted to Hospital on Date of Adverse Event [recorded in VAERS] for treatment of Covid-19 Positive following completion of Covid Vaccine Series


VAERS ID: 1745185 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-09-27
Onset:2021-09-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30130BA / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Underdose
SMQs:, Medication errors (broad)

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

Write-up: Error: Wrong Dose of Vaccine - Too Low-


VAERS ID: 1745219 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-09-27
Onset:2021-09-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 3 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Condition aggravated, Headache, Impaired work ability, 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: Headache January 2nd, 2021 pfizer Covid 1st dose
Other Medications:
Current Illness:
Preexisting Conditions: Systemic Lupus
Allergies: Benadryl, plaquenil
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Terrible headache, then started running fever for the past 2 days at night which I missed 2 days of work. With my first dose in January I got a headache but nothing like this one, and with the second dose nothing happened, With this booster it was much worse headache started about 20 minutes after getting the injection and then the fever started that night, I am starting to feel better today so I think it may be over, but was not expecting this to happen at all.


VAERS ID: 1745238 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-09-27
Onset:2021-09-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039D21A / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dyspnoea, Pain, Rash
SMQs:, Anaphylactic reaction (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Moderna COVID?19 Vaccine EUA Rash all over upper torso. Painful. Achy body. Shortness of breath


VAERS ID: 1745300 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-01-29
Onset:2021-09-27
   Days after vaccination:241
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1686 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Asymptomatic 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:
CDC Split Type:

Write-up: Individual tested Covid positive on 9/27/21. Advised to isolate from family in separate rooms for ten days and to update mgmt. She works remotely from home. She will callback on 10/7/21. DOH has not contacted her yet. She is agreeable to have antibody testing at any DLS after her isolation period is complete. Previously, her daughter tested positive on 9/7/21 and was later released from isolation on 9/17/21 per DOH. The individual was always asymptomatic throughout the entire period.


VAERS ID: 1745336 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-10
Onset:2021-09-27
   Days after vaccination:201
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: Admitted to Hospital on Date of Adverse Event [recorded in VAERS] for treatment of Covid-19 Positive following completion of Covid Vaccine Series


VAERS ID: 1745350 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-27
Onset:2021-09-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047B21A / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Coagulation test, Differential white blood cell count, Full blood count, Haematology test, Laboratory test, Purpura, Rash macular
SMQs:, Haemorrhage terms (excl laboratory terms) (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: Levothyroxine 50mcg cap 1 cap po q daily Losartan 50mg tab 1 tab po q daily
Current Illness: None
Preexisting Conditions: Hypothyroid Hypertension osteoporosis
Allergies: codeine- rash Indocin- sensitivity
Diagnostic Lab Data: CBC w/ diff, Hematology, Chemistry, and Coagulation all done on 9/27/2021 in ER
CDC Split Type:

Write-up: Purpuric-like discoloration to her distal right fourth digit. There was also some mild involvement into the second interphalangeal joint. Patient denied pain, shortness of breath, chest pain. There was no decreased range of motion of her finger. She had no rashes that she knew of anywhere else on her body. Patient was monitored for an additional 30 minutes. When provider returned to the room she had c/o new blotchiness of her arms bilaterally on the ventral aspects. Patient was still asymptomatic, no pain in her finger or anywhere else, no shortness of breath, no throat tightening. Patient then sent to our ER department.


VAERS ID: 1745352 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-07
Onset:2021-09-27
   Days after vaccination:232
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: Admitted to Hospital on Date of Adverse Event [recorded in VAERS] for treatment of Covid-19 Positive following completion of Covid Vaccine Series


VAERS ID: 1745391 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-02-19
Onset:2021-09-27
   Days after vaccination:220
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN9581 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Anxiety, Asthenia, Blood magnesium, Blood potassium, Brain natriuretic peptide increased, C-reactive protein, Chest X-ray, Culture urine, Differential white blood cell count, Dizziness, Dyspnoea, Electrocardiogram, Full blood count, Hypokalaemia, Inflammation, International normalised ratio, Ischaemia, Metabolic function test, Palpitations, Prothrombin time ratio, Troponin, Troponin I, Urine analysis
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypoglycaemia (broad), Hypokalaemia (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Lab Tests Completed BRAIN NATRIURETIC PEPTIDE C-REACTIVE PROTEIN (INFLAMMATION) COMPREHENSIVE METABOLIC PANEL LAB ONLY-COMPLETE BLOOD COUNT WITH DIFFERENTIAL MAGNESIUM POTASSIUM PROTIME/INR TROPONIN I performed 2 times URINE DIP, REFLEX TO MICROSCOPIC, REFLEX TO CULTURE Icon Imaging Orders Placed Today Imaging Tests EKG performed 2 times XRAY CHEST PORTABLE -
CDC Split Type:

Write-up: Pt with anxiety, shortness of breath, weakness, lightheaded, palpitations. EKG suggest ischemic changes. Troponin 0.006. BNP elevated. Is an 89-year-old female that presented to the outside facility with palpitations and more frequent episodes of anxiety as well as some mild shortness of breath. During the course of their evaluation she was found to be hypokalemic. We discussed replacement. She does have a mildly elevated troponin. Icon Lab Tests Completed


VAERS ID: 1745416 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-01-29
Onset:2021-09-27
   Days after vaccination:241
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6023 / 2 UN / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3302 / 1 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Dialysis, SARS-CoV-2 test positive, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Acute renal failure (narrow), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Chronic kidney disease (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Hospital Diabetes Mellitus Type 2 Failure Renal End Stage Hyperparathyroidism Renal Secondary Hypertension Essential Primary Prosthesis Heart Valve Hemodialysis Status Syncope COVID-19 Infection Non-Hospital Other Iron Deficiency Anemias Thrombocytopenia
Allergies: NKA
Diagnostic Lab Data: Coronavirus 2 PCR Detect, V symptomatic POSITIVE
CDC Split Type:

Write-up: Situation/Background: The patient is an 85 year old foreign language speaking female who at 1000 today had a syncopal episode. This was witnessed by her son who caught the patient, no trauma and the patient took 60 seconds to return to normal. The patient has dialysis M-W-F, missed her run today and last received dialysis Friday 9/24/2021. The patient has a medical history that includes Diabetes Mellitus Type II, ESRD, CAD, Aortic Stenosis with valve, HTN, poor vision and CVA.


VAERS ID: 1745419 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-18
Onset:2021-09-27
   Days after vaccination:162
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: Admitted to Hospital on Date of Adverse Event [recorded in VAERS] for treatment of Covid-19 Positive following completion of Covid Vaccine Series


VAERS ID: 1745434 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-20
Onset:2021-09-27
   Days after vaccination:191
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: Admitted to Hospital on Date of Adverse Event [recorded in VAERS] for treatment of Covid-19 Positive following completion of Covid Vaccine Series


VAERS ID: 1745435 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-09-25
Onset:2021-09-27
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Lymphadenopathy, Neck pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: I developed swelling in my left armpit, and pain in my neck. I also had a fever.


VAERS ID: 1745447 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-03-30
Onset:2021-09-27
   Days after vaccination:181
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026B21A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Calcium carbonate 500mg TID cyanocobalamin 1000mg ergocalciferol 2000IU Daily ferrous sulfate 325mg every other day levothyroxine 75mcg daily multivitamin daily nitrofurantoin 100mg Tuesdays and Fridays Oxymetazoline nasal daily pantoprazol
Current Illness: None documented
Preexisting Conditions: Vaginal cystocele, Recurrent UTI, arthritis, diverticulosis of sigmoid colon, hypothyroidism, insomnia, degeneration of lumbar intervertebral disc, Lumbar spondylosis, Greater trochanteric pain syndrome, anxiety, morbid obesity
Allergies: No known allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient contracted COVID after being fully vaccinated asymptomatic


VAERS ID: 1745500 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-27
Onset:2021-09-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 049E21A / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Extra dose administered, Fatigue, Headache, Injection site pain, Pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: 2/4/21 Covid, Moderna - severe rash. 3/9/21 Covid, Moderna - Flu-like symptoms + fever
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Very sore left arm. Headache. Body aches. Tired. Lasted 1-1/2 days


VAERS ID: 1745540 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-09-27
Onset:2021-09-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204B21A / UNK - / SYR

Administered by: Public       Purchased by: ?
Symptoms: Chills, Feeling abnormal, Lethargy, Mobility decreased, Pain, Product administered to patient of inappropriate age, Sleep disorder
SMQs:, Dementia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Tendinopathies and ligament disorders (broad), Medication errors (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: None
Current Illness: None, but had been exposed to a Covid positive classmate at school as a close contact on September 16, 2021. Patient tested negative by rapid test on September 21st, and negative again by PCR test on September 22nd.
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt who just turned 12, was given the Johnson & Johnson Covid vaccine on Monday evening, September 27th. It was an adult dose, given at a pop-up vaccine clinic managed by the Health Department. Her dad and I have 50/50 custody, and he took her to the vaccine clinic. She has been with him since that time, but I talked to her last night and I have been very concerned about her. She told me she had extreme chills beginning around 11:00 pm Monday night, September 27th. She felt unable to move to pull a blanket over herself. She was in so much pain all over her body that she kept waking up every half hour, all night long. She reports that her dad gave her some sort of pain medicine, but that it didn''t work, so he gave her something else. Her headache has persisted, and she was unable to attend school on Tuesday, September 28th because she was in so much pain. When I spoke with her Tuesday evening she sounded very lethargic and not like her usual self. Her dad and I are going through another custody fight, and he has not responded with my questions about how she is doing, or how she was administered the wrong vaccine.


VAERS ID: 1745553 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: Idaho  
Vaccinated:2021-09-27
Onset:2021-09-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 3 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Eye pain, Ocular hyperaemia, Photophobia, Uveitis
SMQs:, Anaphylactic reaction (broad), Noninfectious meningitis (narrow), Glaucoma (broad), Corneal disorders (broad), Retinal disorders (broad), Ocular infections (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Yes, had hives 3 weeks after dose 2 of the pfizer covid vaccine in January 2021
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: Unknown
Diagnostic Lab Data: Seen in ED and then by a specialist
CDC Split Type:

Write-up: Within hours of receiving the vaccine, patient reported severe eye pain, redness and photophobia. Diagnosed with uveitis/iritis and prescribed oral and topical steriods, along with cycloplegics


VAERS ID: 1745599 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-25
Onset:2021-09-27
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: 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: None
Current Illness: None
Preexisting Conditions: None
Allergies: Latex, pcn
Diagnostic Lab Data:
CDC Split Type:

Write-up: Right axillary lymph nodes swelling


VAERS ID: 1745605 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-01-15
Onset:2021-09-27
   Days after vaccination:255
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK4176 / 2 LA / IM

Administered by: Work       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: 9/29 SARS/COV-2 NAAT Positive
CDC Split Type:

Write-up: Breakthrough COVID


VAERS ID: 1745609 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-09-27
Onset:2021-09-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: AGE 75, Similar but less severe reaction after 2nd dose of Pfizer. 2/10/2020 Pfizer Covid Vax
Other Medications: 81 MG aspirin diltiazem HCI ER Beads 240MG Famotidine 20 MG Pravachol 20 MGWarfarin 5MG Biotin 5000 MG Calcium Caltrate 600 MG + D3 One A Day Proactive 65+Cirrucel 1 cap Zyrtec 10 MG
Current Illness: None
Preexisting Conditions: artificial mitral valve
Allergies: Bee Stings
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Symptoms started about 8:30 pm on the evening of the vaccination. I experienced Chills. Fever, Headache, Body Aches, Exhaustion. Symptoms continued into the following day and lasted all day long into the following evening.


VAERS ID: 1745635 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-27
Onset:2021-09-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Burning sensation, Dizziness, Dyspnoea, Nausea, Palpitations, Pruritus, Rash, Rash erythematous, Urticaria, Vomiting, Wheezing
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (narrow), Asthma/bronchospasm (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: omeprazole, triamterene, Pepcid AC, albuterol, fish oil, flaxseed oil, folic acid, probiotic, zinc, magnesium, vitamin D, biotin, beta carotene
Current Illness: N/A
Preexisting Conditions: Celiac Disease, arthritis, Raynaud''s, RNA Polymerase iii Antibody elevated (mother passed away from Scleroderma), anemia, mitral valve prolapse and enlarged right side of the heart
Allergies: penicillin, ciprofloaxin, flagyl, nuts (especially peanuts)
Diagnostic Lab Data: On two occasions, I was provided with cipro/flagyl for Hpylori in my stomach. Both times, I developed an adverse reaction, one brought me to the hospital to receive an IV.
CDC Split Type:

Write-up: Upon receiving the vaccination, I was feeling faint. Arrived at home, within two hours, hives developed over my entire body and a rash on my face and neck which was red and burning. My breathing was compromised and I was wheezing. My scalp was itching. I became nauseous and vomited several times. Heart was palpitating.


VAERS ID: 1745660 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-03-19
Onset:2021-09-27
   Days after vaccination:192
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 015M20A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Hypoaesthesia, Injection site pain
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Sexual dysfunction (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: alendronate sodium ,amlodipine benefiter betamethasone valerate levothyroxine sodium , meclizine, miralax Mylanta Tylenol viactiv vitamin b12 , vitamin D , hydrocortisone biotin
Current Illness: no
Preexisting Conditions: Blood pressure, glaucoma osteoporosis
Allergies: sodium pentanol
Diagnostic Lab Data:
CDC Split Type:

Write-up: injection site sill panful and left pinky finger numb


VAERS ID: 1745668 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-09-27
Onset:2021-09-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004F21A / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache, Muscle fatigue, Night sweats, Pain in extremity, Pyrexia, Sleep disorder
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Sore arm Muscle fatigue (legs, arms) Headache Fever Night sweats, inability to sleep


VAERS ID: 1745678 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-09-27
Onset:2021-09-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Chest pain, Dyspnoea, Headache, Nausea, Neck pain, Pain, Pain in extremity, Pain of skin, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), 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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lisinopril, amitryptaline rizatripran omeprazole
Current Illness:
Preexisting Conditions: High blood pressure, migraines
Allergies: Dimetapp
Diagnostic Lab Data:
CDC Split Type:

Write-up: Sore arm for 3 days. Nausea vomiting SOB body aches joint pain skin pain headache neck pain for approximately 24 hours chest pain currently ongoing.


VAERS ID: 1745683 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-26
Onset:2021-09-27
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Confusional state, Decreased appetite, Diarrhoea, Hyperhidrosis, Pain, Pyrexia
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), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Fever 103, sweats, chills, diarrhea, confusion. Loss of appetite. Full body aches


VAERS ID: 1745713 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-09-24
Onset:2021-09-27
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Local reaction
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: CHRONIC OBSTRUCTIVE PULMONARY DISEASE, UNSPECIFIED (J44.9) PAROXYSMAL ATRIAL FIBRILLATION (I48.0) DRUG INDUCED CONSTIPATION (K59.03) EDEMA, UNSPECIFIED (R60.9) DISAPPEARANCE AND DEATH OF FAMILY MEMBER (Z63.4) PRESSURE ULCER OF SACRAL REGION, STAGE 2 (L89.152) ESSENTIAL (PRIMARY) HYPERTENSION (I10) PRESENCE OF CARDIAC PACEMAKER (Z95.0) INCONTINENCE WITHOUT SENSORY AWARENESS (N39.42) MUSCLE WEAKNESS (GENERALIZED) (M62.81) URINARY TRACT INFECTION, SITE NOT SPECIFIED (N39.0) ANXIETY DISORDER, UNSPECIFIED (F41.9) GENERALIZED ANXIETY DISORDER (F41.1) CONSTIPATION, UNSPECIFIED (K59.00) INSOMNIA, UNSPECIFIED (G47.00) PRESSURE ULCER OF UNSPECIFIED PART OF BACK, UNSTAGEABLE (L89.100) DYSTHYMIC DISORDER (F34.1) OTHER LACK OF COORDINATION (R27.8) ANEMIA, UNSPECIFIED (D64.9) GASTRO-ESOPHAGEAL REFLUX DISEASE WITHOUT ESOPHAGITIS (K21.9) OTHER CHRONIC PANCREATITIS (K86.1)
Allergies: Butorphanol, Codeine, Hydromorphone, Ketorolac, Morphine, Promethazine, Propoxyphene, Darvon, Nubain, Penicillins, Sulfa Antibiotics, iodine contrast oral and IV
Diagnostic Lab Data:
CDC Split Type:

Write-up: LOCALIZED REACTION IN ARM REQUIRING MEDICAL ATTENTION


VAERS ID: 1745714 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-27
Onset:2021-09-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301458A / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Brain natriuretic peptide increased, Chills, Condition aggravated, Dizziness, Dyspnoea, Full blood count, Metabolic function test, Myocarditis, Palpitations, Sinus node dysfunction, Systemic lupus erythematosus, Troponin increased
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Systemic lupus erythematosus (narrow), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Disorders of sinus node function (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: aspirin 81 mg oral tablet, chewable, 81 mg= 1 tabs, Chew, QDAY atorvastatin 80 mg oral tablet, 80 mg= 1 tabs, Oral, NIGHTLY atovaquone 750 mg/5 mL oral suspension, 1500 mg= 10 mL, Oral, QLUNCHAC, 1 refills Bactrim DS 800 mg-160 mg oral t
Current Illness: Drainage of hip abscess from spider bite earlier same day (9/27/21).
Preexisting Conditions: Lupus, HTN, CKD, hemolytic anemia
Allergies: Penicillin, seafood
Diagnostic Lab Data: CBC, CMP, troponin - elevated, BNP - elevated
CDC Split Type:

Write-up: Initial dizziness, watched in hospital for 30 mins, discharged home in stable condition. Over subsequent 48hrs developed chills, sob, lightheadedness, palpitations. Pt with incomplete control of SLE w/ occasional myocarditis. Has had SLE flare w/in past 6 months. Now w/ sx concerning for recurrent myocarditis & sick sinus syndrome. Site Left Deltoid Route Intramuscular Dose 30 Unit mcg Expiration Date FEB 28, 2022 Manufacturer Pfizer Inc. Covid-19 (Pfizer) Published AUG 23, 2021 Given SEP 27, 2021


VAERS ID: 1745934 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-09-01
Onset:2021-09-27
   Days after vaccination:26
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Malaise, Menstruation irregular, Pain in extremity
SMQs:, Fertility disorders (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: Prenatal vitamins
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Sore arm, fatigue and general sick 12-24 hours after second dose. Missed period with no pregnancy which is very irregular for me.


VAERS ID: 1745936 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-27
Onset:2021-09-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047B21A / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Coagulation test normal, Ecchymosis, Extra dose administered, Full blood count normal, Metabolic function test, Skin discolouration
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Hypotonic-hyporesponsive episode (broad), Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Levothyroxine, Losartan, calcium, Vit D3, Vit C, Areds 2, Red Yeast Rice and probiotics
Current Illness: None
Preexisting Conditions: None
Allergies: Indocin and Codeine
Diagnostic Lab Data: CBC, Coag panel, Metabolic Panel all WNL.
CDC Split Type:

Write-up: Approximately 8 minutes after receiving vaccine, the top right of the fourth finger on my right had began to turn purple. It started on the outside right of my nailbed, extended around the top then down through the second joint area where it stopped. 10 minutes later a spontaneous ecchymotic area 1cm in diameter appeared on the top of my right hand. No there areas were affected. (Later that night, I had some common s/e''s but nothing unexpected.) 9/28 am it started to resolve and continues to be self limiting. Went to ED for eval.


VAERS ID: 1745962 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-03-03
Onset:2021-09-27
   Days after vaccination:208
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029A21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory failure, COVID-19, COVID-19 pneumonia, Chills, Cough, Dizziness, Dyspnoea, Fatigue, Headache, Malaise, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: amantadine, atorvastatin, carbidopa-levodopa, celecoxib, gabapentin, levothyroxine, metoprolol succinate ER, pantoprazole, paroxetine, ramelteon, rasagiline
Current Illness:
Preexisting Conditions: Parkinson disease, HTN, and hypothyroidism
Allergies: NKDA
Diagnostic Lab Data: COVID status positive on 9/16/21
CDC Split Type:

Write-up: Patient received Moderna COVID vaccine on 2/3/21 and 3/3/21. Per patient, symptoms (cough, headache, chills, fatigue, malaise, dizziness, and dyspnea) began on 9/14/21 and COVID status positive on 9/16/21. On 9/27/21, patient is admitted to our facility for acute hypoxemic respiratory failure due to COVID-19 pneumonia. Patient is discharged home today (9/29/21) with supplemental oxygen.


VAERS ID: 1745972 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-09-25
Onset:2021-09-27
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 211A21A / 1 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal pain, Abdominal pain upper, Angina pectoris, Chest pain, Dysstasia, Headache, Heart rate irregular, Hypoaesthesia, Peripheral swelling, Swelling face, Vertigo, Vision blurred
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Glaucoma (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Cardiac arrhythmia terms, nonspecific (narrow), Other ischaemic heart disease (narrow), Vestibular disorders (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Sexual dysfunction (broad)

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

Write-up: Facial swelling, legs swelling, severe vertigo, irregular heart rhythm problem- too fast and then too slow, irregularly pulse with sharp and steady heart pain), numbness in left shoulder, numbness behind the neck, can''t feel the right half of my head, severe headache, chest pain, stomach pain, severe abdominal pain, blurry vision, can''t stand on my feet.


VAERS ID: 1746165 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-09-20
Onset:2021-09-27
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047C21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: PENICILLIN ALLERGY - STATES REACTION SIMILAR TO THIS - BODY ALL FEELS ITCHY
Diagnostic Lab Data:
CDC Split Type:

Write-up: THE PATIENT CALLED A WEEK AFTER VACCINATION EXPLAINING SHE HAD EXTREME ITCHINESS OVER HER ENTIRE BODY. SHE PRESENTED TO THE PHARMACY AND WAS VISIBLY RED, BUT NOT SWOLLEN


VAERS ID: 1746172 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-03-16
Onset:2021-09-27
   Days after vaccination:195
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003A21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: COVID-19, Hypoxia, SARS-CoV-2 test positive, Vaccine breakthrough infection
SMQs:, Asthma/bronchospasm (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Covid positive 9/28/21
CDC Split Type:

Write-up: breakthrough covid - hypoxia requiring oxygen


VAERS ID: 1746182 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-27
Onset:2021-09-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dysmenorrhoea, Fatigue, Headache, Injection site pain, Menstrual disorder, Myalgia, Pain
SMQs:, Rhabdomyolysis/myopathy (broad), Extravasation events (injections, infusions and implants) (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Methimazole, Synthroid, Lexapro
Current Illness: Graves? disease, Hashimotos, PCOS
Preexisting Conditions: Graves? disease, Hashimotos, PCOS
Allergies: Azithromycin, dust, pollen
Diagnostic Lab Data:
CDC Split Type:

Write-up: Period changes- Thick cup (1.5 cup clear gelly) of cervical mucus released a few days after vx #1- this has never happened to me before; period stopped mid period after vx 2. Pain in arm at site; headache; fatigue; muscle pain; body soreness; cramping menstrual cramps


VAERS ID: 1746382 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-25
Onset:2021-09-27
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site induration, Injection site rash
SMQs:, Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)

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

Write-up: Patient came back reporting a rash and hard around the injection site. Said that she went to the doctor and was told that it was a reaction to the vaccine. Doctor gave her prednisone daily for 5 days


VAERS ID: 1746402 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-09-13
Onset:2021-09-27
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 2 LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 1 - / SYR

Administered by: Private       Purchased by: ?
Symptoms: Pain, Pain in extremity, Throat irritation
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (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: None
Current Illness:
Preexisting Conditions:
Allergies: NSAIDS
Diagnostic Lab Data:
CDC Split Type:

Write-up: Late in day and towards evening, I get a sharp shooting pain in the left leg. Starts behind the knee goes up the back into the groin. Sometimes it shoots down into the ankle. Heat and ice don''t help. Also started having a weird feeling in the left side of my throat.


VAERS ID: 1746556 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-09-27
Onset:2021-09-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Headache, Injection site erythema, Injection site pain, Injection site swelling, Lymphadenopathy, Migraine, Nausea
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), 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: Pantopropazole
Current Illness: None
Preexisting Conditions: Ibs
Allergies: Gluten and lactose intolerance, allergic to ranitidine
Diagnostic Lab Data: None
CDC Split Type:

Write-up: The first evening 09/27/21 a headache started with some nausea. 09/28/21 I was exhausted with a migraine that continued the next 2 days off and on and would move around my head. My lymph node in left armpit started to swell on 09/29/21 and the injection site has been swollen, red and really sore since the afternoon of 09/28/21.


VAERS ID: 1746558 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-09-27
Onset:2021-09-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004F2114 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Chest discomfort, Dizziness, Mobility decreased
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin D, omega 3
Current Illness:
Preexisting Conditions: Dizziness
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Severe weakness 10 hours after the shot. Then severe dizziness for 48-72 hours after the shot which is today. Chest pressure 72 hours after the shot, making it difficult to go up and down the stairs.


VAERS ID: 1746594 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: Alaska  
Vaccinated:2021-09-26
Onset:2021-09-27
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Genital rash, Headache, Hyperhidrosis, Injection site irritation, Injection site pain, Nausea, Pyrexia, Rash, Urticaria
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: headache, nausea, fever of 101 with chills, sweats and hives/rash on arms and torso and private area, irritation around the injection site and soreness.


VAERS ID: 1747687 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Virginia  
Vaccinated:0000-00-00
Onset:2021-09-27
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210955595

Write-up: ADMINISTERED EXPIRED VACCINE; This spontaneous report received from a health care professional concerned a 6 decade old male. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 202A21A, expiry: 21-SEP-2021) dose was not reported, administered on 27-SEP-2021 for prophylactic vaccination. No concomitant medications were reported. On 27-SEP-2021, the patient experienced administered expired vaccine. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of administered expired vaccine was not reported. This report was non-serious.


VAERS ID: 1747701 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Missouri  
Vaccinated:0000-00-00
Onset:2021-09-27
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210956138

Write-up: ADMINISTRATION OF EXPIRED VACCINE 6 DAYS AFTER EXPIRATION DAY; This spontaneous report received from a health care professional concerned a patient of unspecified age and sex. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 204A21A, and expiry: 21-SEP-2021) dose was not reported, administered on 27-SEP-2021 for prophylactic vaccination. No concomitant medications were reported. On 27-SEP-2021, the patient experienced administration of expired vaccine 6 days after expiration day. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of administration of expired vaccine 6 days after expiration day was not reported. This report was non-serious.


VAERS ID: 1747702 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-09-27
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210956427

Write-up: ADMINISTRATION OF EXPIRED VACCINE; This spontaneous report received from a health care professional concerned a patient of unspecified age and sex. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 206A21A, and expiry: 21-SEP-2021) dose was not reported, administered on 27-SEP-2021 for prophylactic vaccination. No concomitant medications were reported. On 27-SEP-2021, the patient experienced administration of expired vaccine. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of administration of expired vaccine was not reported. This report was non-serious.


VAERS ID: 1749387 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-09-27
Onset:2021-09-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD7204 / UNK - / IM

Administered by: Public       Purchased by: ?
Symptoms: Erythema, Feeling hot, Paraesthesia, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (broad), 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: Sulpha
Diagnostic Lab Data:
CDC Split Type:

Write-up: Within 25 min of receiving the shot my head began to feel tingly and felt like pins and needles going up my neck and head. I then began to feel very hot and turn red. After about 2 minutes I noticed that my body had broken out in hives. This lasted for about an hour.


VAERS ID: 1749391 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-25
Onset:2021-09-27
   Days after vaccination:214
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: Admitted to Hospital on Date of Adverse Event [recorded in VAERS] for treatment of Covid-19 Positive following completion of Covid Vaccine Series


VAERS ID: 1749393 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-26
Onset:2021-09-27
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Axillary pain, Bone pain, Breast pain, Condition aggravated, Extra dose administered
SMQs:, Lipodystrophy (broad), Osteonecrosis (broad), Arthritis (broad), 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: Covid#2 Pfizer 1/28/21 exact same symptoms plus aching down to hand.
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Left shoulder, armpit, lateral aspect of left breast, and collar bone all achy and tender since Monday 9/27/21.


VAERS ID: 1749394 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-25
Onset:2021-09-27
   Days after vaccination:33
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: Admitted to Hospital on Date of Adverse Event [recorded in VAERS] for treatment of Covid-19 Positive following completion of Covid Vaccine Series


VAERS ID: 1749399 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-09-27
Onset:2021-09-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Pain in extremity, Somnolence
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), 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: Sore arm
Other Medications: Vitamins biotin, B-12, D3 Allegra
Current Illness: None
Preexisting Conditions: None
Allergies: Milk, garlic, mushrooms
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Sore arm and sleepiness for 3 days


VAERS ID: 1749403 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-10
Onset:2021-09-27
   Days after vaccination:201
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: Admitted to Hospital on Date of Adverse Event [recorded in VAERS] for treatment of Covid-19 Positive following completion of Covid Vaccine Series


VAERS ID: 1749422 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-09-26
Onset:2021-09-27
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH WALG5178 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Chills, Dyspnoea, Headache, Nasopharyngitis, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Arthritis (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: Same as above
Other Medications: Sotalol 80 mg every 12 hours~Keeps heart rhythm 2. Lisinopril 20 mg twice a day~blood pressure 3. Nexium 20 mg~~antiacid 4. Rosuvastatin 10 mg~~ high cholesterol 5. Eliquis 5mg twice a day. Blood thinner 6. Aspirin 81 mg~ prevents heart
Current Illness: None
Preexisting Conditions: Diabetes High blood pressure
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: 104 degree temperature Cold chills Breathing labored Sever joint pain Severe headache


VAERS ID: 1749474 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-29
Onset:2021-09-27
   Days after vaccination:182
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: Positive covid test 09/29/21


VAERS ID: 1749486 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-27
Onset:2021-09-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Dyspnoea, Hypersensitivity, Myalgia, Pharyngeal swelling, Rash, Swelling face, Vein disorder
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (narrow), Angioedema (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Swelling of face throat, severe allergic reaction and rash all over body, shortness of breath, muscle and joint pains, burst blood veins


VAERS ID: 1749489 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: West Virginia  
Vaccinated:2021-09-26
Onset:2021-09-27
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: alendronate (FOSAMAX) 70 mg Oral Tablet ALPRAZolam (XANAX) 0.5 mg Oral Tablet amLODIPine (NORVASC) 5 mg Oral Tablet aspirin (ASPIR-LOW) 81 mg Oral Tablet, Delayed Release (E.C.) atorvastatin (LIPITOR) 40 mg Oral Tablet Blood Glucose Control
Current Illness:
Preexisting Conditions: Cardiovascular System History of MI (myocardial infarction) Coronary artery disease involving native coronary artery of native heart without angina pectoris Essential hypertension Mixed hyperlipidemia History of ischemic cardiomyopathy Diastolic dysfunction History of PTCA Digestive Gastroesophageal reflux disease without esophagitis Endocrine Diabetes mellitus Multiple thyroid nodules Musculoskeletal Primary osteoarthritis of both knees Post-traumatic osteoarthritis of right knee Primary osteoarthritis of right knee Postoperative stiffness of total knee replacement Ophthalmologic No diabetic retinopathy in both eyes Nuclear cataract of both eyes Psychiatric Anxiety
Allergies: Bactrim, clindamycin, amoxicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient got this at another location and then reported a skin reaction to PCP. her arm became red and warm one day after the vaccine. They became itchy and painful in the following days. looks like Covid arm but is not with Moderna.


VAERS ID: 1749568 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-09-27
Onset:2021-09-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 3 - / -

Administered by: Private       Purchased by: ?
Symptoms: Chills, Fatigue, Headache, Nausea
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

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

Write-up: Chills, headache, nausea, fatigue.


VAERS ID: 1749581 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-02-16
Onset:2021-09-27
   Days after vaccination:223
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL8982 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9810 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Sofia Antigen COVID-19 test with a positive result.
CDC Split Type:

Write-up: Patient was vaccinated on 1/26/21 and 2/16/21, so was fully vaccinated when testing positive for COVID-19 on 9/27/21.


VAERS ID: 1749592 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-05-24
Onset:2021-09-27
   Days after vaccination:126
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039C21A / UNK - / -

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

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

Write-up: Covid positive work contact


VAERS ID: 1749595 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-04-24
Onset:2021-09-27
   Days after vaccination:156
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8732 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0153 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Antigen COVID-19 test with a positive result.
CDC Split Type:

Write-up: Patient was vaccinated on 4/3/21 and 4/24/21, so was fully vaccinated when testing positive for COVID-19 on 9/27/21.


VAERS ID: 1749653 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-09-17
Onset:2021-09-27
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Erythema, Extra dose administered, Lymph node palpable
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: 1 week and half after covid booster, developed red streak on R upper arm and palpable lymph node. Booster was given in L arm.


VAERS ID: 1749733 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-09-27
Onset:2021-09-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 211A21A / 1 LA / IM

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

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

Write-up: Chills, fever, vomiting, nausea and headaches. Saw patient on day 3 and still having these symptoms.


VAERS ID: 1749748 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-09-27
Onset:2021-09-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Eye movement disorder, Feeling hot, Syncope, Urinary incontinence
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Ocular motility disorders (narrow), 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: Patient briefly fainted. She urinated on herself, eyes rolled back in her head, and she got very hot. We called EMS, got her an ice pack, and monitored for consciousness/breathing. She did not go with EMS, they released her to her mother.


VAERS ID: 1749782 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-09-27
Onset:2021-09-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / UNK - / IM

Administered by: Private       Purchased by: ?
Symptoms: Body temperature fluctuation, Fatigue, Headache, Injection site pain, Musculoskeletal stiffness, Rhinorrhoea
SMQs:, Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Arthritis (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: slight rash at site pneumonia vaccine
Other Medications: Calcium chews One a Day Vitamins for Seniors
Current Illness: none
Preexisting Conditions: none
Allergies: bee venom
Diagnostic Lab Data: none
CDC Split Type:

Write-up: 12:30 pm received injection. 7pm muscles in arm very sore applied cold pak. 9:15pm took two Alleve. 10:15 pm much better but still pronounced stiffness in neck and left arm and site tenderness. Sept. 28, 2021, 4:15 am temperature 98.6. 6:23 am temperature 101.3. Took two Tylenol. 7am temperature 97.7, runny nose, slight headache. 7:50am temperature 98.4. 11:45 am temperature 98.9. 12:26pm temperature 100.1. Took two Tylenol. 3:56 pm temperature 98.4. 7pm temperature 99.1. Took two Tylenol. 8:01 pm temperature 99.5. 11:47 pm temperature 97.3. Sept. 29, 2021 temperature within normal range but very and very tired. 1:52 pm took two Alleve and felt nearly normal about an hour later.


VAERS ID: 1749784 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Unknown  
Location: California  
Vaccinated:2021-09-27
Onset:2021-09-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 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:
CDC Split Type:

Write-up: Administered Pfizer vaccine to an 11 year old patient.


VAERS ID: 1749839 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-27
Onset:2021-09-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30130BA / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Back pain, Chills, Extra dose administered, Fatigue, Gait disturbance, Injection site pain, Injection site swelling, Local reaction, Muscle strain, Myalgia, Pain, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Patient developed body aches and chills 4-5 hours after administration of vaccine. 12-14 hrs after vaccination, patient developed severe body aches, very severe myalgia and arthralgia. this was accompanied with severe fatigue and chills. Over the next 24 hrs, developed low grade fever, maximum reordered temperature was 100.5F. Myalgias were significantly worse with 3rd dose, as compared to 2nd dose -- described as severe pain all across back and shoulder, felt like muscles tearing apart. Arthralgias - pain in both knees and ankles, accompanied with difficulty in walking. Symptoms slowly evolved after 36-40 hrs. Local reaction - pain and swelling at injection administration site. This was also significantly worse as compared to vaccine dose 1 and 2. Pain is still ongoing on day 4 but milder now.


VAERS ID: 1749842 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-27
Onset:2021-09-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 2 LA / -

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

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

Write-up: headache, body ache, hives behind legs/buttocks area


VAERS ID: 1749874 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-24
Onset:2021-09-27
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / UNK LA / SYR

Administered by: Work       Purchased by: ?
Symptoms: Arthralgia, Back pain, Chest pain, Lymphadenopathy, Myalgia, SARS-CoV-2 test
SMQs:, Rhabdomyolysis/myopathy (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (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: Lebatolol
Current Illness: None
Preexisting Conditions: High blood
Allergies: Sulfa, cappicola, liquid Advil
Diagnostic Lab Data: I took a covid-19 test 19 yesterday of September 29th from waiting for my results at this moment.
CDC Split Type:

Write-up: 3 days later I woke up with the swollen lymph nodes in my arm and then the following day which would have been Tuesday I had one on my neck and then Wednesday I had swollen I mean my muscles are sore in my back and in my chest my seat belt was real tight to put on and today is Thursday now I feel like it''s moving down to my hips.


VAERS ID: 1749882 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-27
Onset:2021-09-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD0809 / 3 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Allergy test, Dysphagia, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Hypersensitivity (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: ALBUTEROL, ZOFRAN, INSULIN NPH, HCTZ, NORVASC, LIPITOR
Current Illness: NONE
Preexisting Conditions: DIABETES, BILATERAL MENIERES DISEASE
Allergies: BENADRYL, PROMETHAZINE, SULFA
Diagnostic Lab Data: ALLERGY TESTING 9/29/21
CDC Split Type:

Write-up: THROAT TIGHTENING, DIFFICULTY SWALLOWING


VAERS ID: 1749886 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-04-15
Onset:2021-09-27
   Days after vaccination:165
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041B21A / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: COVID + 9/27/2021
CDC Split Type:

Write-up: Admission to the hospital for COVID-19 infection symptoms.


VAERS ID: 1749910 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-09-27
Onset:2021-09-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Fatigue, Nausea, Pain, Pain in extremity, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Metoprolol Succinate ER
Current Illness: Similar side effects with Phizer Covid-19 vaccine #1, 26 days prior
Preexisting Conditions: Controlled hypertension
Allergies: Seasonal allergies
Diagnostic Lab Data: None
CDC Split Type:

Write-up: severe ache in left arm x 48 hours with fatigue. nausea, body aches, fever/chills x 72 hours


VAERS ID: 1749916 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-23
Onset:2021-09-27
   Days after vaccination:157
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: COVID + 9/27/21
CDC Split Type:

Write-up: Admission to the hospital for COVID-19 infection symptoms


VAERS ID: 1749963 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-09-27
Onset:2021-09-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 3013581A / 3 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Body temperature increased, Diarrhoea, Fatigue, Headache, Hypersomnia, Pain
SMQs:, Neuroleptic malignant syndrome (broad), Pseudomembranous colitis (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Depression (excl suicide and self injury) (broad), Noninfectious diarrhoea (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: Letrozole, lipitor
Current Illness:
Preexisting Conditions: High cholesterol treated by lipitor
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: body aches (extreme), extreme fatigue so that I slept about 32 hours, temp of 101.1, diarrhea, headache


VAERS ID: 1750055 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-09-26
Onset:2021-09-27
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8839 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Breast swelling, Injection site swelling, Oedema peripheral, Swelling
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), 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: COMPLAINED OF SWELLING WHERE INJECTED AND ARMPIT THAT ALSO WENT TO RIBS AND BREAST (STARTED MONDAY 9/27/21) - RIBS SWELLING DECREASED ON OWN - HOWEVER SWELLING DID NOT GO DOWN IN ARM OR ARMPIT, NO TREATMENT AS OF YET


VAERS ID: 1750059 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-27
Onset:2021-09-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / 2 LA / IM

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

Write-up: Pt with a PMHx of previous allergic reaction to COVID-19 vaccine on 8/4/21, where pt reported right side throat tightness following vaccine administration and was given benadryl PO which relieved her sx. Pt saw her allergist today, and was given a letter by her allergist clearing her to receive the second dose of the vaccine but rec that the pt be monitored for 30 min following the vaccine. Pt received the second dose of the vaccine at approx 13:20, and was monitored until 13:50. At approx 13:50, pt reported sx of mild right sided throat irritation and requested PO benadryl. Pt was given benadryl 25mg PO. Pt was observed until 2:50pm, at which time she reported "feeling much better" and denied any chest pain, throat pain, throat tightness. Pt was determined to be safe for discharge home


VAERS ID: 1750071 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-27
Onset:2021-09-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Chest discomfort, Dizziness, Paraesthesia
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad)

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

Write-up: Pt received vaccine at 12:27pm. Pt C/O chest tightness / tingling and lightheadedness at 12:43pm. Pt took 2 puffs of home inhaler. BP 168/70 HR 96 SPO2 100%. Pt then c/o itchiness at 12:45pm. No wheezing or stridor noted. Pt instructed to take her own EPi Pen. Epi Pen administered at 12:45pm. RRT called, pt escorted to ED with RRT team.


VAERS ID: 1750100 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-26
Onset:2021-09-27
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Axillary pain, Head discomfort, Headache, Lymphadenopathy, 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: Symbicort , Multi vitamin, calcium zinc , Vitamin D
Current Illness:
Preexisting Conditions: asthma
Allergies: penicillin metrodzole
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever 102.3 lasted 24 hours , Headache 3 days . Head pressure when lowering head . Arm pit glands swollen and painful


VAERS ID: 1750101 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-09-26
Onset:2021-09-27
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH PFIZER / 2 LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH PFIZER / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test normal, Chest X-ray normal, Chills, Dyspnoea, Electrocardiogram normal, Fatigue, Headache, Heart rate increased, Lymph node pain, Lymphadenopathy, Mononucleosis heterophile test negative, Nausea, SARS-CoV-2 test negative
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), 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? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Prilosec, Align Probiotic, Aurovela 24 FE
Current Illness: She was diagnosed with a sinus infection a week before. 09/20
Preexisting Conditions: Gastritis
Allergies: N/A
Diagnostic Lab Data: Bloodwork, covid test, mono test, chest x-ray, EKG All normal results
CDC Split Type:

Write-up: Fatigue, nausea, headache, chills, shortness of breath, rapid heart rate at times, lymph nodes swollen under arm and breast area. Went to ER 09/28 to get chest X-ray and bloodwork. Everything was normal per ER doctor. She has continued to have shortness of breath. Other symptoms are not really an issue now, but the shortness of breath and rapid heart rate is an issue. Lymph nodes still swollen and sore. Following up with pediatrician tomorrow 10/01.


VAERS ID: 1750145 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-03-31
Onset:2021-09-27
   Days after vaccination:180
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805029 / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Multivitamin, Albuterol, Zyrtec
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: Codeine
Diagnostic Lab Data: Positive COVID-19 PCR Test.
CDC Split Type:

Write-up: Positive COVID-19 While Fully vaccinated.


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