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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 90 out of 8,010

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VAERS ID: 1750172 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
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 / 2 LA / IM

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

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

Write-up: Patient had moderna for first dose at different pharmacy for first dose and received pfizer for second dose at our pharmacy


VAERS ID: 1750205 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
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 301308A / 3 LA / IM
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Injection site pain, Limb discomfort, Musculoskeletal stiffness, Pain in extremity
SMQs:, Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: OTC Aspirin 81 mg; Dietary Supplements include (daily): Zinc - 50 mg Magnesium - 500 mg Chromium Picolinate - 800 mcg Vitamin D3 - 25 mcg NatureMade Super B-Complex - 2 tablets Red Yeast Rice - 1200 mg Centrum Silver - 1 tablet
Current Illness: none
Preexisting Conditions: Obesity
Allergies: NKA
Diagnostic Lab Data: none
CDC Split Type:

Write-up: First dose COVID19 Pfizer (recv''d 3-04-2021) =$g slight soreness in upper arm; symptoms cleared in 24 hours Second dose COVID19 Pfizer (recv''d 3-25-2021) =$g no adverse reaction, no arm soreness Third dose COVID19 Pfizer - waited 15 minutes, then departed pharmacy. Soreness in both arms, significantly greater in left arm. Soreness in left arm continued to increase, significant around 6 PM. About 10 hours after injection, began to experience chills followed by intense shivering/shakes. Went to bed about 12 hours after injection where intense shivering/shakes continued under full winter blanket coverage (room temperature ~ 76 degrees F). Shivering/shakes gone on waking. After 46 hours, left arm soreness has resolved to stiffness, but still significantly greater than any right arm discomfort.


VAERS ID: 1750220 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-01-07
Onset:2021-09-27
   Days after vaccination:263
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK9231 / 2 - / IM

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

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

Write-up: positive Covid19 PCR test


VAERS ID: 1750237 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-02-11
Onset:2021-09-27
   Days after vaccination:228
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012M20A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Cough, Fatigue, Headache, Nasal congestion
SMQs:, Anaphylactic reaction (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? No
Previous Vaccinations:
Other Medications: diclofenac topical QID hydrochlorothiazide 25mg daily metformin xr 1000mg daily metformin 1000mg olmesartan 20mg daily semaglutide 2mg/1.5mL once per week
Current Illness: None documented
Preexisting Conditions: hypertension, vitamin d deficiency, obesity, history of secondary hyperparathyroidism, type II diabetes, lumbar radiculopathy, anorectal fistula, diverticulosis of colon, history of adenomatous polyp of colon, hyperlipidemia.
Allergies: penicillin - unknown
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient contracted COVID after being fully vaccinated cough, congestion, fatigue, headache


VAERS ID: 1750311 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Kentucky  
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 (MODERNA)) / MODERNA 048F21A / 3 RA / IM

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

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

Write-up: Patient came to pharmacy for 3rd dose and pharmacist determined he was eligible. Computer system instructed booster dose as 0.25 mL and that is what was administered.


VAERS ID: 1750363 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Arizona  
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 - / 3 RA / IM
FLU4: INFLUENZA (SEASONAL) (AFLURIA QUADRIVALENT) / SEQIRUS, INC. - / UNK LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Chills, Extra dose administered, Injection site pain, Pain, Pyrexia, Wrong product administered
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: This is not a report of an adverse event, but instead an administration error. My patient is a medical doctor, colleague and employee. The patient arrived on the first morning boosters were recommended and the first day offering flu shots to employees. We were swamped and overwhelmed. She stated she received her influenza vaccination at another clinic in the right deltoid earlier in the week. I screened her, and had no concerns. I administered and documented a COVID-19 vaccine in the left deltoid IM on 9/24/21. The pt tolerated the injection well and waited the 15 minute post-vaccination time period without problem. HOWEVER, she returned after the wait period to ask if the covid syringe was glass. This was an odd question. She recalled seeing me grab a glass syringe from a white tray in the fridge and screw on a needle and adjust the bubble. This is NOT consistent with the covid vaccine, which is pre -drawn in plastic syringes with the needles already attached. The covid vaccines are in a basket in the fridge, but NOT in a white tray. The white trays hold flu vaccines. She wondered if she received a flu shot and not the COVID vaccine. All documentation was done on paper and not interactively on the computer. I could not recall that exact vaccination in my memory, as I had given shots for hours. We discussed at length and decided there was a potential administration error, with the pt receiving and additional dose of flu vaccine instead of covid vaccine. With shared clinical decision making and a discussion of the risks (reactogenicity, no boosted coverage for covid as a HCP) and benefits (ensured coverage as a HCP), we decided to administer covid vaccine IM in the right deltoid. We did discuss that the ACIP meeting did not initially vote to offer boosters for HCPS and likely the coverage remains high for severe covid disease. We also discussed increased potential for reactogencity and Nonetheless, she wanted to proceed with an additional vaccination and I agreed. I f/u on 9/27 and she had anticipated mild to moderate side effects, including aches/chills, fever of 101, and sore arm (right delt) over the weekend of 9/25-9/26. Her side effects were similar to her 2nd dose of Pfizer vaccine.


VAERS ID: 1750387 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
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 (JANSSEN)) / JANSSEN 1808986 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Nausea, Pain, Vomiting
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: prozac, multivitamin
Current Illness: none
Preexisting Conditions: none
Allergies: sulfa drugs
Diagnostic Lab Data: none were done
CDC Split Type:

Write-up: nausea, vomiting, chills, body aches


VAERS ID: 1750423 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Wisconsin  
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 (MODERNA)) / MODERNA 017F21A / 3 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: Not illnesses
Preexisting Conditions: No outstanding health conditions
Allergies: No allergies
Diagnostic Lab Data: N/A - no adverse reactions
CDC Split Type:

Write-up: No adverse reaction - third dose (full dose of 0.5ml) was administered without proper implications (only risk factor was age above $g65).


VAERS ID: 1750434 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Female  
Location: Virginia  
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 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site erythema, Injection site induration, Injection site pruritus, 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? 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: ENTIRE LEFT UPPER ARM SURROUNDING INJECTION SITE IS RED, ITHCY, SWOLLEN, HARD, HOT TO TOUCH


VAERS ID: 1750445 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Hawaii  
Vaccinated:2021-01-29
Onset:2021-09-27
   Days after vaccination:241
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9262 / 2 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1686 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Anosmia, Dizziness, Fatigue, Headache, Pain, Respiratory tract congestion, Rhinorrhoea, Throat irritation
SMQs:, Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Vestibular disorders (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? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Headache, runny nose, fatigue, body aches, itchy throat, congested, loss of smell, and dizziness.


VAERS ID: 1750500 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-09-13
Onset:2021-09-27
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 031458A / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Dysmenorrhoea, Heavy menstrual bleeding, Menstrual disorder
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Mirena IUD
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: I have called my obgyn and have an appt. scheduled to be seen.
CDC Split Type:

Write-up: I have had an extremely heavy and painful menstrual cycle. This is extremely abnormal for me as a I have been on the Mirena IUD contraceptive for years and have consistently not had a menstrual cycle. This is the first cycle I have had in years and it has only been 2 weeks since I received the first dose of the Pfizer vaccine.


VAERS ID: 1750511 (history)  
Form: Version 2.0  
Age: 74.0  
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 (MODERNA)) / MODERNA 061E21A / 3 LA / IM

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

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

Write-up: Patient recevied a booster dose which patient doesnt qualify .


VAERS ID: 1750515 (history)  
Form: Version 2.0  
Age: 66.0  
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 (MODERNA)) / MODERNA 061E21A / 3 LA / IM

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

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

Write-up: patient recevied the booster for moderna which patients doesnt qualify for yet.


VAERS ID: 1750544 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Florida  
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 (MODERNA)) / MODERNA 061E21A / 3 LA / IM

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

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

Write-up: Patient was given a booster dose that was not eligible and outside of the guidelines


VAERS ID: 1751777 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Virginia  
Vaccinated:0000-00-00
Onset:2021-09-27
Submitted: 0000-00-00
Entered: 2021-10-01
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: USJNJFOC20210958525

Write-up: ADMINISTRATION OF AN EXPIRED VACCINE; This spontaneous report received from a health care professional concerned a 49 year old male. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine (suspension for injection, route of admin not reported and batch number: 206A21A 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 an expired vaccine. The action taken with covid-19 vaccine was not applicable. The outcome of administration of an expired vaccine was not reported. This report was non-serious. This case, from the same reporter is linked to 20210958806, 20210958566 and 20210959351. This case, from the Others is linked to 20210958716.


VAERS ID: 1751781 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Virginia  
Vaccinated:0000-00-00
Onset:2021-09-27
Submitted: 0000-00-00
Entered: 2021-10-01
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: USJNJFOC20210958566

Write-up: ADMINISTRATION OF AN EXPIRED VACCINE; This spontaneous report received from a health care professional concerned a 24 year old male. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 206A21A, expiry: 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 an expired vaccine. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of administration of an expired vaccine was not reported. This report was non-serious. This case, from the same reporter is linked to 20210958425, 20210958525, 20210958716, 20210958371, 20210958806, 20210958977, 20210958518 and 20210958348.


VAERS ID: 1751787 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: Virginia  
Vaccinated:0000-00-00
Onset:2021-09-27
Submitted: 0000-00-00
Entered: 2021-10-01
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: USJNJFOC20210958716

Write-up: ADMINISTRATION OF EXPIRED VACCINE; This spontaneous report received from a health care professional concerned a 45 year old male. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 206A21A, 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. This case, from the same reporter is linked to 20210958566, 20210958321, 20210958525 and 20210958993.


VAERS ID: 1751793 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: California  
Vaccinated:0000-00-00
Onset:2021-09-27
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808986 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Body temperature, Dyskinesia, Gait inability, Headache, Hypokinesia, Nausea, Paraesthesia, Pyrexia
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dyskinesia (narrow), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Alcohol use (On occasion.); Non-smoker
Preexisting Conditions: Comments: Patient was not pregnant at the time of reporting. Patient had no history of drug abuse or illicit drug usage. Patient had no known allergies.
Allergies:
Diagnostic Lab Data: Test Date: 20210928; Test Name: Body temperature; Result Unstructured Data: 101 F
CDC Split Type: USJNJFOC20210958906

Write-up: COULD NOT CONTROL HANDS OR FEET, HANDS WERE FORMING A FIST (NAILS INTO PALMS); COULD NOT MOVE HANDS OR FEET; COULD NOT WALK; TINGLING OF EXTREMITIES (UP TO KNEE, ARMS, FEET AND HAND) AND UPPER LIP AREA; NAUSEOUS; FEVER; HEADACHE; This spontaneous report received from a patient concerned a 51 year old female. The patient''s height, and weight were not reported. The patient''s concurrent conditions included: alcohol user, and non smoker, and other pre-existing medical conditions included: Patient was not pregnant at the time of reporting. Patient had no history of drug abuse or illicit drug usage. Patient had no known allergies. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 1808986, expiry: UNKNOWN) dose was not reported, administered on 27-SEP-2021 17:00 for prophylactic vaccination. No concomitant medications were reported. On 27-SEP-2021, the patient experienced nauseous. On 27-SEP-2021, the patient experienced fever. On 27-SEP-2021, the patient experienced headache. On 28-SEP-2021, the patient experienced could not control hands or feet, hands were forming a fist (nails into palms). On 28-SEP-2021, the patient experienced could not move hands or feet. On 28-SEP-2021, the patient experienced could not walk. On 28-SEP-2021, the patient experienced tingling of extremities (up to knee, arms, feet and hand) and upper lip area. Laboratory data included: Body temperature (NR: not provided) 101 F. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient was recovering from nauseous, fever, headache, could not control hands or feet, hands were forming a fist (nails into palms), tingling of extremities (up to knee, arms, feet and hand) and upper lip area, could not walk, and could not move hands or feet. This report was non-serious.


VAERS ID: 1751794 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Virginia  
Vaccinated:0000-00-00
Onset:2021-09-27
Submitted: 0000-00-00
Entered: 2021-10-01
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: USJNJFOC20210958977

Write-up: ADMINISTRATION OF EXPIRED VACCINE; This spontaneous report received from a health care professional concerned a 38 year old male. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 206A21A, 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. This case, from the same reporter is linked to 20210958566, 20210959351, 20210958518, 20210959620, 20210958321, 20210958806, 20210958425, 20210959581, 20210958371 and 20210958525.


VAERS ID: 1753013 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-09-27
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210927; Test Name: COVID-19 virus test; Result Unstructured Data: POSITIVE
CDC Split Type: USJNJFOC20210958417

Write-up: SUSPECTED CLINICAL VACCINATION FAILURE; SUSPECTED COVID-19 INFECTION; This spontaneous report received from a patient via social media concerned a male of unspecified age, race and ethnicity.. 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: Unknown) dose was not reported, 1 total administered on AUG-2021 for prophylactic vaccination. The batch number was not reported. Per procedure, no follow-up will be requested for this case. No concomitant medications were reported. On 27-SEP-2021, the patient reported that he had it much worse. The patient went to hospital and tested positive for covid-19 (Suspected clinical vaccination failure and suspected covid-19 infection). Laboratory data included: COVID-19 virus test (NR: not provided) POSITIVE. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the suspected clinical vaccination failure and suspected covid-19 infection was not reported. This report was serious (Other Medically Important Condition). This case, from the same reporter is linked to 20210958300.; Sender''s Comments: V0 20210958417-COVID-19 VACCINE AD26.COV2.S-suspected clinical vaccination failure. This event(s) is considered not related. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There are other factors more likely to be associated with the event(s) than the drug. Specifically: SPECIAL SITUATIONS.


VAERS ID: 1753029 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-09-27
Onset:2021-09-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site bruising, Injection site erythema, Injection site pain, Injection site rash, Injection site swelling, Injection site warmth, Nausea, Pyrexia
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Site: Bruising at Injection Site-Medium, Site: Pain at Injection Site-Medium, Site: Redness at Injection Site-Medium, Site: Swelling at Injection Site-Medium, Systemic: Nausea-Mild, Additional Details: pt called the pharmacy stating that after her booster shot she felt nauseous the next day and was burning up with slight fever, also had large rash at the injection site that is hot to the touch, not going away with benadryl


VAERS ID: 1753227 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-09-24
Onset:2021-09-27
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 3 LA / IM
FLU4: INFLUENZA (SEASONAL) (AFLURIA QUADRIVALENT) / SEQIRUS, INC. NOT SURE OF TYP / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Losartan Potassium (100mg) Amlodipine Besylate (5 mg) Rosuvastatin (40 mg) Janumet (50mg/150mg) Tadalafil (5 mg) Allopurinol (300 mg) Preservision ARED x2 Vitamin B12 (2500mcg) Folic Acid (1mg) Aspirin (81 mg)
Current Illness:
Preexisting Conditions: Diabetes (type 2)
Allergies: Lisinopril
Diagnostic Lab Data: Must note that I had flu shot at same time (different arm) as COVID shot.
CDC Split Type:

Write-up: Chills (severe shivering), fever (102), nausea, vomiting. Worst symptoms over in 2-3 hours. Back to normal after 10 hours.


VAERS ID: 1753287 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-02-11
Onset:2021-09-27
   Days after vaccination:228
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9264 / 2 UN / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6199 / 1 UN / IM
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME) / UNKNOWN MANUFACTURER / / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Dyspnoea, Orthopnoea, Peripheral swelling, Rash, SARS-CoV-2 test positive, Swelling face, Weight increased
SMQs:, Cardiac failure (broad), Anaphylactic reaction (narrow), Angioedema (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Coronavirus 2 PCR Detect, V symptomatic POSITIVE
CDC Split Type:

Write-up: CHIEF COMPLAINT Shortness of breath HISTORY OF PRESENT ILLNESS: The patient is a 76 y.o. female who presents with shortness of breath. Her pertinent medical comorbidities include HFrEF (LVEF 25%) coronary artery disease (based on noninvasive testing, atrial fibrillation on Eliquis, Parkinson''s disease, CKD stage 3b-4, left renal artery stenosis, obstructive sleep apnea, sick sinus syndrome s/p pacemaker implantation. The patient was in her usual state of health until 3 days ago, when she began to develop increasing dyspnea, orthopnea, weight gain, and swelling in her face and hands. She has a home dose of torsemide 40 mg p.o. q.d. and noticed decreasing urine output on this dose. She try to double her prescribed dose, an even triple the dose the day prior to admission with little improvement in urine output. She had no chest pain, fevers, chills, night sweats, or worsening lower extremity edema (though she has kept her legs wrapped recently due to new bilateral rash seen by wound care). With concerns for the symptoms, she presented to the Hospital Emergency Department for further evaluation and management.


VAERS ID: 1753288 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-02-05
Onset:2021-09-27
   Days after vaccination:234
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN9581 / 2 RA / 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: 9/30 SARS/COV-2, NAAT Positive
CDC Split Type:

Write-up: Breakthrough COVID


VAERS ID: 1753311 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Female  
Location: Nebraska  
Vaccinated:2021-09-26
Onset:2021-09-27
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / 3 - / -

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

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

Write-up: Weak, fever, fatigue.


VAERS ID: 1753330 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-05-13
Onset:2021-09-27
   Days after vaccination:137
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 2 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, 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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospitalized Breakthrough case


VAERS ID: 1753353 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-09-01
Onset:2021-09-27
   Days after vaccination:26
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site erythema, Injection site pruritus, 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: Famotidine 20 mg, Multi vitamins, Preservision, Calcium
Current Illness: None
Preexisting Conditions: None chronic or long-standing
Allergies: None
Diagnostic Lab Data: home, ice and Benadryl itch cooling spray
CDC Split Type:

Write-up: Around shot area, swollen, warm and red about 5 inches down arm, and itching lasting 4 days. Today, red somewhat fading, arm still warm, and some swelling.


VAERS ID: 1753373 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-04-07
Onset:2021-09-27
   Days after vaccination:173
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045A21A / 2 AR / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040A21A / 1 AR / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / 3 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal discomfort, Abnormal behaviour, Blood creatine increased, Blood culture, Blood lactic acid, Blood pressure increased, COVID-19, Chest X-ray abnormal, Chest discomfort, Cough, Diarrhoea, Extra dose administered, Fatigue, Feeling abnormal, Nausea, Oedema peripheral, Oxygen saturation decreased, Procalcitonin, Productive cough, SARS-CoV-2 antibody test positive, Stool analysis normal, Tracheal disorder
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Dementia (broad), Pseudomembranous colitis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Acute central respiratory depression (broad), Psychosis and psychotic disorders (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypertension (narrow), Cardiomyopathy (broad), Noninfectious diarrhoea (narrow), Respiratory failure (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Accu-Chek Aviva Plus Test Strips Accu-Chek Softclix Lancets acetaminophen (TYLENOL) 500 MG tablet acetylcysteine (MUCOMYST) 10 % nebulizer solution albuterol (PROVENTIL) (2.5 MG/3ML) 0.083% nebulization ascorbic acid (VITAMIN C) 500 MG tabl
Current Illness: 8.26.21 - Urology appt - difficulty urinating 8.27.21 - palliative care appt - insomnia, generalized weakness, chronic pain 9.2.21 - reported to have received the COVID booster vaccine - but not in patient chart 9.8.21 - ED visit; UTI 9.20.21 - diarrhea 9.24.21 - severe abdominal pain
Preexisting Conditions: Personal history of Paget''s disease of bone Weakness generalized COVID-19 Blind Paget disease of bone Tracheal stenosis HLD (hyperlipidemia) Vocal cord paralysis Glaucoma Dysphagia causing pulmonary aspiration with swallowing OSA (obstructive sleep apnea) Celiac disease Cardiomegaly Non-rheumatic mitral valve stenosis Chronic cough Chronic kidney disease, stage 3 History COVID-19 virus infection Multiple drug resistant organism (MDRO) culture positive Restrictive lung disease Tracheostomy present Celiac disease Obstructive sleep apnea of adult Tracheal stenosis Gastrointestinal tube present Anemia Sepsis Respiratory insufficiency Debility Neuropathy AKI (acute kidney injury) Acute respiratory insufficiency Acute diastolic congestive heart failure Type 2 diabetes mellitus with diabetic nephropathy Opioid use Other constipation Diabetic ulcer of right heel associated with type 2 diabetes mellitus, unspecified ulcer stage Morbid obesity Stage III pressure ulcer of right heel Depression, recurrent Elevated ferritin Hypothyroidism, unspecified type Other insomnia Chronic indwelling Foley catheter
Allergies: VancomycinSkin Rashes/Hives, Red man syndrome CodeineOther, Unknown Coffee Bean Extract [Coffea Arabica] FoodNausea and Vomiting GlutenNausea and Vomiting, GI Upset LisinoprilCough Statin [Atorvastatin]Other Zosyn [Penicillins]
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospitalized (9.27.21); COVID-19 positive (9.27.21); Fully Vaccinated PLUS booster CHIEF COMPLAINT: Pneumonia due to COVID-19 virus HISTORY OF PRESENT ILLNESS: Patient is a 81 y.o. male with past medical history of TBI, tracheal stenosis s/p tracheostomy, BPH, cardiac arrest, celiac disease, HTN, Hyperlipidemia, GERD with PUD, CVA and DMT2. Patient presented to ED for increased O2 demands and increased tracheal secretions per home care nurse. Patient had COVID in 5/2020, was fully vaccinated and received booster vaccine, also had positive antibody testing 9/17/21. Home nurse reports for the past 72 hours he has not been himself. He has had increased oxygen needs, typically only wears oxygen PRN but has been needing 3L constantly with ongoing desaturations into 70s. She has noted increased thick yellow secretions from trach. He has chronic productive cough which she notes is worse the past 72 hours or so. She has also noted new edema in feet x1 week, increased fatigue and decreased participation in conversation. Patient reports he feels "terrible". Notes chest discomfort. Cannot describe further. When asked if he it was chest pressure, like and elephant sitting on his chest or chest pain he says "no like an ant sitting on it, just discomfort" Denies feeling SOB. Complains of abdominal discomfort and nausea which per home care nurse has been ongoing for 3 weeks. Taking zofran at home. Had been having diarrhea too but patient reports has has not had any in a couple of days. Home nurse reports he had stool studies which were unremarkable. In ED he was initially on 5L O2 but has been weaned to 3L currently. BP elevated, remainder of VSS. Labs with Creatinine 2.03, LA 1.6, Procalcitonin 0.08. COVID positive. BCx2 drawn. CXR with bibasilar airspace disease suspicious for pneumonia. He was given Rocephin, Azithro and decadron in ED. NOTE from 9.30.21: Plan: -continue remdesivir and decadron for treatment of COVID 19 -ASA and plavix currently on hold due to concern of bleeding near feeding tube -IR replaced feeding tube on 9/29. -follows with home Palliative care. Palliative care consulted and following. -continue to monitor H/H q12h-stable -continue home meds as appropriate: Nebulizers per home regimen, gabapentin, Synthroid, metoprolol, inhalers, ppi, Flomax, trazodone -continue basal bolus insulin. Monitor blood sugars closely and adjust as needed while receiving Decadron. Increase lantus and corrective insulin. Consult DGMS for assistance of management with insulin. -Doctor requesting patient to be started on pancrealipase supplements due to concerns for pancreatic insufficiency. Discussed with inpatient pharmacist, will start with pancrealipase 24 2 tabs with meals and 1 tab with snacks -monitor mentation closely. Possibly related to steroids and hospital delirium. Redirect as able -PT/OT -redirect is needed -diet: Diabetic diet, 300mL water flushes q4h -DVT prophylaxis: if FIT negative, subq heparin -Full code Dispo: Continue current treatments for COVID 19 (remdesivir & decadron). If worsening mentation, may have to consider holding steroids. DGMS consulted for assistance with insulin and blood sugars. Continue free water flushes through feeding tube. Redirect as needed. PT/OT. Continue nebulizers treatments and other meds. Start creon for pancreatic insuffiency


VAERS ID: 1753409 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-03-16
Onset:2021-09-27
   Days after vaccination:195
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030A21A / 2 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 015M20A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Acute respiratory failure, Arthralgia, Asthenia, Blood potassium normal, Blood sodium decreased, Brain natriuretic peptide increased, C-reactive protein, COVID-19, COVID-19 pneumonia, Chest X-ray abnormal, Chills, Computerised tomogram abdomen abnormal, Cough, Diarrhoea, Diverticulum, Dyspnoea, Femur fracture, Fibrin D dimer, Hypoxia, Lung disorder, Neoplasm, Nephrectomy, Oropharyngeal pain, Procalcitonin, Pyrexia, SARS-CoV-2 test positive, White blood cell count normal
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Pseudomembranous colitis (broad), Malignancy related therapeutic and diagnostic procedures (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hyponatraemia/SIADH (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Osteoporosis/osteopenia (broad), Chronic kidney disease (broad), Hypersensitivity (broad), Arthritis (broad), Noninfectious diarrhoea (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Non-haematological tumours of unspecified malignancy (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, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: alendronate (FOSAMAX) 70 MG tablet ammonium lactate (LAC-HYDRIN) 12 % lotion aspirin EC 81 MG enteric coated tablet atorvastatin (LIPITOR) 20 MG tablet DULoxetine (CYMBALTA) 60 MG delayed release capsule fluticasone (FLONASE) 50 MCG/ACT nas
Current Illness: NA
Preexisting Conditions: Acute diastolic CHF (congestive heart failure), HA class 3 11/27/2020 ? Anxiety ? Arteritis, unspecified ? Bronchitis as a kid ? Cancer right kidney removed, kidney cancer ? Clear cell renal cell carcinoma, right 2/22/2016 Clear cell renal cell carcinoma, right s/p RIGHT LAPAROSCOPIC RADICAL NEPHRECTOMY 2-10-16 CT abdomen/pelvis 6-14-16 IMPRESSION: Interval right nephrectomy. No evidence of recurrent or metastatic disease. Cystic lesions in the left kidney, will continue to observe on follow-up exams. CT abdomen/pelvis 10-13-17 IMPRESSION: No findings to indicate tumor recurrence or metas ? Coronary artery disease ? Cough ? Cystocele ? Cystocele, midline ? Depression ? Diabetes mellitus ? Esophageal reflux ? Heart disease ? Hypercholesterolemia ? Hypertension ? Kidney cancer, primary, with metastasis from kidney to other site ? Lip pain 9/8/2015 ? Neuropathic pain ? Neuropathy ? Post-menopausal ? Prediabetes 10/10/2014 Updated by Regulatory ? Prolapse of female pelvic organs ? Symptomatic menopausal or female climacteric states ? Thyroid disorder ? Type II or unspecified type diabetes mellitus with neurological manifestations, not stated as uncontrolled ? Unspecified prolapse of vaginal walls ? Vaginal prolapse
Allergies: Mold Shortness of Breath and Throat swelling ? Amoxicillin GI Upset diarrhea ? Bactrim [Sulfamethoxazole W-Trimethoprim] Hives ? Blistex Swelling ? Cetyl Dimethicone Unknown ? Instant Pain Relief Swelling ? Lisinopril GI Upset ? Metronidazole "made me violently ill" "made me violently ill" ? Other Unknown Sunscreen ? Oxybenzone ? Sunscreens Unknown
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospitalized (9.27.21); COVID-19 positive (9.27.21); Fully Vaccinated CHIEF COMPLAINT SOB. Cough. Fever HISTORY OF PRESENT ILLNESS Patient is a 72 y.o. female who presents today with cough, SOB and fever. Patient has a PMHx significant for diastolic CHF, CAD status post CABG x 3, DM ll and anxiety. The patient states that two days ago she started having a sore throat and has since developed fever, chills, generalized weakness, SOB, cough, arthralgias and diarrhea. The patient states that she was feeling so SOB that she decided to come to the ED to be evaluated. Upon arrival to the ED Na 133. K 4.4. BNP 3856. Procal 0.12. WBC 9.26. CXR possible left and/or right LL pneumonia. CT abdomen/pelvis shows abnormal lung bases. Changes status post right nephrectomy for neoplasm. Diverticulosis. Fragmentation of proximal femur suggesting ununited fracture status post ORIF. The patient was hypoxic requiring supplemental oxygen. She has otherwise remained hemodynamically stable. The patient is being admitted for further management and evaluation. PLAN Covid Pneumonia Acute Respiratory Failure Symptom onset: 9/25 + PCR 9/27 Vaccinated moderna. Remdesivir x 4 doses Decadron 6mg daily Prone as tolerated Wean supplemental oxygen as able Note from 9/30/21: ASSESSMENT / PLAN: Principal Problem: Pneumonia due to COVID-19 virus Covid Pneumonia Acute Respiratory Failure with hypoxia secondary, currently on 2 L nasal cannula Symptom onset: 9/25 + PCR 9/27 Vaccinated moderna. Remdesivir x 5 doses Decadron 6mg daily for 10 doses Prone as tolerated, incentive spirometry Wean supplemental oxygen as able Trend CRP, D-dimer


VAERS ID: 1753416 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-23
Onset:2021-09-27
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Electrocardiogram abnormal, Palpitations, Ventricular extrasystoles
SMQs:, Arrhythmia related investigations, signs and symptoms (broad), Ventricular tachyarrhythmias (narrow), Cardiomyopathy (broad), Hypokalaemia (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: None.
Diagnostic Lab Data: PVC''s found on EKG on 9/29/21.
CDC Split Type:

Write-up: Heart palpitations. PVC''s found on EKG.


VAERS ID: 1753453 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-02-09
Onset:2021-09-27
   Days after vaccination:230
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Ageusia, Anosmia, COVID-19, COVID-19 pneumonia, Chest pain, Computerised tomogram thorax abnormal, Cough, Diarrhoea, Dizziness, Dyspnoea, Lung opacity, SARS-CoV-2 test positive, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Interstitial lung disease (narrow), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Noninfectious diarrhoea (narrow), Infective pneumonia (narrow), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: zyrtec 10mg, hydodiuril 25mg, atarax 25mg, cozaar 25mg, flonase, aleve 220mg
Current Illness: hypertension, hyperlipidemia, TIA, migraine-cluster headache syndrome
Preexisting Conditions: hypercholesterolemia, hypertension, migrain-cluster headache syndrome, TIA (left arm numbness)
Allergies: Topamax
Diagnostic Lab Data: COVID PCR NP swab positive 9/19/21 9/27/21 CT Chest: 1. Organizing pattern of lung injury consistent with known Covid infection. 2. No pulmonary embolism or acute aortic syndrome.
CDC Split Type:

Write-up: Patient completed Pfizer COVID-19 vaccine series on 2/9/21. Patient presented to reporting hospital ER on 9/19/21, 9/22/21, and 9/27/21 with worsening of symptoms of COVID. Admitted 9/27/21 and currently inpatient at facility. Symptoms include diarrhea, cough, loss of taste and smell, vomiting, dizziness, chest pain, and shortness of breath. Patient was ultimately admitted for COVID pneumonia with mild bilateral opacities.


VAERS ID: 1753595 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-09-24
Onset:2021-09-27
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Atrial fibrillation, COVID-19, Chest X-ray normal, Fatigue, Headache, Nasopharyngitis, Pyrexia, SARS-CoV-2 test positive
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Supraventricular tachyarrhythmias (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: ADDERALL; multivitamins; iron; B12
Current Illness: N/a
Preexisting Conditions: N/a
Allergies: N/a
Diagnostic Lab Data: Covid - positive - 9/29/2021; Chest X-ray - clear/normal - 9/29/2021
CDC Split Type: vsafe

Write-up: Well I got the vaccine and had cold like symptoms and then on Wednesday I went into A-fib and went to urgent care. It is hard to say if it is the vaccine or Covid itself. I had lots of fatigue, a headache and a fever of 99.5. The ER prescribed metoprolol and I have been referred to a cardiologist. Other than that I have just been quarantined at home.


VAERS ID: 1753635 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-04-12
Onset:2021-09-27
   Days after vaccination:168
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038B21A / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Rhinorrhoea
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: acetaminophen 1000mg prn amitriptyline 50mg daily aspirin 325mg daily atorvastatin 40mg daily cholecalciferol 5000IU daily gabapentin 300mg TID ibuprofen 400mg prn metoprolol 100mg daily nifedipine 60mg daily pentoxifylline 400mg TID spiron
Current Illness: None documented
Preexisting Conditions: peripheral neuropathy, meningioma, hypertension, headaches, periodic limb movement disorder, obstructive sleep apnea, history of colon polyps, impetigo, tinea cruris, condyloma, eczema, superficial thrombophlebitis, anxiety, hypercholesterolemia, meralgia paresthetica, anemia, dyspnea on exertion, restrictive lung disease, obesity, diabetes, hypokalemia, thyroid nodule, vitamin d deficiency, history of bell''s palsy, hypocalcemia
Allergies: lisinopril - cough tranexamic acid - TIA and remote history of MI Zestril - Cough
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient contracted COVID after being fully vaccinated runny nose


VAERS ID: 1753686 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-22
Onset:2021-09-27
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FP8448 / 2 - / SYR

Administered by: Other       Purchased by: ?
Symptoms: Blood creatine phosphokinase increased, C-reactive protein increased, Drug screen negative, Epstein-Barr virus antibody negative, Epstein-Barr virus antibody positive, Gait disturbance, Human chorionic gonadotropin negative, Mononucleosis heterophile test negative, Myositis, Pain in extremity, Procalcitonin, Pyrexia, Red blood cell sedimentation rate normal, Respiratory viral panel, SARS-CoV-2 test negative, Urine analysis normal, White blood cell count increased
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Hypoglycaemia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: Cough first week of September 2021
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: 9/29/21 WBC 15.4 9/30/21 WBC 11.9 10/1/21 WBC 10.4 9/29/21 CK 228 9/30/21 CK 145 9/29/21 CRP 2.050 9/30/21 CRP 5.960 10/01/21 CRP 4.160 9/29/21 Sed Rate 12 (normal) 9/29/21 Procalcitonin <0.05 10/01/21 Procalcitonin $g0.05 Coronavirus PCR Negative Respiratory Viral Panel Negative UA negative Mononucleosis Screen Negative EBV Ab + IgG and negative IgM Urine Drug Screen Negative Blood HcG Negative
CDC Split Type:

Write-up: Patient became febrile 5 days after vaccination with second COVID Pfizer Vaccine. She was admitted to hospital with fever and myositis w/ b/l thigh pain w/ difficulty walking on 9/29/21. CK elevated on admission and down trending. She had complete resolution of symptoms on 10/1/21.


VAERS ID: 1753693 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-09-27
Onset:2021-09-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chills, Decreased appetite, Fatigue, Feeling of body temperature change, Headache, Hypersomnia, Joint swelling, Pain, Pain in extremity, Rash
SMQs:, Anaphylactic reaction (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Depression (excl suicide and self injury) (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: Pfizer Covid 1 & 2 similar reactions
Other Medications: Calcium +D, Satin, baby aspirin , Tylenol
Current Illness: 8/17/2021 back surgery
Preexisting Conditions:
Allergies: Codeine, Morphine, OxyContin
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Sore left arm when lifting or using, hot and cold (chills) dur the night of 9/27 and early morning of 9/28. Woke up with headache, sore body, extremely tire, slept off and on throughout the day waking up with more chills, no appetite. 9''29 some what better but still tire, no apatite, early evening still had light chills. Good 9''30, 10/1 woke up with unexplained rash on both ankles, and some welling in left ankle. I have no idea if the booster could cause a rash, but did not do anything that should have caused a rash or do I have rashes normally. I have not seen or called doctor.


VAERS ID: 1753709 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-01
Onset:2021-09-27
   Days after vaccination:26
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30130BA / 3 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Auditory disorder, Fatigue, Headache, Musculoskeletal stiffness, Photosensitivity reaction, Pyrexia, Sleep disorder
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Hearing impairment (narrow), Hypersensitivity (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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prenatal Vitamin, Vitamin D, Folic Acid, Fiber, Calcium, Baby Aspirin
Current Illness: None
Preexisting Conditions: None
Allergies: Latex, Trazadone
Diagnostic Lab Data: None so far
CDC Split Type:

Write-up: I am currently 13 weeks and 2 pregnant and decided to get the booster vaccine. Interestingly- I received my first two doses in December and January and had no side effects - other than a sore arm. Since my shot on Monday I have experienced fevers, headaches, neck stiffness, photo and auditory sensitivity. My fevers have responded to Tylenol q4-6 hours for the first 48 hours. I no longer have a fever. However- my headaches with photo and auditory sensitivity have persisted and I?ve been waking up at night with headache. Since then I was advised to check my BPs which diastolic have been consistent elevated ranging in mid 80-90s. Prior to this I have not had elevated BPs. I?m also experiencing greater fatigue with walking etc. I will be checking in with my OB today as well since my headache is now on day 5.


VAERS ID: 1753711 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-03-01
Onset:2021-09-27
   Days after vaccination:210
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6202 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: COVID-19, Pyrexia, SARS-CoV-2 test positive
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: acetaminophen 650mg q4hr prn cholecalciferol 2,000IU daily furosemide 20mg daily ibuprofen 400mg prn levothyroxine 25mcg daily paroxetine 20mg daily quetiapine 25mg HS
Current Illness: 2.19.2021 Bilateral Edema
Preexisting Conditions: Down Syndrome, hyperlipidemia, hypothyroidism, obesity, venous insufficiency, osteoarthritis, GERD, chronic edema, chronic kidney disease stage 3, vitamin d deficiency, depression
Allergies: penicillin - rash
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient contracted COVID after being fully vaccinated low grade fever


VAERS ID: 1753746 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-04-28
Onset:2021-09-27
   Days after vaccination:152
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017C21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Fatigue, Headache, Myalgia, Respiratory tract congestion, Rhinorrhoea, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (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? No
Previous Vaccinations:
Other Medications: amlodipine clobetasol topical hydrochlorothiazide-triamterene metoprolol multivitamins omeprazole potassium chloride triamcinolone topical
Current Illness: None documented
Preexisting Conditions: Hypertension, GERD, Hyperlipidemia, Hashimoto''s thyroiditis, Palpitations, Uterine leiomyoma.
Allergies: atenolol: headache; lisinopril, rash
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient contracted COVID after being fully vaccinated. Runny nose, congestion, headache, muscle aches, and fatigue.


VAERS ID: 1753775 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-20
Onset:2021-09-27
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021C21A / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Disturbance in attention, Sleep disorder, Tinnitus
SMQs:, Noninfectious encephalopathy/delirium (broad), Depression (excl suicide and self injury) (broad), Hearing impairment (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
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None so far.
CDC Split Type:

Write-up: Tinnitus so loud it wakes me up when I am sleeping. The tinnitus is heard whenever I am awake. It is miserable and makes it very hard to concentrate.


VAERS ID: 1753782 (history)  
Form: Version 2.0  
Age: 8.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-09-27
Onset:2021-09-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 1 LA / IM

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

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

Write-up: No adverse event. Reporting administration error in that child was too young to receive vaccine.


VAERS ID: 1753837 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-04-19
Onset:2021-09-27
   Days after vaccination:161
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Cough, Dizziness, Fatigue, Headache, Pyrexia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none known
Current Illness: none known
Preexisting Conditions: none known
Allergies: none known
Diagnostic Lab Data: + rapid test for Covid on 9/29/2021
CDC Split Type:

Write-up: Client was vaccinated with Moderna vaccines for Covid in mid April and mid May 2021. Client not sure of actual dates. Symptoms started on 9/27: dizziness, fatigue, fever, headache, cough. Reported as a case of breakthrough Covid in a fully vaccinated person.


VAERS ID: 1753840 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-02-16
Onset:2021-09-27
   Days after vaccination:223
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9264 / 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: 9/30 SARS/COV-2, NAAT, Positive
CDC Split Type:

Write-up: Breakthrough COVID


VAERS ID: 1753863 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-26
Onset:2021-09-27
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 008C21A / 3 RA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Fatigue, Headache, Ophthalmic migraine, Photopsia, Visual impairment
SMQs:, Anticholinergic syndrome (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: First Moderna arm swelled up at injection site suddenly after 10 days. About the size of a fist and hard. Resolved after 2 days.
Other Medications: Methotrexate Metoprolol Rovustatin Losartan Potassium Folic Acid Vitamin D Aspirin 81 mg Ezetimibe Magnesium Zinc Glucosamine Chondroitin Turmeric
Current Illness: None
Preexisting Conditions: CREST Scleroderma
Allergies: Penicillin Tetracycline, Sulfa, Duricef
Diagnostic Lab Data:
CDC Split Type:

Write-up: Severe headache and fatigue followed by vision disturbances in the Right eye-like an occular migraine. Taken a week to slowly resolve, but still have light flashes in the right eye.


VAERS ID: 1753940 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: West Virginia  
Vaccinated:2021-09-27
Onset:2021-09-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE8839 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Cellulitis, Erythema, Mass, Migraine, Neck pain, Paraesthesia, Skin warm
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Hypersensitivity (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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: anti seizure meds
Current Illness: no
Preexisting Conditions: epilepsy
Allergies: no
Diagnostic Lab Data:
CDC Split Type:

Write-up: Developed a red warm lump, multiple migraines and developed cellulitis. Have tingling in her which went down to her fingers. Soreness in shoulder and neck. Spoke with a NP and Neurologist


VAERS ID: 1753954 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-09-26
Onset:2021-09-27
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Adenovirus test, Brain natriuretic peptide increased, C-reactive protein, Chest pain, Red blood cell sedimentation rate normal, SARS-CoV-2 antibody test positive, SARS-CoV-2 test, Troponin I increased
SMQs:, Cardiac failure (broad), Myocardial infarction (narrow), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: Troponin-I, HS: 6159; 3366 COVID PCR - NT-Pro BNP 35 Adenovirus PCR negative CRP < 2.9 Additional tests for infectious etiologies of myocarditis/pericarditis are pending at this time. ESR 2 Covid AB+
CDC Split Type:

Write-up: Patient developed chest pain 1 day following 2nd Pfizer COVID 19 vaccination. Worsened over 3 days; family spoke to PCP who recommended ED evaluation. Found to have elevated troponin and BNP in ED and subsequently admitted for further evaluation and monitoring.


VAERS ID: 1753981 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-09-27
Onset:2021-09-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Fatigue, Headache, Hypersomnia, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Eosinophilic pneumonia (broad), Depression (excl suicide and self injury) (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: Routine meds: Pantoprazole, Lisinipril, Hydrochlorthiazide, Lovastatin, Celecoxib, Fltucasone, Fexofenadine; Supplements: Vit D, Omega-3, Citracal, MultiVit
Current Illness: None
Preexisting Conditions: HBP, GERD, Arthrutis
Allergies: Cefadroxil
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Within 12 hrs of 3rd shot, chills, mild headache; all became stronger next day + ,100 degree fever, total body muscle aches, fatigue. Slept most of that day, plus thru 2nd overnight


VAERS ID: 1754004 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: New Hampshire  
Vaccinated:2021-09-27
Onset:2021-09-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 076C21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Blood pressure increased, Fatigue, Feeling abnormal, Feeling hot, Headache, Heart rate increased, Nausea, Pain, Pruritus, Pyrexia, Rash, Restlessness
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Akathisia (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (narrow), Hypersensitivity (narrow), Arthritis (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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Moderna 4/6/21 anaphylaxis throat swelling, very itchy skin, confusion and Flu Shot 2016, rash all over lower body
Other Medications: Zyrtec and Zantac as a pre dose due to anaphylaxis reaction from the first dose in on 4/6/21 as prescribed by my PCP.
Current Illness: None, healthy up to Monday.
Preexisting Conditions: None
Allergies: Flu shot, spironolactone, tetracycline, latex, iodine, sulfa based drugs, dicflonec, and the 1st Moderna shot. MSG or any derivatives, including tofu.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Itchy face began at 11;55 am, achy body at 8:20 pm, awoke in middle of the night with a fever, joint pain, headache and body aches. Could not stand up or sit up, extreme fatigue. Could not move on Tuesday all day, remained in bed with same symptoms, severe head ache. Nausea, could only eat 1/2 PB & J at 1:30 pm and then 1/2 cheese sandwich at 8:00 pm. Remained in bed throughout evening with same symptoms. Did not sleep. Wednesday, was still brain fog, fatigue and joint pain, headache disappeared. No fever. Large rash on left arm appeared, hot to touch, itchy. Pulse rate elevated, normal 62 resting rate, pulse was fluctuating between 80 - 95. Thursday, exhaustion, continued elevated pulse between 70 - high 80''s. Restless, not feeling right. Friday, brain fog, fatigue, heart rate in high 70s. Took blood pressure, elevated, 144/88 left arm, 129/84 in right. Took Tylenol at 7:00 am, no other medication taken.


VAERS ID: 1754051 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-27
Onset:2021-09-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / 1 AR / IM

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

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

Write-up: Vaccine affected by temperature excursion administered to the patient


VAERS ID: 1754059 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-27
Onset:2021-09-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / 1 AR / IM

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

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

Write-up: Vaccine affected by temperature excursion administered to the patient.


VAERS ID: 1754064 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-27
Onset:2021-09-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / N/A AR / IM

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

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

Write-up: Vaccine affected by temperature excursion administered to the patient.


VAERS ID: 1754075 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-09-03
Onset:2021-09-27
   Days after vaccination:24
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045C21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest X-ray, Echocardiogram, Electrocardiogram, Fibrin D dimer, Full blood count, Pericarditis, Troponin
SMQs:, Systemic lupus erythematosus (broad), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Medication cyclobenzaprine 10 mg tablet take 1 tablet by oral route every bedtime as needed Flonase Allergy Relief 50 mcg/actuation nasal spray,suspension spray 1 - 2 spray by intranasal route every day in each nostril as needed hydroch
Current Illness: HTN, migraine, tachycardia, peripartum cardiomyopathy,
Preexisting Conditions: HTN, migraine, tachycardia, peripartum cardiomyopathy,
Allergies: NKA
Diagnostic Lab Data: ED did echo, D Dimer, CXR, EKG, troponin and CBC
CDC Split Type:

Write-up: 9/3/21 vaccine received. 9/27/21 pt developed a CP, went to ED 9/28/21. Pt says she was told she had pericarditis. Pt was treated with Ibuprofen, Pt states she is improving as of today 10/1/21.


VAERS ID: 1754077 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-04-08
Onset:2021-09-27
   Days after vaccination:172
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021B21A / 2 UN / IM

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: PT VACCINATED WITH MODERNA 3/4/21 (LOT 030A21A) + 4/08/21 (LOT 0241B21A)


VAERS ID: 1754086 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-27
Onset:2021-09-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / N/A AR / IM

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

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

Write-up: Vaccine affected by temperature excursion administered to the patient


VAERS ID: 1754099 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-27
Onset:2021-09-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / N/A AR / IM

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

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

Write-up: Vaccine affected by temperature excursion administered to the patient.


VAERS ID: 1754107 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-27
Onset:2021-09-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / N/A AR / IM

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

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

Write-up: Vaccine affected by temperature excursion administered to the patient


VAERS ID: 1754112 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-27
Onset:2021-09-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / 2 AR / IM

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

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

Write-up: Vaccine affected by temperature excursion administered to the patient


VAERS ID: 1754114 (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: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / 1 AR / IM

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

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

Write-up: Vaccine affected by temperature excursion administered to the patient


VAERS ID: 1754115 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-27
Onset:2021-09-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / N/A AR / IM

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

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

Write-up: Vaccine affected by temperature excursion administered to the patient.


VAERS ID: 1754116 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-27
Onset:2021-09-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / 1 AR / IM

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

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

Write-up: Vaccine affected by temperature excursion administered to the patient.


VAERS ID: 1754117 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-27
Onset:2021-09-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / N/A AR / IM

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

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

Write-up: Vaccine affected by temperature excursion administered to the patient.


VAERS ID: 1754127 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-27
Onset:2021-09-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / N/A AR / IM

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

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

Write-up: Vaccine affected by temperature excursion administered to the patient.


VAERS ID: 1754132 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-27
Onset:2021-09-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD0809 / 3 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, Arthralgia, Cold sweat, Dizziness, Extra dose administered, Flushing, Migraine, Myalgia, Nausea, Pain, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Hypersensitivity (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: Pfizer Covid vaccine 1 & 2- same as listed above 12/27/20 and 1/7/21 35 years of age
Other Medications: Birth control Women?s multivitamin Naproxen
Current Illness: Virus about 3 weeks prior
Preexisting Conditions: Migraines Back injury
Allergies: Pork Soy
Diagnostic Lab Data:
CDC Split Type:

Write-up: Dizzy, light headed, facial flushing, cool/clammy, fever, severe body aches/ joint pain/ muscle pain/ migraines/ nausea/ abdominal pain Home care with rest/fluids/meds Today 10/1 is the first back to normal day


VAERS ID: 1754147 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-27
Onset:2021-09-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / N/A AR / IM

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

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

Write-up: Vaccine affected by temperature excursion administered to the patient


VAERS ID: 1754241 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-02-09
Onset:2021-09-27
   Days after vaccination:230
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6198 / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest discomfort, Cough, Headache, Taste disorder
SMQs:, Anaphylactic reaction (broad), Taste and smell disorders (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; CLARITIN; TAMSULOSIN; OMEPRAZOLE; LOSARTAN; METOPROLOL; MECLIZINE
Current Illness: None
Preexisting Conditions: GERD; Diastolic Dysfunction; Hypertension; Obese
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Chest tightness, nonproductive cough, headache, taste is different, but not completely gone. Starting on 9/27/21.


VAERS ID: 1754246 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-27
Onset:2021-09-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / 2 AR / IM

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

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

Write-up: Vaccine affected by temperature excursion administered to the patient.


VAERS ID: 1754250 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-27
Onset:2021-09-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / N/A AR / IM

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

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

Write-up: Vaccine affected by temperature excursion administered to the patient.


VAERS ID: 1754256 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-27
Onset:2021-09-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / N/A AR / IM

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

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

Write-up: Vaccine affected by temperature excursion administered to the patient.


VAERS ID: 1754257 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-27
Onset:2021-09-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / N/A AR / IM

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

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

Write-up: Vaccine affected by temperature excursion administered to the patient.


VAERS ID: 1754258 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-27
Onset:2021-09-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / N/A AR / IM

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

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

Write-up: Vaccine affected by temperature excursion administered to the patient


VAERS ID: 1754263 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-27
Onset:2021-09-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / 1 AR / IM

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

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

Write-up: Vaccine affected by temperature excursion administered to the patient


VAERS ID: 1754278 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-27
Onset:2021-09-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / N/A AR / IM

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

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

Write-up: Vaccine affected by temperature excursion administered to the patient.


VAERS ID: 1754281 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-27
Onset:2021-09-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / 2 AR / IM

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

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

Write-up: Vaccine affected by temperature excursion administered to the patient.


VAERS ID: 1754282 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-27
Onset:2021-09-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / N/A AR / IM

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

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

Write-up: Vaccine affected by temperature excursion administered to the patient.


VAERS ID: 1754313 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-26
Onset:2021-09-27
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Diarrhoea, Dyspnoea, Lethargy, Paraesthesia, Visual impairment, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Optic nerve disorders (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Noninfectious diarrhoea (narrow), Hypoglycaemia (broad)

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

Write-up: Vomiting, Diarrhea, 102 temp, pins and needles in palms of hands and bottom of feet. Vision issues. SOB. Lethargy.


VAERS ID: 1754349 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-27
Onset:2021-09-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anxiety, Dizziness, Dyspnoea, Heart rate increased, Hypoaesthesia, Muscular weakness, Presyncope, Throat tightness, Vibratory sense increased, Vision blurred
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Angioedema (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Glaucoma (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Hypoglycaemia (broad), Dehydration (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Within 5 minutes of receiving the shot - Rapid heartrate, dizziness, focus on breathing Within 10 minutes - Continually increasing heartrate, dizziness, elevated legs and people fanning me Within 15 minutes - Lying down on floor because I was certain I was going to pass out After getting on floor, an ambulance was called. Loss of feeling in arms/legs/body and/or vibrating sensation, windpipe narrowing, difficulty breathing, blurred vision, sense of doom/impending death, loss of muscle control (could not control bowels, felt like I was going to defecate myself, began to release gas uncontrollably - could not clench or control lower muscles)


VAERS ID: 1754350 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-09-27
Onset:2021-09-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: KEFLEX; LABETALOL
Current Illness:
Preexisting Conditions:
Allergies: Sulfa
Diagnostic Lab Data: Unknown. Patient was prescribed prednisone and famotidine as treatment.
CDC Split Type:

Write-up: Patient waited the requisite 15 minutes but when she left she complained of her hands itching and asked if that was normal. I told her it was unlikely to be caused by the vaccine but if they continued to itch or she noticed a rash or swelling to go be seen by her PCP. Patient went to walk-in clinic on 10/1 where they diagnosed her with an allergy to the Pfizer Covid vaccine.


VAERS ID: 1754524 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-02
Onset:2021-09-27
   Days after vaccination:178
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 RA / -

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? No
Previous Vaccinations:
Other Medications: no
Current Illness: no
Preexisting Conditions: no
Allergies: no
Diagnostic Lab Data:
CDC Split Type:

Write-up: Positive to COVID. Both Antigen and PCR were positive


VAERS ID: 1754554 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-09-05
Onset:2021-09-27
   Days after vaccination:22
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048F21A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047C21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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 was inadvertently given the second dose of Moderna at 22 days instead of 28 days. Patient has not experienced any adverse effect from early vaccination.


VAERS ID: 1754951 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-21
Onset:2021-09-27
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / 3 LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8730 / 2 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abscess, Conjunctivitis, Eye pain, Eye pruritus, Eyelid disorder, Fatigue, Hordeolum, Lymphadenopathy, Ophthalmological examination, Swelling face
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Angioedema (narrow), Glaucoma (broad), Conjunctival disorders (narrow), Periorbital and eyelid disorders (narrow), Ocular infections (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: Mercaptopurine(6mp) , multivitamins , Estroven , zinc,
Current Illness: None
Preexisting Conditions: Crohns disease
Allergies: Possible Betadine, Bannana allergy.
Diagnostic Lab Data: Eye dr 9/29/21 after dose 3. After dose 2 four eye dr visits, I don?t know the dates. I did not report second dose eye issue as drs did not think vaccine related.
CDC Split Type:

Write-up: Lower eyelid infection right eye 6 days after vaccine dose 2 and dose 3. Currently have an abscess eyelid with facial swelling under eye, painful , itchy. I have had some gland swelling and tiredness. Same symptoms I had in April with second shot after 6 days vaccinated was treated by drs for stye, then allergic pink eye after for two months.Prior to this haven?t had a stye since childhood, no prior eye allergies.


VAERS ID: 1755606 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-27
Onset:2021-09-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Tachyarrhythmia
SMQs:, Tachyarrhythmia terms, nonspecific (narrow), Hypokalaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Metformin Atorvastatin
Current Illness: None
Preexisting Conditions: Diabetes
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Tachyarrhythmia for 2 days, I had to be admitted from the ER to Inpatient.


VAERS ID: 1755737 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Virginia  
Vaccinated:0000-00-00
Onset:2021-09-27
Submitted: 0000-00-00
Entered: 2021-10-02
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: USJNJFOC20210959909

Write-up: ADMINISTRATION OF AN EXPIRED VACCINE; This spontaneous report received from a health care professional concerned a 33 year old male. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 206A21A, 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 an expired vaccine. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of administration of an expired vaccine was not reported. This report was non-serious. This case, from the same reporter is linked to 20210959581, 20210958425, 20210959620, 20210959351, 20210958518, 20210958348, 20210958371, 20210958525, 20210958566, 20210958806 and 20210958977. This case, from the Others is linked to 20210958423.


VAERS ID: 1756466 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-09-27
Onset:2021-09-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Injection site pain, Joint range of motion decreased, Pain, Pain in extremity, Sleep disorder
SMQs:, Extravasation events (injections, infusions and implants) (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None taken although I am using a topical painkiller for tennis elbow on my left arm.
Current Illness: None
Preexisting Conditions: Sinus issues
Allergies: Sulfa drugs, erythromycin
Diagnostic Lab Data: None. I do have pictures showing where the bandage was placed to cover the shot. My sense is that the shot was administered too high to place the vaccine in the deltoid muscle. Yesterday, I reported this incident to the pharmacy where I had taken the shot and they agreed that the shot was placed too high in the shoulder and likely caused the pain.
CDC Split Type:

Write-up: I had a lot of pain at the time of injection. The job wasn''t noticeable but the infusion of the vaccine was very painful. That stopped in a few minutes and there were no side effects as I waited the 15 minutes. A few hours later, my right arm hurt, not with the dull muscle pain I''ve had with other vaccines but with a sharp pain in the shoulder joint that was made worse by any motion. It was impossible for me to sleep that night. By the morning, the pain diminished if I didn''t move but continued with any motion and my range of motion was substantially reduced. Over several days, the severity of the pain diminished somewhat and now occurs only on full extension of the arm/shoulder in any direction, particularly in reaching back as in attaching a seat belt. After a few nights, I was able to sleep again.


VAERS ID: 1756472 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-09-01
Onset:2021-09-27
   Days after vaccination:26
Submitted: 0000-00-00
Entered: 2021-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Military       Purchased by: ?
Symptoms: Chills, Fatigue, Headache, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (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: Daily MTV
Current Illness:
Preexisting Conditions: Chronic Back Pain
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Excruciating headache lasting 2 days, soreness at the injection site for 2 days, chills lasting 3 days, and fatigue lasting 4 days.


VAERS ID: 1756507 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-25
Onset:2021-09-27
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Chest discomfort, Chest pain, Echocardiogram, Electrocardiogram, Palpitations
SMQs:, Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

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

Write-up: Two days following vaccination, I started experiencing chest pain, palpitations, pressure which is still continuing. I went to see cardiologist and he believes the inflammation from the vaccine may have exacerbated my mitral valve prolapse resulting in my symptoms, which I have never experienced before the vaccine.


VAERS ID: 1756518 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-24
Onset:2021-09-27
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048F21A / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Contusion, Immediate post-injection reaction, Rash erythematous, Rash pruritic
SMQs:, Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Accidents and injuries (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: Protonix 40mg, Zoloft 100mg, Crestor 20mg, Osphena 60mg, Zetia 10mg, metoprolol ER 50mg, metformin 500mg, aspirin 81mg
Current Illness: N/A
Preexisting Conditions: High blood pressure, high cholesterol, diabetes
Allergies: NKA
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient has an extremely large bruise, spanning over half the diameter of the arm. She reports that the bruise developed immediately after the shot. Patient also has a red rash surrounding the bruised area, which she reports began approximately 3 days after she received the vaccine and has steadily worsened. She reports that the rash is itchy, and she has been using hydrocortisone successfully to control the itching.


VAERS ID: 1756527 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-09-26
Onset:2021-09-27
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Body temperature increased, Dyspnoea, Pain, Stomatitis
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (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: moderna
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: hard to breath, sores in mouth, temperature, body aces


VAERS ID: 1756642 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-23
Onset:2021-09-27
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 3 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Pruritus, Skin exfoliation
SMQs:, Severe cutaneous adverse reactions (broad), 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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Na
Current Illness: None
Preexisting Conditions: Hyperlipidemia , asthma
Allergies: Nkda
Diagnostic Lab Data: Na
CDC Split Type:

Write-up: Patient says she has skin peeling and severe itching


VAERS ID: 1756710 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Montana  
Vaccinated:2021-09-06
Onset:2021-09-27
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Chronic inflammatory demyelinating polyradiculoneuropathy, Condition aggravated, Hypoaesthesia, Mobility decreased
SMQs:, Peripheral neuropathy (broad), Parkinson-like events (broad), Guillain-Barre syndrome (narrow), Demyelination (narrow), Tendinopathies and ligament disorders (broad), Immune-mediated/autoimmune disorders (narrow), Sexual dysfunction (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: Yellow fever vaccine/2013
Other Medications: IVIG
Current Illness:
Preexisting Conditions: Chronic Inflammatory Demylinating Polyneruopathy (CIDP)
Allergies: None
Diagnostic Lab Data: Multiple IVIG infusions as treatment - from Feb - October
CDC Split Type:

Write-up: All three doses (2+ booster) of the Moderna Covid-19 vaccine caused significant relapse/resurgence of symptoms from CIDP - numbness, weakness, difficulty in mobility. Reporting because people with demylenating illnesses were excluded from vaccine trials so might be helpful for some patients to know.


VAERS ID: 1756757 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-09-27
Onset:2021-09-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / 3 AR / IM

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

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

Write-up: Error: Improper Storage (temperature)-


VAERS ID: 1756784 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-23
Onset:2021-09-27
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 1 - / SYR

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

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

Write-up: Facial swelling. Swelling in areas of facial fillers. Rash.


VAERS ID: 1756827 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-09-27
Onset:2021-09-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301258A / 3 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Decreased appetite, Diarrhoea, Ear discomfort, Headache, Influenza like illness, Neck pain, Pain, Vomiting
SMQs:, Acute pancreatitis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Arthritis (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: Lisinopril 15 mg/day; Vitamin C
Current Illness: none noted
Preexisting Conditions: Elderly arthritis; high blood pressure
Allergies: All Fluoroquinolone antibiotics; Ampicillin; iodine
Diagnostic Lab Data:
CDC Split Type:

Write-up: 1st night (9/27/21): Pain in right side of neck & headache; pressure in back of eyeballs; aches & pain throughout body much like flu symptoms 2nd day/night (9/28/21): same symptoms throughout the day; tylenol helped relieve pain; no appetite; only consumed water and stayed in bed; vomited at 11pm in evening 3rd day/night (9/29/21): symptoms somewhat diminished; diarrhea mid-day; con''t to rest & drink water; ate some soup; took a tylenol 4th day/night (9/30/21): awoke and felt quite well except for a continued neck ache


VAERS ID: 1756987 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-09-16
Onset:2021-09-27
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Aphasia, Asthenia, Computerised tomogram head, Eye movement disorder, Laboratory test, Muscle spasms, Muscle tightness, Muscle twitching, Muscular weakness, Paraesthesia, Seizure like phenomena, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Convulsions (narrow), Dyskinesia (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Sertraline, vitamins
Current Illness: anxiety
Preexisting Conditions:
Allergies: none
Diagnostic Lab Data: Head CT, labs 09/27/2021
CDC Split Type:

Write-up: 11th day after receiving 1st dose of vaccine increased tingling in hands/arms, could not move hand to pick up cup as hand stuck in contorted dystonic manner. began to effect whole body, collapsed on floor as unable to stand. Hands would not open, unable to speak. Went to ER was treated with Benadryl and Ativan, iv medication. Left ER after 6 hours mom drove 4 blocks and it started again in hands and went into whole body, unable to speak. looked as like was having seizure activity. Went back to ER and was immediately taken back to room. received Valium, etc. while in ER mom and nurse noticed involuntary eye movement, facial twitching. For the last week have been taking Vistaril and Ativan regular. Primary Physician request Neuro and Cardiology Evaluation. Still having tingling symptoms in hands, arms, legs and feet. Some muscle cramping/tightness. Started Sertraline and took 6 doses before the issues started, started taking 3 days after receiving 1st dose of vaccine. Never have had this happen before. Not sure if Vaccine or Sertraline related. NO PREVIOUS MEDICAL ISSUES


VAERS ID: 1757003 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-09-24
Onset:2021-09-27
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 061E21A / 1 LA / 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? Yes
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: Patient experienced an enlargement of lymph nodes located on left upper body, particularly the neck and axillary closest to injection site.


VAERS ID: 1757041 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-09-15
Onset:2021-09-27
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Swollen lymph nodes under both armpits


VAERS ID: 1757054 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-09-26
Onset:2021-09-27
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 211A21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Anxiety, Condition aggravated, Constipation, Dysuria, Headache, Nasopharyngitis, Nausea, Pyrexia, Respiratory tract congestion
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: 103.4 fever x2d, nausea x3d, headache x2d, constipation x3d, difficulty urinating x3d, increased anxiety x4d Congestion/cold 5 days after vaccine


VAERS ID: 1757058 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-26
Onset:2021-09-27
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 211A21A / 1 - / IM

Administered by: Private       Purchased by: ?
Symptoms: 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: Idiopathic intermittent rash
Preexisting Conditions: Chronic sinusitis
Allergies: PCN, rocephin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Headache x2d, nausea x2d


VAERS ID: 1757059 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: D.C.  
Vaccinated:2021-09-27
Onset:2021-09-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Chills, Cold sweat, Decreased appetite, Fatigue, Heart rate irregular, Malaise
SMQs:, Cardiac arrhythmia terms, nonspecific (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Yes. Multivitamins, vitamin B complex drops, seamoss, elderberry, soursop and Eucalyptus and spearmint leaf teas.
Current Illness: chronic sinusitis, ibs
Preexisting Conditions: Ibs, chronic sinusitis, anxiety
Allergies: Yes. Haldol.
Diagnostic Lab Data: I did not go to the hospital, I was told that some side effects would make me sick. I''m a mother of five and was home alone so I couldn''t go to the hospital the only concern I had was my heartbeat being irregular and be being sick for more than 3 days.
CDC Split Type:

Write-up: Feeling sick, chills, cold sweats, fatigue, irregular heartbeat, loss of appetite.


VAERS ID: 1757065 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-24
Onset:2021-09-27
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood test normal, Chest X-ray normal, Chest discomfort, Chest pain, Chills, Electrocardiogram normal, Myocardial necrosis marker normal, Palpitations, Panic attack, Thyroid function test normal, Tremor, Urine analysis normal
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (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: Prenatal (breastfeeding), vitamin c and d, ibuprofen and probiotics
Current Illness:
Preexisting Conditions: HSV2 - dormant
Allergies: None
Diagnostic Lab Data: Ekg, blood work ok heart enzymes, chest X-rays, thyroid, urine test- everything normal on paper.
CDC Split Type:

Write-up: On day 3 I woke up with chest tightness which progressed to slight chest pain. By day four it progressed worse and something felt like it squeezed my heart, first visit to the ER, all tests normal. Day 5 chest tightness became worse and slight pains again. Day 6 when I went to sleep I woke up with heart palpitations and pounding and chills and tremors. I checked back into a different ER (the heart hospital), all tests again are normal but I experienced multiple episodes again while there. Believed to be having panic attacks. I have improved by avoiding all triggers but chest is sore and slightly painful still, somewhat tight.


VAERS ID: 1757164 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-09-01
Onset:2021-09-27
   Days after vaccination:26
Submitted: 0000-00-00
Entered: 2021-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 RA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Chills, Cough, Ear pain, Fatigue, Hyperhidrosis, Neck pain, Oropharyngeal pain, Pain in extremity
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Methotrexate hydroxychloriquine losarten metropol ranolizine venaflaxen aspirin pilocarpine metformen
Current Illness: Sjogrens
Preexisting Conditions: Sjogrens with ra lupus high blood pressure
Allergies: Linsinopril
Diagnostic Lab Data:
CDC Split Type:

Write-up: Sore throat arm neck fatigue chills sweats ear ache cough several days


VAERS ID: 1757295 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-01-19
Onset:2021-09-27
   Days after vaccination:251
Submitted: 0000-00-00
Entered: 2021-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Covid-19 test
CDC Split Type:

Write-up: Employee tested positive for Covid-19 after being fully vaccinated


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