National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

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

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

Government Disclaimer on use of this data



Case Details (Reverse Sorted by Onset Date)

This is page 91 out of 8,753

Result pages: prev   1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131 132 133 134 135 136 137 138 139 140 141 142 143 144 145 146 147 148 149 150 151 152 153 154 155 156 157 158 159 160 161 162 163 164 165 166 167 168 169 170 171 172 173 174 175 176 177 178 179 180 181 182 183 184 185 186 187 188 189 190   next


VAERS ID: 1825740 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Hawaii  
Vaccinated:2021-09-22
Onset:2021-10-26
   Days after vaccination:34
Submitted: 0000-00-00
Entered: 2021-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 2 LA / 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: tested Positive for covid with Rapid test .


VAERS ID: 1825744 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-10-26
Onset:2021-10-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939903 / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Got a rash from the first 2 vaccines
Other Medications: acid reflux meds
Current Illness: no
Preexisting Conditions: no
Allergies: penicillin and bell peppers
Diagnostic Lab Data: no
CDC Split Type:

Write-up: Started getting a headache the same night of taking the vaccine. Had a temp of 102 degrees. Nausea and arm was very sore.


VAERS ID: 1825745 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-02-10
Onset:2021-10-26
   Days after vaccination:258
Submitted: 0000-00-00
Entered: 2021-10-28
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, Infection, 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: 10/27 SARS/COV-2, NAAT, Positive
CDC Split Type:

Write-up: Breakthrough COVID


VAERS ID: 1825760 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: New York  
Vaccinated:2021-10-15
Onset:2021-10-26
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Levothyroxine Sodium 112mcg Progesterone 200mg Ganirelix Acetate 250 mcg Follistim Aq 300 unt
Current Illness:
Preexisting Conditions: Hypothyroidism Hypercholesterolemia Obesity
Allergies: Penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Large localized reaction to Pfizer booster. Reports warmth, erythema, pain - denies fever Treat with Keflex.


VAERS ID: 1825764 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-01-09
Onset:2021-10-26
   Days after vaccination:290
Submitted: 0000-00-00
Entered: 2021-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK4176 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 10/27 SARS/COV-2, NAAT, Positive
CDC Split Type:

Write-up: Breakthrough COVID


VAERS ID: 1825768 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-10-25
Onset:2021-10-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012F21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Headache, Injection site erythema, Injection site pain, Injection site swelling, Injection site warmth, Pain in extremity, Skin reaction
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: n/a
Current Illness:
Preexisting Conditions: CKD stage 3, diabetus 2
Allergies: n/a
Diagnostic Lab Data:
CDC Split Type:

Write-up: 10/26/2021- 10/27/2021 sore arm. fatigue. headache 10/28/2021 delayed skin reaction, large red, swollen, hot & painful below injection site


VAERS ID: 1825782 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-10-26
Onset:2021-10-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032F21A / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Bundle branch block right, Dizziness, Electrocardiogram abnormal, Fall, Loss of consciousness, Vision blurred
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Conduction defects (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Glaucoma (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Levothyroxine 25 mcg daily Alendronate Sodium tablets 70 mg weekly Daily vitamins: calcium, A, B complex, D, biotin
Current Illness: None
Preexisting Conditions: Just the thyroid which I started taking Levothyroxine for a few years ago
Allergies: Sulpha drugs
Diagnostic Lab Data: At the pharmacy and at the hospital they gave me EKGs even though I no longer was faint. The EKG mentioned some evidence of right bundle branch block, however no acute ischemic changes otherwise. After which they let me leave the hospital.
CDC Split Type:

Write-up: Within a few minutes of receiving the Moderna Booster shot, I started to get very dizzy. I knew I was about to faint, having experienced that a few times in my life. I had had no adverse reactions to the first 2 Moderna vaccines, so this was shocking. I was sitting and put my head down between my legs. The pharmacist brought me water but that did not help. My vision blurred badly and I tried breathing deeper after lowering my mask. I tried to stand up and then based upon what the pharmacist told me, I dropped to the floor passing out and he caught me. About 10-15 minutes later laying on the floor, I recovered and was no longer dizzy. They called an ambulance to take me to the hospital.


VAERS ID: 1825786 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-01-28
Onset:2021-10-26
   Days after vaccination:271
Submitted: 0000-00-00
Entered: 2021-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011M20A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025A21A / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Chills, Headache, Respiratory tract congestion
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Calcium; Cranberry; Metrogel; Prolia, Vitamin B-12, and Vit D and Vitamin C; Latanoprost
Current Illness: none
Preexisting Conditions: history of breast cancer; osteoporosis, polyarthritis
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Symptoms began 2 days ago with mild headache, chills and upper respiratory congestion. She denies any cough, shortness of breath, chest pain, tightness or hemoptysis. starting 10/26/21


VAERS ID: 1825791 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-10-25
Onset:2021-10-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 062E21A / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Adverse drug reaction, Chills, Diarrhoea, Headache, Lethargy, Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Pseudomembranous colitis (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Zinc, vitamin D, C, multi (NeoVitin), Niacin, krill oil
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: None
CDC Split Type:

Write-up: The day after the 2nd dose I had chills, head ache, felt nauseous. Second day these symptoms got worst and I threw up some with diarrhea. Today more head aches, lethargic, throwing up. I feel a little better this evening. Hoping to get back to work tomorrow. I felt it is important to report these side effects in the hope that there is on going research to make these vaccines less likely to cause bad side effects. This really knocked me down for the past few days.


VAERS ID: 1825801 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-10-26
Onset:2021-10-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822811 / 2 LA / IM

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

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

Write-up: Chills, diarrhea, chills and muscle aches


VAERS ID: 1825810 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-10-26
Onset:2021-10-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Chills, Fatigue, Myalgia, Pain, Pain in extremity
SMQs:, Rhabdomyolysis/myopathy (broad), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: mild body ache and fatigue after first Moderna Covid-19 vaccination
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Muscle/body ache, chills, weakness, tiredness, sore arm. Treated with acetaminophen. Symptoms dissipated by 1:00 pm on 10/27/21. Symptom duration was 19 hours.


VAERS ID: 1825822 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-25
Onset:2021-10-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, Bone pain, Decreased appetite, Dizziness, Headache, Muscle spasms, Nausea, Pain of skin, Pyrexia, Urticaria
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Osteonecrosis (broad), Hypersensitivity (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Very dizzy, skin hurts, bones hurt, all joints (knees, ankles, elbows and entire spine) very painful, headache, fever, nauseous, muscle spasms in chest area and abdominal area as well as lower back. Hives on injection arm, Loss of appetite. These symptoms lasted 3 days. October 26-28


VAERS ID: 1825852 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-25
Onset:2021-10-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 - / SYR

Administered by: Other       Purchased by: ?
Symptoms: Fatigue, Pain
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Effexor. Synthroid. Abilify. Lisinopril. Lipitor. Concerta.
Current Illness: None
Preexisting Conditions: Depression. Hypothyroidism.
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Fatigue. Sore body. 3 days


VAERS ID: 1825861 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-10-22
Onset:2021-10-26
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 076C21A / 3 LA / 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Second Moderna dose, same reaction, lasted five days
Other Medications: Multivitamin, Tums, Vitamin D3
Current Illness: None
Preexisting Conditions:
Allergies: Penicillin, macrodantin
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Itchy, red, raised patch on arm around injection site. Approx 3 inches x 2 inches. Took one Benadryl after appearance, took two Benadryl the following evening. Red area was also hot to he touch.


VAERS ID: 1825874 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-10-26
Onset:2021-10-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048F21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Pyrexia, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Patient stated that she developed fever and chills the night of the vaccines and the next morning she fainted while walking in her house.


VAERS ID: 1825876 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-03-31
Onset:2021-10-26
   Days after vaccination:209
Submitted: 0000-00-00
Entered: 2021-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8733 / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0169 / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Chills, Dyspnoea, Ear pain, Headache, Lymphadenopathy, Nasal congestion, Oropharyngeal pain, Pain, Productive cough, Sinus congestion, Sneezing, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (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: ?Triamcinolone Acetonide 0.1 % Cream 1 application Externally twice a day ?Fluticasone Propionate 50 MCG/ACT Suspension 2 sprays Nasally Once a day ?Vitamin D ?Albuterol Sulfate HFA 108 (90 Base) MCG/ACT Aerosol Solution 2 puffs a
Current Illness: none
Preexisting Conditions: Anemia. Rt breast lumpectomy. Depression. 1/03 left hemmorrhagic cyst. G3P3. R abdomen shingles. Allergic rhinitis. GERD. Nicotine dependence. scoliosis, chronic neck pain. cervical DDD. colon/EGD 4/2015 esophagitis & colon polyps repeat q 5 yrs. Asthma/ reactive airway disease. Elevated cholesterol.
Allergies: PENICILLIN DRUGS: hives - Allergy Doxycycline Monohydrate: skin burning, feet swelling
Diagnostic Lab Data:
CDC Split Type:

Write-up: headache- sore throat- chills- productive cough- shortness of breath- body aches- ear pain- sinus congestion- nasal congestion- swollen glands- wheezing- sneezing starting 10/26/21


VAERS ID: 1826044 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-10-25
Onset:2021-10-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 058E21A / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Axillary pain, Breast pain, Flank pain, Impaired work ability, Insomnia, Lymphadenopathy, Pain
SMQs:, Retroperitoneal fibrosis (broad), Lipodystrophy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: moderna dose 2- 02/02/2021- less severe swelling and pain under left armpit that only lasted 1 day
Other Medications: Multivitamin Glucosamine
Current Illness: none
Preexisting Conditions: none
Allergies: sulfa medications
Diagnostic Lab Data: none
CDC Split Type: vsafe

Write-up: The day after my vaccine, the lymph nodes in my left armpit got really swollen and painful. It radiated down my side and into the left breast area. It hurts just sitting around or trying to move at all. I couldn''t teach any of my fitness classes for 2 days. I took tylenol and Celebrex and it did not really do anything. I was having a hard time sleeping. I texted my physician and sent her pictures of the swelling. I also took some pain meds left over from a mouth surgery. We agreed to just keep monitoring it and it it got worse I should come in for a visit. Today 10/28/2021 it is still swollen but the pain is about half of what its been the two previous days. I was able to teaching classes today.


VAERS ID: 1826063 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: American Samoa  
Vaccinated:2021-10-25
Onset:2021-10-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Chills, Dermatitis acneiform, Eye pruritus, Fatigue, Headache, Nausea, Rash, Rash papular, Sinus congestion, Somnolence, Tremor
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Both Moderna Covid Shots-See list
Other Medications: See attached list Carvedilol 12.50mg Tab Atorvastatin 20mg Tab Omperzole 40mg Tab Hydrochlorothiazide 25mg Tab Levalbuterol HFA 45 mcg Fluticasone 50mcg Spray Metronidazole 0.75% Cream Xiidra 5% OPH Cephalexin
Current Illness: UTI/Kidney Stone
Preexisting Conditions: Asthma
Allergies: Penicillin-Doxycline-Sulfa/Sulfites-Melatonin
Diagnostic Lab Data:
CDC Split Type:

Write-up: October 25-12:10PM Booster Booster of Moderna o Headache in back of head October 26 o 8:10 AM severe chills and shaking. o Severe headache in back of head o Fatigue-slept most of the day o Nausea o Sore Joints o 4PM chills o Sinus Congestion-very bad October 27 o Headache in back of head o Rash-chest only o Fatigue-slept on an off all day. October 28, 2021 o Rash-chest/neck/arms/some facial o Rash turning to patches o 4 PM rash patches swelling o Itchy Eyes o Called Hospital 6:10 PM o Dr. Return call immediate-expect call in AM o Take photos February 24, 2021, 7:50 AM appointment for 1st dose Moderna Vaccine-Health Department o Nausea came a few minutes after shot, and headache o Went home and napped gone after a few hours o 4PM Headache came back, and lasted until 7PM March 2-knee pain March 3-on waking up couldn''t walk March 9-Woke up with Covid Arm-Swollen arm, rash, and chills March 24-7:41 appointment for 2nd dose of Moderna-Health Department o Nausea came a few minutes after shot, muscle pain, and headache March 25th-Fever, pain, and muscle aches. Trouble walking March 26th-Rash, and turned to red patches everywhere. Nausea. March 27th-Rash is getting worse (like penicillin poisoning), and nausea. March 28th-Nausea March 29th-Nausea, and could not even get out of bed. March 30th-Nausea March 31st-Nausea April 1st-Nausea and chills April 2nd-Headache pain in back of head in one spot. April 3rd-Headache pain in back of head in one spot. April 5th-Headache pain in back of head in one spot. April 6th-Headache pain in back of head in one spot. April 8th-Night sweats. April 9th-Vertigo. April 10th-Hot flashes. April 11th-Hot flashes. April 12th-Vertigo and nausea. April 13th-Nausea. April 16th-Nausea, and bad headache. Vertigo late evening. I have photos of the rash if needed.


VAERS ID: 1826270 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-10-24
Onset:2021-10-26
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FG3527 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Pain in extremity
SMQs:, 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: NOT MENTIONED
Current Illness: NO
Preexisting Conditions: NOT MENTIONED
Allergies: NO
Diagnostic Lab Data: UNKNOWN. PHARMACY DISTRICT MANAGER TRIED CONTACTING THE PATIENT SEVERAL TIMES BUT HAD NO LUCK GETTING HOLD OF HER
CDC Split Type:

Write-up: PATIENT STATED THAT AFTER THE SHOT HER ARM WAS HURTING AND SHE WORKS AT A ORTHOPEDIC OFFICE AND WAS TOLD BY THE PHYSICIAN THAT IT IS DUE TO THE PLACE OF ADMINISTRATION


VAERS ID: 1826273 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-26
Onset:2021-10-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 RA / SC

Administered by: Private       Purchased by: ?
Symptoms: Chills, Cough, Decreased appetite, Diarrhoea, Erythema, Fatigue, Malaise, Pain, Peripheral swelling, Respiratory tract congestion
SMQs:, Cardiac failure (broad), Anaphylactic reaction (narrow), Angioedema (broad), Pseudomembranous colitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Cardiovascular; Hypertension, unspecified type; Hyperlipidemia, unspecified hyperlipidemia type; GI and Hepatology; Gastroesophageal reflux disease, unspecified whether esophagitis present; Vitamin D deficiency; Endocrine; Hypothyroidism, unspecified type; Musculoskeletal and Integumentary Acne, unspecified acne type
Preexisting Conditions: Cardiovascular; Hypertension, unspecified type; Hyperlipidemia, unspecified hyperlipidemia type; GI and Hepatology; Gastroesophageal reflux disease, unspecified whether esophagitis present; Vitamin D deficiency; Endocrine; Hypothyroidism, unspecified type; Musculoskeletal and Integumentary Acne, unspecified acne type
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: C/o feeling sick including swelling and redness in arm, fatigue, diarrhea, low appetite, body aches Denies taking her temp but having chills Had third Covid injection 2 days ago and sx started same night as injection C/o cough and congestion


VAERS ID: 1826275 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-10-25
Onset:2021-10-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Lethargy, 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), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Fever, lethargy, cold chills, achy muscles started on 2nd day and still present today (4th day) post shot


VAERS ID: 1826283 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-10-26
Onset:2021-10-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034C21A / 2 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Abnormal dreams, Dizziness, Injection site erythema, Injection site induration, Injection site pain, Insomnia, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: extreme soreness at injection site, redness and hard surrounding injection site 2 inch diameter. moderate grade fever (100.8 F) for 12 hours, insomnia and strange dreams when I was able to sleep. muscle aches in left arm and abdomen, light-headed feeling


VAERS ID: 1826294 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-10-26
Onset:2021-10-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test, Diarrhoea, Headache, Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Endometriosis
Allergies: Morphine, penicillin, hydrocodone
Diagnostic Lab Data: Bloodwork - 10/27/2021
CDC Split Type:

Write-up: Nausea and headache appeared immediately. Began vomiting + diarrhea within 2 hours of injection time. After being unable to keep food/fluids down over 24 hours, was instructed to go to ER.


VAERS ID: 1826303 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: California  
Vaccinated:2021-10-25
Onset:2021-10-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011F21A / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Injection site pruritus, Injection site rash, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Micardis 80 mg for Hypertension
Current Illness: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: The 2nd Day I had swelling that was kind of large and today 10-28-2021, I broke out in a huge rash where the injection site was and intense itching started to accrue.


VAERS ID: 1826313 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-10-25
Onset:2021-10-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 091D21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Dysuria, Headache, Influenza like illness, Myalgia, Pain of skin, Pollakiuria, Pyrexia, Sleep disorder
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Levothyroxine 0.075 mg Montelukast 10 mg Otezla 30 mg 2 x per day Vitamins A, B, C, D Fish Oil
Current Illness: ?
Preexisting Conditions: Asthma, psoriasis
Allergies: Contrast Dye
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever 101 ? Chills ? Muscle ache and headache ? Flu-like symptoms SKIN HURT. It hurt to wear clothes and to lie down on the bed. I had to urinate frequently a teaspoon or so but it was painful enough to wake me up.


VAERS ID: 1826437 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-10-25
Onset:2021-10-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 909904 / 3 LA / IM

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

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

Write-up: PATIENT RECEIVED MODERNA BOOSTER VACCINE MONDAY AFTERNOON, THEN STATED THAT SYMPTOMS STARTED THE FOLLOWING DAY. PATIENT''S INJECTION SITE BECAME SWOLLEN, RED, HARD AND PAINFUL TO TOUCH AND PATIENT IS STILL EXPERIENCING THESE SYMPTOMS AS OF TODAY (THURSDAY). PATIENT DID NOT REPORT ANY SYMPTOMS OF FEVER, CHILLS OR PUS AT THE SITE. PATIENT WAS ADVISED TO CONTACT DOCTOR TO DETERMINE IF IT IS A HYPERSENSITIVITY REACTION OR CELLULITIS AND ALSO ADVISED INTERIM MANAGEMENT OF SYMPTOMS WITH ICE PACK, ORAL ANTIHISTAMINE, ARM ELEVATION AND MONITORING OF REDNESS PERIMETERS.


VAERS ID: 1826441 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-10-25
Onset:2021-10-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Axillary pain, Dysphagia, Fatigue, Headache, Injection site pain, Lymph node pain, Lymphadenopathy, Oropharyngeal pain, Pain
SMQs:, Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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: DIM, Omega3/CoQ 10, Probiotic, Zinc, Multivitamin, Iodine. Testosterone and Estrogen sq pellets for over 3 years, Progesteron oral capsule for over 3 years
Current Illness: none
Preexisting Conditions: none
Allergies: Penicillin, Ibuprofen
Diagnostic Lab Data: no tests were performed, throat was clear on exam, on self exam felt residual lymph nodes enlargement and tenderness on day 3, improving.
CDC Split Type:

Write-up: Stingling for over 2 hours at the site of injection. The next day deltoid tenderness and axillary tenderness, pain on lifting the arm, tender swelling in the axillare are on side of the injection, that lasted for for the next day, but started to go away on day 3. Also had vague headache and sore throat with dysphagia the next day after injection and feeling tired- all resolved on day 3.


VAERS ID: 1826653 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-10-25
Onset:2021-10-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032F21A / 3 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache, Motor dysfunction, Muscular weakness
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Akathisia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (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: Multiple Sclerosis
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Lost all motor function in legs and extreme weakness in arms, extreme headache


VAERS ID: 1826654 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Alabama  
Vaccinated:2021-10-26
Onset:2021-10-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Hyperhidrosis, Loss of consciousness, Malaise, Pallor, Somnolence, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

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

Write-up: After receiving the first dose of the COVID-19 vaccine, Dr was alerted that Patient was in the back of the room and not feeling well. When Dr approached Patient, she noticed that his was pale and not responding to questions. At this time, we asked someone to call ER and Dr joined Dr in the back of the room. Dr approached Mr and also noticed his pale complexion, his lack of verbal responses, and was beginning to sweat. As Dr went to retrieve the emergency medical kit, Dr began rubbing Patient''s sternum and yelling his name, attempting to illicit a response. At this point, Patient''s briefly lost consciousness. Dr continued rubbing his sternum, patting him on the back and yelling his name. Mr continued breathing the entire episode. After a few moments, Mr regained consciousness and although groggy, was orientated times 4 (person, place, time, and situation). At this point, emergency personnel arrived and proceeded to assess Patient After a brief examination and interview, Mr decided that he did not want to be transported to a hospital. Dr also discussed with Patient''s the need for him to see a healthcare provider to alert him of this episode and to receive a checkup to rule out other health conditions. Patient remained in the vaccination area for about an hour, received a snack and beverages, and was dismissed to his work area after he informed Drs that he was feeling better. Dr contact Patient on Thursday and he informed her that he was feeling much better.


VAERS ID: 1826670 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-10-25
Onset:2021-10-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Headache, Laboratory test, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Metformin, Losartan, Chlorthalidon, Glimepride, Metoprolol, Amitriptyline, Simvastation, Vit B 12, Ferrous, Novolog,
Current Illness: None
Preexisting Conditions: Diabeites, Heart disease, High blood pressure.
Allergies:
Diagnostic Lab Data: several test were run. Spent the night in the hospital.
CDC Split Type:

Write-up: Muscle aches, headache, fever of 104.3, weakness,


VAERS ID: 1827881 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-10-25
Onset:2021-10-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014F21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Headache, Injection site pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (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: Lisinopril/Hctz
Current Illness: none
Preexisting Conditions: High blood pressure
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Day2 and 3, soreness at the injection site, headache, low fever, fatigue,


VAERS ID: 1827173 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: Kentucky  
Vaccinated:0000-00-00
Onset:2021-10-26
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 211A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Poor quality product administered, 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: USJNJFOC20211052134

Write-up: PUNCTURED VIAL OF THE VACCINE WAS ADMINISTERED EXCEEDED TIME FRAME BY 1 ONE HOUR OUTSIDE OF THE 6 HOUR TIME PERIOD; VIAL OF VACCINE WAS PUNCTURED OUTSIDE OF THE 6 HOUR TIME PERIOD; This spontaneous report received from a health care professional concerned a 48 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, and batch number: 211A21A expiry: 14-DEC-2021) dose was not reported, administered on 26-OCT-2021 15:05 for prophylactic vaccination. No concomitant medications were reported. On 26-OCT-2021, the patient experienced punctured vial of the vaccine was administered exceeded time frame by 1 one hour outside of the 6 hour time period. On 26-OCT-2021, the patient experienced vial of vaccine was punctured outside of the 6 hour time period. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the punctured vial of the vaccine was administered exceeded time frame by 1 one hour outside of the 6 hour time period and vial of vaccine was punctured outside of the 6 hour time period was not reported. This report was non-serious.


VAERS ID: 1827181 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Florida  
Vaccinated:0000-00-00
Onset:2021-10-26
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Body temperature, Chest pain, Chills, Dizziness, Headache, Hyperhidrosis, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Abstains from alcohol; Allergic reaction to bee sting; Disability; Non-smoker; Penicillin allergy; Sulfonamide allergy
Preexisting Conditions: Comments: Patient had no drug abuse and illicit drug use.
Allergies:
Diagnostic Lab Data: Test Date: 20211027; Test Name: Body temperature; Result Unstructured Data: 105 F; Test Date: 20211027; Test Name: Body temperature; Result Unstructured Data: 102 F; Test Date: 20211027; Test Name: Body temperature; Result Unstructured Data: 103 F
CDC Split Type: USJNJFOC20211055237

Write-up: SWEATING; CHILLS; HEADACHE; FEVER; CHEST PAIN; LITTLE DIZZY, BUT NOTHING TOO CRAZY; BODY ACHES; This spontaneous report received from a patient concerned a 50 year old male. The patient''s weight was 188 pounds, and height was 68 inches. The patient''s concurrent conditions included: disabled veteran (multiple chronic conditions), penicillin allergy, sulfa allergy, bee sting allergy, non smoker, and non alcoholic, and other pre-existing medical conditions included: Patient had no drug abuse and illicit drug use. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 042A21A, expiry: 19-SEP-2022) dose was not reported, administered on 26-OCT-2021 14:30 for prophylactic vaccination. No concomitant medications were reported. On 26-OCT-2021, the patient experienced chest pain. On 26-OCT-2021, the patient experienced little dizzy, but nothing too crazy. On 26-OCT-2021, the patient experienced body aches. On 26-OCT-2021, the patient experienced chills. On 26-OCT-2021, the patient experienced headache. On 26-OCT-2021, the patient experienced fever. On 27-OCT-2021, the patient experienced sweating. Laboratory data included: Body temperature (NR: not provided) 105 F, 103 F, 102 F. Treatment medications included: paracetamol. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from chest pain, and little dizzy, but nothing too crazy on 26-OCT-2021, had not recovered from body aches, headache, and fever, and the outcome of chills and sweating was not reported. This report was non-serious.


VAERS ID: 1827910 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-25
Onset:2021-10-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025D21A / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Fatigue, Headache, Injection site erythema, Injection site warmth, Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Metformin, HCTZ, olmestran, slow Fe, vitamins D3 and B12, sertraline, rovustatin, Prilosec, magnesium, fenofibrate, ASA 81mg
Current Illness: None
Preexisting Conditions: Diabetes, iron deficiency anemia, hypertension, hyperlipidemia,
Allergies: NKA
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Fatigue, fever to 101.3, headache, chills, back rash, red warm injection site. Fever present 10/26, 10/27. Back rash developed 10/27 pm, arm redness and warmth and back rash continuing 10/29


VAERS ID: 1828452 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-10-26
Onset:2021-10-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Injection site pain, Movement disorder, Pain, Pain in extremity, Peripheral swelling
SMQs:, Cardiac failure (broad), Angioedema (broad), Akathisia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Daily vitamins
Current Illness: None
Preexisting Conditions: None
Allergies: Allergic reaction to stadol and Zyrtec
Diagnostic Lab Data: None yet. Going to the dr today
CDC Split Type:

Write-up: Joint pain that lasted for a few days but has resulted in the swelling in my right hand and inability to extend my fingers, clench my fist it close my fingers, and palm pain. This worsens at night. Extension of my fingers is the greatest concern, inability to hold objects or open doors. This started the night of the vaccine, the same time when my injection site started to ache. I felt pain in most joints, but the right hand got worse each day since the vaccine.


VAERS ID: 1828570 (history)  
Form: Version 2.0  
Age: 92.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-11
Onset:2021-10-26
   Days after vaccination:229
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA UNKNOWN / 2 UN / 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, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: breakthrough COVID-19 case


VAERS ID: 1828613 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-10-26
Onset:2021-10-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest discomfort, Erythema, Nausea, Pruritus, Throat irritation
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Patient was administered the COVID-19 vaccine. Within a few minutes she began to experience pruritus, her throat itching, mild chest tightness, nausea. There are no visible hives, lungs were clear, no angioedema of the oral mucosa and blood pressure was 122/78. Patient denied any throat swelling or difficulty breathing. Patient was talking comfortably. She just kept itching her skin and then the skin would become slightly red. She reported having an allergic reaction to the flu vaccine that required an EpiPen injection. She also has a history of chronic idiopathic urticaria. She takes Zyrtec daily. Administered Benadryl 50 mg orally Administered Solu-Medrol 40 mg IM Patient symptoms remain stable Patient was escorted to the ED for further observation and management.


VAERS ID: 1828616 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-10-25
Onset:2021-10-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / SC

Administered by: Private       Purchased by: ?
Symptoms: Bell's palsy
SMQs:, Hearing impairment (broad)

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

Write-up: Bell''s Palsy


VAERS ID: 1828620 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-10-25
Onset:2021-10-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Hypoaesthesia, Sleep disorder
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Sexual dysfunction (broad)

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

Write-up: Patient is a 17-year-old young lady who was previously healthy. She had COVID at the very beginning of the pandemic. She was immunized with Pfizer on 10/25/2021 and then about 24 hours later she woke up with some right-sided facial numbness. This increased and she developed some weakness as well, she came to the ED but she was referred back to her PMD. She has no fever she has no other symptoms.


VAERS ID: 1828649 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-10-23
Onset:2021-10-26
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017F21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Interchange of vaccine products, Menstruation delayed
SMQs:, Fertility disorders (broad), 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: None
Current Illness: None.
Preexisting Conditions: None
Allergies: Penicillin, sulpha, latex, sunflower seeds & byproducts, banana, kiwi, avocado, papaya, mango, pineapple
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: My post moderna booster symptom was a delay in menstrual cycle by at least three days and a lighter than usual flow when it finally began. My cycle is very predictable and I am not currently sexually active so there was no chance of pregnancy. I got the moderna booster two days before I was supposed to start my period. I got the j&j vaccine 4/7/21 and did not experience a delay in my menstrual cycle post-vaccine.


VAERS ID: 1828669 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-10-25
Onset:2021-10-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / 2 LA / -

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Back pain, Chills, Confusional state, Lymph node pain, Lymphadenopathy, Neck pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: fever, chills, upper back pain, pain in shoulder and neck, underarm swollen/painful, confusion


VAERS ID: 1828670 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Male  
Location: Maine  
Vaccinated:2021-03-13
Onset:2021-10-26
   Days after vaccination:227
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006N20A / 1 - / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040A21A / 2 - / SYR

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

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

Write-up: Second dose of vaccine was given on 3-13-21, patient started having symptoms of cough and fainting spell on 10-27-21, patient was admitted through ED for one day on 10-27-21, discharged on 10-28-21, unsure if any labs were done or if any imaging was done. Unknown if patient has recovered fully.


VAERS ID: 1828688 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-25
Onset:2021-10-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8028 / 1 RA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin C, Vitamin D3-K2, Nexium, Miralax, Zofran 8mg , Wellbutrin 150mg, aspirin 81mg, prenatal
Current Illness: Head/chest cold in early October. Covid test was negative.
Preexisting Conditions: Asthma, High blood pressure, PTSD, BMI 51
Allergies: Egg, pork, penicillin.
Diagnostic Lab Data:
CDC Split Type:

Write-up: 3rd pregnancy, 2/10/22 due date. Muscle aches, nausea and stomach pain for 4 days.


VAERS ID: 1828734 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-10-26
Onset:2021-10-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017F21A / 3 LA / IM

Administered by: School       Purchased by: ?
Symptoms: Inappropriate schedule of product administration
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: Booster dose given 5 months after dose 2.


VAERS ID: 1828765 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: New York  
Vaccinated:2021-10-25
Onset:2021-10-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2593 / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test abnormal, Platelet count decreased
SMQs:, Haematopoietic thrombocytopenia (narrow), Systemic lupus erythematosus (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Pfizer.
Other Medications: Anastrozole; Lupron; Zometa.
Current Illness: N/A
Preexisting Conditions: Low platelets.
Allergies: N/A
Diagnostic Lab Data: Blood work.
CDC Split Type: vsafe

Write-up: I went to check to see if my low platelets had dropped. I went to get blood work, it confirmed that it had. I got medicine for it.


VAERS ID: 1828766 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-10-26
Onset:2021-10-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Asthenia, Chills, Pain
SMQs:, Guillain-Barre 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: MS
Preexisting Conditions: Ms
Allergies: Sulfa
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Severe chills, ache, weakness for 12 hours


VAERS ID: 1828785 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-09-20
Onset:2021-10-26
   Days after vaccination:36
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8735 / 3 LA / SYR

Administered by: Military       Purchased by: ?
Symptoms: Blood test, Chest X-ray, Computerised tomogram, Condition aggravated, Drainage, Pneumothorax, Pulmonary calcification, SARS-CoV-2 test negative, X-ray abnormal
SMQs:, COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Eliquis, 2 other medications, vitamin D3, vitamin B12, anti acid
Current Illness: None
Preexisting Conditions: COPD, emphysema, Asthma, bull eye in my lungs, congestive heart failure, A flutter
Allergies: None
Diagnostic Lab Data: 2 CT scans- I do not have the results 6 x-rays- first x-ray showed I had pneumothorax and bull eye. blood tests- I do not have the results Covid test- negative
CDC Split Type: vsafe

Write-up: The bull eye exploded. It collapsed my lower left lobe of my lung. I went to the ER. They stuck in a drainage tube. They inflated my lung by taking out the fluid. I was in the hospital for 3 days. They did 2 CT scans, 6 x-rays, blood tests, Covid test. The first x-ray showed I had pneumothorax and bull eye.


VAERS ID: 1828790 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-10-26
Onset:2021-10-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017F21A / 3 LA / IM
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME) / UNKNOWN MANUFACTURER SHINGRIX / 1 AR / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Contusion, Fatigue, Hypersomnia
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Depression (excl suicide and self injury) (broad)

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

Write-up: Pt got extremely tired that evening, states she slept for 13 hours, also had large bruise on left arm, which is subsiding, pt feels better


VAERS ID: 1828805 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-10-26
Onset:2021-10-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026021A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Injection site erythema, Injection site pruritus, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (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: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Pt. states that after receiving the 3rd Booster of Moderna 10/26/2021, started experiencing symptoms that evening of itchiness at the injection site, warm to the touch, and fatigue. No noted Primary visit/communications. Still experiencing symptoms of redness (5in x 4in) at the injection site.


VAERS ID: 1828822 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-10-26
Onset:2021-10-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2593 / 2 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Fatigue, Pain, Somnolence
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (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: Depo shot
Current Illness: No
Preexisting Conditions: No
Allergies: No
Diagnostic Lab Data:
CDC Split Type:

Write-up: Extreme body aches over the course of three days treated with ibuprofen, hot baths, and heating pads. Chills, lasting two days. Fatigue over the course of three days, increased intake of caffeine to stay awake.


VAERS ID: 1828830 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-10-25
Onset:2021-10-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039C21A / 3 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Burning sensation, Clumsiness, Confusional state, Dizziness, Fatigue, Swelling, Tenderness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Vestibular disorders (broad), Arthritis (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Levetiracetam 1400 mg a day carbedidol isosorbide mon er30 2 x per day lisinapril 2.5 daily medium 1 x daily junevia metformin 500 mg baclofen 10 mg 3 x aday b-12 vit e zinc
Current Illness: None
Preexisting Conditions: Dystonia heart anomaly diabetes
Allergies: Latex tape erothromiacin augmenton
Diagnostic Lab Data:
CDC Split Type:

Write-up: Burning fatigue swelling clumsiness dizzy sore to touch 4 days later aching in every joint confusion


VAERS ID: 1828837 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-10-25
Onset:2021-10-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037F21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Computerised tomogram head, Diarrhoea, Discomfort, Disorientation, Fatigue, Full blood count normal, Headache, Nausea, Speech disorder, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Pseudomembranous colitis (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: AFTER 2ND MODERNA COVID VACCINATION - 1 DAY OF HEADACHE AND NAUSEA
Other Medications: ATENOLOL, CRESTOR, PAXIL, OMEPRAZOLE
Current Illness: NONE
Preexisting Conditions: OSTEOPOROSIS, GIRD
Allergies: PENICILLIN, DEMOROL, SULFA DRUGS
Diagnostic Lab Data: COMPLETE BLOOD PANEL AND HEAD CT SCAN. ALL NORMAL - ALL AT THE HOSPITAL EMERGENCY ROOM ON 10/26
CDC Split Type:

Write-up: ON THE MORNING OF 10/26 I EXPERIENCED SEVERE HEADACHE, NAUSEA, VOMITING, DIARRHEA, VERY DISORIENTED INCLUDING LOSING THE ABILITY TO SPEAK COHERENTLY AFTER ABOUT 5 HOURS. I WENT TO THE EMERGENCY ROOM AT 5:00 PM AT THE ADVICE OF MY PRIMARY PHYSICAN. MY HUSBAND ACCOMPANIED ME AND WAS ABLE TO SPEAK TO THE DOCTORS AND NURSES ABOUT MY SYMPTOMS, ETC. I WAS AT THE HOSPITAL FROM 5:00 PM UNTIL 10:30 PM OR SO. I WAS FEELING SOMEWHAT BETTER - ABLE TO SPEAK CLEARLY BUT WAS STILL VERY UNCOMFORTABLE - PARTICULARLY HEADACHE AND NAUSEA. THEY ADMINISTERED A BAG OF SALINE AND INFUSION OF ANTI-NAUSEA AND HEADACHE MEDICATION BEFORE DISCHARGE. I STILL FELT VERY FATIGUED WITH A HEADACHE FOR THE NEXT 2 DAYS (WEDNESDAY & THURSDAY) BUT FEEL MUCH BETTER TODAY (10/29)


VAERS ID: 1828841 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-10-25
Onset:2021-10-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939903 / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Discomfort, Erythema, Feeling hot, Injection site erythema, Injection site swelling, Lymphadenopathy, Pain, Peripheral swelling, Pruritus, Sensitive skin, Skin warm
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), 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: 3/4/2021 Covid 19 shot #2 Moderna
Other Medications: warfarin, metoprolol, lisinopril, low dose aspirin, levothyroxine, multi vitamins
Current Illness: none
Preexisting Conditions: atrial fibrillation
Allergies: strawberries
Diagnostic Lab Data: none
CDC Split Type:

Write-up: redness and swelling in the area of the injection, increasing heat and pain, glands swollen under arm of injection arm on day 2, Day 3 redness spread further away from the injection site and increased in redness, upper arm became very itchy and sensitive to touch, day 4 arm became swollen down to below the elbow and biceps area, applied cold compress to relieve discomfort. Researched and day 5 took one antihistamine in a.m. and helped with the itchiness, swelling has come down a small bit, still very warm to the touch. Continuing course of cold compress and antihistamine daily.


VAERS ID: 1828872 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: Alaska  
Vaccinated:2021-10-25
Onset:2021-10-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8028 / 2 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Epistaxis, Feeling cold, Feeling of body temperature change, Muscle spasms, Night sweats, Pyrexia
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (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: the first covid shot listed above
Other Medications: Zinc, CoQ10, aspirin, D
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: I woke up the next morning running a fever of 101.2. The fever persisted through the day and into the night. That night I alternately felt chilled and hot. I also had muscle cramping throughout my body predominantly on the backside of my body. This lasted longer than the fever which broke late in the afternoon the next day. The night after the fever broke, I felt chilled but sweated all night. I continued to feel cold despite raising the temperature of my home by 2 degrees, wearing thermal underwear, and a light jacket in addition to my normal attire. I finally started to feel warm again later in the evening, when I started to get nose bleeds. I had three of them that evening, and have had one this morning. It has been several hours since I''ve had any additional effects. So, I think I may have recovered from them.


VAERS ID: 1828920 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-10-26
Onset:2021-10-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Diarrhoea, Fatigue, Nausea, Pain
SMQs:, Acute pancreatitis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)

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

Write-up: body aches, exhaustion, diarrhea - 3 days neusea - 2 days


VAERS ID: 1828939 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Maine  
Vaccinated:2021-10-25
Onset:2021-10-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041C21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Bacterial infection, Cellulitis, Chills, Erythema, Headache, Hyperhidrosis, Hypoaesthesia oral, Oropharyngeal pain, Pain in extremity, Peripheral swelling, Pyrexia
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), 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: I have celiac disease.
Allergies: I am allergic to penicillin and I have celiac disease.
Diagnostic Lab Data: On October 27, 2021, I went to the ER and was treated. No test was ran and the ER doctor concluded that it was cellulitis as well. Dr. prescribe me Cephalexin that is to treat a bacterial infection , Loratadine which is an allergy pill, and Zofram . Today, October 29th, 2021, the nurse at my doctors office called to check on me and I told her about the twitching from the cephalexin so she prescribed me Bactrim instead.
CDC Split Type: vsafe

Write-up: Around 2:00 am on October 26, 2021, I woke up in the middle of the night with a 103 fever, severe pain in my left leg, I was sweating, and had chills, severe headache to wear my head felt numb, and the pain in my left arm where I received the vaccine. I called my doctor on Tuesday, Oct 26, 2021, and describe my symptoms and Dr. told me to take ADVIL and TYLENOL and alternate it every 3 hours. Then Wednesday, October 27, 2021, I still had all of the same symptoms, but my left arm had swelling up like a balloon. My arm was bright red and externally painful, and it looked like my arm was burned all the way down from you shoulder to elbow. I called my doctor again the same day Oct 27th. 2021 and she stated that she thinks that I had cellulitis, so she told me to go into the emergency. I arrived at 11:30 am on Oct 17th, 2021, and was treated by the ER doctor. No test were ran and the ER doctor concluded that it was cellulitis as well. Dr. prescribe me Cephalexin that is to treat a bacterial infection, Loratadine which is an allergy pill, and ZOFRAN. I had an allergic reaction to the sulfur drug, cephalexin. It gave me twitches at night in my legs and arms and I could not sleep. Thursday, Oct 28, 2021, my symptoms were still the same and last night I developed a sore throat, and I called the afterhours health line, and I was told if my symptoms get worst go back to the ER. Today, October 29th, 2021, the nurse at my doctor''s office called to check on me and I told her about the twitching from the cephalexin, so she prescribed me Bactrim instead.


VAERS ID: 1828941 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-10-26
Onset:2021-10-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-29
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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: swollen lymph nodes under both arm pits


VAERS ID: 1828980 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: New York  
Vaccinated:2021-10-25
Onset:2021-10-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Tinnitus
SMQs:, Hearing impairment (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: plavix, ramapril, amlodipine, lithium, welbutrin, lamictal, lipitor, aspirin
Current Illness: none
Preexisting Conditions: heart condition
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: tinnitus


VAERS ID: 1828982 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-01-19
Onset:2021-10-26
   Days after vaccination:280
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3249 / 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: 10/28 SARS/COV-2, NAAT positive
CDC Split Type:

Write-up: Breakthrough COVID


VAERS ID: 1829004 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-01-13
Onset:2021-10-26
   Days after vaccination:286
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK4176 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 10/28/21
CDC Split Type:

Write-up: Breakthrough COVID


VAERS ID: 1829012 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-10-26
Onset:2021-10-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017F21A / 3 LA / -

Administered by: Public       Purchased by: ?
Symptoms: Immediate post-injection reaction, Inflammation, Injection site erythema, Pruritus
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Have redness on the skin about the size of a fist around the injection site. Started about 5 hours after injection and the nurse noticed some inflammation immediately upon injection. Definitely itchiness also. 3 days later still have the redness. Suggestion may be this booster should have been in a different arm than the other two shots?


VAERS ID: 1829015 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: West Virginia  
Vaccinated:2021-10-25
Onset:2021-10-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Cerebrovascular accident
SMQs:, Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient admitted to hospital with stroke after received booster dose of Covid vaccine. Patient received alteplase.


VAERS ID: 1829047 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-10-26
Onset:2021-10-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2590 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dyspnoea exertional
SMQs:, Pulmonary hypertension (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: Lipitor 10mg, Synthroid 112 mcg, Estradiol 25 mg, ASAP 325mg,
Current Illness: none
Preexisting Conditions: Thyroid insufficiency, Heart blockage. History of cancer.
Allergies: IV contrast Severe. Marcaine, Severe
Diagnostic Lab Data: none at this time
CDC Split Type:

Write-up: Shortness of breath with activity.


VAERS ID: 1829058 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-25
Onset:2021-10-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2593 / 3 UN / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood urine present, Chromaturia, Haematuria, Urine analysis
SMQs:, Rhabdomyolysis/myopathy (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (narrow), Tubulointerstitial diseases (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Systemic: Hematuria-Medium, Additional Details: Patient complains of blood in urine the day after receiving booster shot. She says the urine has become darker and brighter each day. Patient is upset and insists that it is caused by the vaccine. She went to her clinic to get a urine analysis and is awaiting results. Patient says she did not experience this after the first and second Pfizer dose. She says she does not have any side effects around the injection site.


VAERS ID: 1829088 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-10-25
Onset:2021-10-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3540 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Sensory disturbance
SMQs:, Peripheral neuropathy (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (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: Azithromycin
Diagnostic Lab Data: No tests done yet since this has only been occurring in the last 4 evenings (since the 2nd Pfizer shot)
CDC Split Type:

Write-up: The last 4 nights since I received the 2ndPfizer vaccine. I have woken up early in the morning with weird sensations in my body. My leg muscles feel like they are moving, even though they are not. My heart feels like it''s racing- but when I check my heart rate on my fitness watch- it is normal.


VAERS ID: 1829109 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-10-22
Onset:2021-10-26
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301558A / 1 LA / IM

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

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

Write-up: Site: Bruising at Injection Site-Mild, Site: Itching at Injection Site-Medium, Site: Pain at Injection Site-Mild, Site: Redness at Injection Site-Mild, Site: Swelling at Injection Site-Medium


VAERS ID: 1829137 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-08-25
Onset:2021-10-26
   Days after vaccination:62
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Back pain
SMQs:, Retroperitoneal fibrosis (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: I take albubutrin 150mg once a day I also centrum 88mcgs once a day
Current Illness: none
Preexisting Conditions: none
Allergies: Amoxicillin
Diagnostic Lab Data: none
CDC Split Type: vsafe

Write-up: I had a lower back pain. It was hurting while I sat or when I was standing. I was having a hard time at work. The doctor had told me that she had the same side effects from the boster. I didnt go to work yesterday or today. I was given a muscle relaxer cyclobenendaprine once a nigh and a prescription strength ibuprofen. i apply ice and heat. it has improved from yesterday but not 100 percent.


VAERS ID: 1829149 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-03-25
Onset:2021-10-26
   Days after vaccination:215
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017B21A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007C21A / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Cough, Nasal congestion, Pain, Pyrexia, Respiratory tract congestion, Sinus congestion, Sneezing, Upper-airway cough syndrome
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Calcium Citrate + D 315-250 MG-UNIT Tablet 1 tablet Orally two times a day Vitamin D 2000 UNIT Capsule 1 capsule Orally Once a day Atenolol 25 MG Tablet 0.5 tablet Orally two times a day Simvastatin 40 MG Tablet 1 tablet in the eve
Current Illness: none
Preexisting Conditions: COPD. Hyperlipidemia. Hypertension. impaired fasting glucose with syndrome X.
Allergies: thimerosal
Diagnostic Lab Data:
CDC Split Type:

Write-up: fever-low grade temp of 99.4, sneezing, congestion, runny nose, nonproductive cough, body aches, sinus congestion, nasal congestion, post nasal drainage starting on 10/26/21


VAERS ID: 1829174 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-10-25
Onset:2021-10-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blindness, Influenza like illness, Laboratory test, Vision blurred
SMQs:, Anticholinergic syndrome (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: I visited my optometrist and she ran several tests and found no abnormalities, other then loss of vision.
CDC Split Type:

Write-up: I have blurred vision that started the morning after my vaccine. I also experienced flu like symptoms, but those went away after ~48hrs. The blurred vision still persists.


VAERS ID: 1829177 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-26
Onset:2021-10-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 3 LA / IM

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

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

Write-up: On Tuesday October 26, 2021 client was given 0.25ml of the Pfizer vaccine. Proper dosage is 0.3ml. No adverse outcomes. No further treatment needed per CDC guidelines.


VAERS ID: 1829188 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-10-25
Onset:2021-10-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011F21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Diarrhoea, Fatigue, Myalgia, Rash, Skin warm
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Arthritis (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Losartan 25mg., Miralax, Estrate Cream .1mg, Fluticasone 50mg, Cetirigine 10mg. stool softner, fiber tablet
Current Illness: Arthritis flare up in the right knee
Preexisting Conditions: Arthritis, IBS w/ constipation
Allergies: Sulfa, Gluten
Diagnostic Lab Data: no
CDC Split Type: vsafe

Write-up: Later that night after the vaccine my muscles got very sore sore, my joints hurt, I had diarreah for about 2 hours and was just really tired and fatigued which all lasted about 24hrs and all symptoms subsided. About 11hrs after I developed a rash about 6" long and 3" wide on the back of my right leg below my knee right above the calf which was hot to touch which lasted about 3 days and finally went away. I went to the Urgent Care to have it checked. The Dr. prescribed a steroid and some antibiotics but because I was advised it may interferer with the vaccine I didn''t take them.


VAERS ID: 1829192 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-26
Onset:2021-10-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 3 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: No adverse event, Underdose
SMQs:, Medication errors (broad)

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

Write-up: On Tuesday October 26, 2021 client was given 0.25ml of the Pfizer vaccine. Proper dosage is 0.3ml. No adverse outcomes. No further treatment needed per CDC guidelines.


VAERS ID: 1829200 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: California  
Vaccinated:2021-10-26
Onset:2021-10-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 3 LA / IM

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

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

Write-up: On Tuesday October 26, 2021 client was given 0.25ml of the Pfizer vaccine. Proper dosage is 0.3ml. Spoke with client on October 29, 2021. Verbalized understanding of the event. No adverse outcomes. No further treatment needed per CDC guidelines.


VAERS ID: 1829201 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-10-25
Onset:2021-10-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 091D21A / 3 LA / IM

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

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: Lethargy.
Other Medications: Tylenol 500mg (as needed for pain); Multivitamin; Vitamin D3
Current Illness: None
Preexisting Conditions: Hypothyroidism
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Upon waking the morning after vaccination, patient discovered the injection site was raised about 1.5 inches, red, and warm to the touch within a four inch diameter surrounding deltoid. The exact injection site had a "white dot." The area has slowly started to return to normal but is still somewhat raised, red, and warm to the touch (4 days post injection). Patient also experienced muscle aches and chills throughout entire body for 24 hours. Patient experienced a low-grade fever (Max: 99 degrees) during the morning of 10/26/2021, resolved by afternoon.


VAERS ID: 1829220 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-31
Onset:2021-10-26
   Days after vaccination:209
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027B21A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007C21A / 2 LA / IM

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

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

Write-up: breakthrough case


VAERS ID: 1829221 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-10-26
Onset:2021-10-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 076C21A / 3 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Haematoma, Pain, Pain in extremity
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: vitamin D, baby aspirin, Lasix, crestor, warfarin, multi-vitamin & a medication for mucous
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: Unknown
Diagnostic Lab Data: Patient went to visit his family physician on 10/28/2021 & was told that the pain in his hand was due to a hematoma
CDC Split Type:

Write-up: Patient c/o pain to his right hand from the wrist down that he said started around 11am and worsened around 12:30pm or 1pm. Patient denied having any swelling, pain, numbness, tingling or discoloration at the injection site or to his right hand. Patient denied pain up his right arm and no chest pain, Patient said that it was only his right hand that felt pain when he tried to close his hand to make a fist.


VAERS ID: 1829255 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-10-26
Onset:2021-10-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017F21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Dizziness, Fatigue, Headache, Injection site erythema, Injection site pain, Lethargy, Pain
SMQs:, Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Vestibular 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Site: Pain at Injection Site-Medium, Site: Redness at Injection Site-Medium, Systemic: Body Aches Generalized-Severe, Systemic: Chills-Medium, Systemic: Dizziness / Lightheadness-Medium, Systemic: Exhaustion / Lethargy-Medium, Systemic: Headache-Medium


VAERS ID: 1829258 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-03-05
Onset:2021-10-26
   Days after vaccination:235
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA UNKNOWN / 2 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Albumin globulin ratio, Blood bicarbonate decreased, Blood bilirubin increased, Blood creatine phosphokinase increased, Blood glucose increased, COVID-19, Cough, Diabetic ketoacidosis, Dyspnoea, Electrocardiogram ST segment elevation, Electrocardiogram ST-T change, Hyperbilirubinaemia, Intensive care, Kussmaul respiration, Lipase increased, Myalgia, Rhabdomyolysis, SARS-CoV-2 test positive, Tachycardia
SMQs:, Rhabdomyolysis/myopathy (narrow), Liver related investigations, signs and symptoms (narrow), Cholestasis and jaundice of hepatic origin (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Lactic acidosis (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Myocardial infarction (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Biliary system related investigations, signs and symptoms (narrow), Biliary tract disorders (narrow), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: liver function test abnormality hypertension hyperlipidemia vitamin D deficiency Type 2 diabetes
Allergies: NKA
Diagnostic Lab Data: In ER he was noted to have Kussmaul breathing, was tachycardic with HR 130s. Glucose 294, AG 21, Bicarb 9.0. Lipase elevated at 449, T bili 3.1, CK 1342. Sinus rhythm with a rate of 129. There is no acute ST segment elevation or depression noted. Nonspecific ST wave changes noted otherwise. There is discordant ST elevation noted in leads V1 to V3. This is seen on previous study. There is no ST depression. Nonspecific ST wave changes noted otherwise.
CDC Split Type:

Write-up: patient tested COVID + on 10/26/2021 despite being fully vaccinated. He presented to the ED on the same day with cough and shortness of breath increasing for 3 days. Denied chest pain. Endorses mild myalgias. Tachycardic with heart rate in the 130s. Admitted to the ICU for supportive care for diabetic ketoacidosis, rhabdomylysis and hyperbilirubinemia. (not b/c of COVID it seems)


VAERS ID: 1829291 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Nebraska  
Vaccinated:2021-10-25
Onset:2021-10-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2593 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Cold sweat, Confusional state, Fatigue, Headache, Loss of personal independence in daily activities, Vision blurred
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Hypoglycaemia (broad)

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

Write-up: Headache. Chills / Cold Sweats. Extreme fatigue. Confusion. Unable to perform basic tasks due to the confusion. Blurred vision at times.


VAERS ID: 1829297 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: New York  
Vaccinated:2021-10-25
Onset:2021-10-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Back pain, Chills, Fatigue, Headache, Influenza like illness, Muscular weakness, Nausea, Neck pain, Pain, Pyrexia, Vertigo
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Usual: simvastatin, Vit D, 81 mg aspirin, sambucus, quill CoQ10
Current Illness: None
Preexisting Conditions: None that I know of at this time . But in past had: pulmonary embolism around yr 2000, total knee replacement 2013, had TIA 2006
Allergies: Penicillin codeine
Diagnostic Lab Data: Physical done 10/29/2021. No explanation for vertigo
CDC Split Type:

Write-up: Severe body aches, especially low back pain and neck pain; legs especially both knees felt very weak; fever 99+; bad chills; mild nausea; very tired; felt like I had flu ( but I received flu shot at end of September 2021. All these symptoms were on 10/26/2021. Wednesday 10/27/2021 felt 100%better; no symptoms except mild headache and mild low backache. Thursday 10/28/2021 at 3:00AM went to get up to go to BR and had extreme vertigo. Finally fell back to sleep and woke up at 9:45AM and had bad vertigo that continues today1029/2021. Called Dr 10/28/2021. Prescribed Meclizine 25 mg/ 1 tab every 6 hrs. After taking 3 doses as directed, was then seen by Dr On 10/29/2021. Suggested I file reaction to site


VAERS ID: 1829305 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-10-23
Onset:2021-10-26
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017F21A / 3 LA / IM

Administered by: Unknown       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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Yes
Current Illness:
Preexisting Conditions: Thyroid
Allergies:
Diagnostic Lab Data:
CDC Split Type: vsafe

Write-up: I experienced a swollen lymph node under my left arm after being vaccinated.


VAERS ID: 1829310 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-10-25
Onset:2021-10-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017F21A / 3 LA / SYR
FLU4: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE QUADRIVALENT) / SANOFI PASTEUR - / 1 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Erythema, Joint swelling, Pain
SMQs:, Anaphylactic reaction (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Anastrozole; hydrochlorothiazide; losartan; levothyroxine; simvastatin; CENTRUM SILVER OVER 50; tart cherry extract; cinnamon tablets; Pancrelise Bitalise; Hapatolise
Current Illness: None
Preexisting Conditions: High Blood pressure but being managed
Allergies: Tape
Diagnostic Lab Data: Prescribed antibiotic in case it didn''t go away.
CDC Split Type: vsafe

Write-up: less than 24 hours later arm was red, sore, no fever, by Tuesday evening redness got brighter and swollen above elbow, bottom outer area where shot was.


VAERS ID: 1829318 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-10-22
Onset:2021-10-26
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012F21A / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Pain in extremity, Peripheral swelling, Ultrasound scan abnormal, Venous injury
SMQs:, Cardiac failure (broad), Angioedema (broad), Malignancy related therapeutic and diagnostic procedures (narrow), Accidents and injuries (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Nasalcort, B12, D, E, low dose aspirin
Current Illness: none
Preexisting Conditions: hay fever
Allergies: sulfas, penicillin, aspirin
Diagnostic Lab Data: Ultrasound of right calf and leg Oct. 28, 2021 - result is Right popliteal vein noncompressible and contained echogenic material with no blood flow. The common femoral, profundus femoris, an femoral veins are patent and compressible. The peroneal veins do not compress well. The anterior and posterior tibial veins compress and show color flow.
CDC Split Type:

Write-up: October 27 pain in leg noticed in afternoon October 28 pain worse -- went to ER at 2:00 AM - leg swollen, pain


VAERS ID: 1829333 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-10-26
Onset:2021-10-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017F21A / 3 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Asthenia, Fall, Fatigue
SMQs:, Guillain-Barre syndrome (broad), Accidents and injuries (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: REACTION TO SHOT- EXTREMELY WEAK, FATIGUE, FELL TO THE FLOOR- CALLED AMBULANCE NO TRANSPORT


VAERS ID: 1829356 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-10-23
Onset:2021-10-26
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / SYR
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / 1 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Blood test, Cardiac flutter, Electrocardiogram, Lymphadenopathy, Palpitations
SMQs:, Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Cardiomyopathy (broad), Tachyarrhythmia terms, nonspecific (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: Liothyroine, Synthnoid, Metformin ER, Emercen-C, Elderberry, Pepcid -?AC
Current Illness:
Preexisting Conditions: Diabetes, Hypothyroidism (surgically removed) , PCOS
Allergies: Codine, Penicillin, Mango
Diagnostic Lab Data: Waiting on EKG and bloodwork
CDC Split Type:

Write-up: I have fluttering and palpitations in my chest. I went to the doctor and they noticed swollen lymph nodes under my arm and I am awaiting EKG results


VAERS ID: 1829374 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: New York  
Vaccinated:2021-10-26
Onset:2021-10-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2590 / 1 LA / UN

Administered by: Pharmacy       Purchased by: ?
Symptoms: Erythema, Inflammation, Mastitis, Maternal exposure during breast feeding, Tenderness
SMQs:, Anaphylactic reaction (broad), Functional lactation disorders (narrow), Neonatal exposures via breast milk (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prenatal vitamins, Zyrtec 10mg
Current Illness: None
Preexisting Conditions: Endometriosis
Allergies: Penicillin
Diagnostic Lab Data: Visited Family Practice on October 29, 2021 and was diagnosed with Mastitis.
CDC Split Type:

Write-up: Symptoms of Mastitis started showing in right breast roughly 18 hours after vaccination. Symptoms included red, tender spot on right breast with an inflamed vein going up the breast. I stopped breastfeeding mid-August 2021.


VAERS ID: 1829394 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: California  
Vaccinated:2021-10-25
Onset:2021-10-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 2 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Fall, Injury, Pain in extremity, Tooth fracture, Tooth injury
SMQs:, Anticholinergic syndrome (broad), Accidents and injuries (narrow), Hostility/aggression (broad), Vestibular disorders (broad), Tendinopathies and ligament 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? No
Hospitalized? No
Previous Vaccinations: per patient, he has not felt well following previous influenza vaccinations
Other Medications: on file as the patient has already submitted his own adverse reaction report
Current Illness: on file as patient has already submitted his own adverse reaction report
Preexisting Conditions: on file as patient has already submitted his own adverse reaction report
Allergies: No medication allergies; allergic to dust, pollen etc.
Diagnostic Lab Data: per the report already submitted by patient.
CDC Split Type:

Write-up: Per employee, the patient received his second Pfizer injection at 9:30AM on 1025/21. On 10/26/21, he experienced the usual arm soreness but at approximately 11:15PM, he experienced extreme dizziness causing him to fall and hit his chin on the floor requiring multiple stitches to the chin and a dental appointment for a chipped tooth. Patient has already submitted his own report to VAERS (discussed the event with him on 10/29/21).


VAERS ID: 1829438 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-10-26
Onset:2021-10-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 076C21A / 3 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 308523 / 1 RA / IM

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

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

Write-up: patient received 0.5mL for Moderna booster - should have been 0.25mL.


VAERS ID: 1829453 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-10-26
Onset:2021-10-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dyspnoea
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (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: Pfizer second dose, had difficulty breathing went to the E.R. and was given medications which resolved my breathing issues.
Other Medications: Viibryd, sonata, prozac, multivitamin
Current Illness: None
Preexisting Conditions: DM 2, asthma, Ehlers-Danlos syndrome
Allergies: Eggs
Diagnostic Lab Data: None
CDC Split Type:

Write-up: After receiving the shot, within 15 minutes I began having difficulty breathing. A doctor was called and after examining me prescribed an epi-pen. After the injection I was able to breathe normally.


VAERS ID: 1829478 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-10-25
Onset:2021-10-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 13203080 / UNK RA / IM
UNK: VACCINE NOT SPECIFIED (OTHER) / UNKNOWN MANUFACTURER INFLUENZA (QUAD / UNK LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Dizziness, Ear pain, Fatigue, Feeling abnormal, Injection site pain, Myalgia, Nasal congestion, Nausea, Oropharyngeal pain, Pyrexia, Sleep disorder
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Mild dizziness/nausea that went away in a few hours after second dose of Pfizer on April 10
Other Medications: Metformin ER 500mg 24 hr tabs (2/day in AM) Atorvastatin 80mg (1/day in PM) Bupropion SR 150mg (2/day - 1 in AM and 1 in PM - 12 hrs apart) Bayer Low Dose Aspirin 81mg (1/day in AM)
Current Illness: None known
Preexisting Conditions: Type 2 Diabetes Cardiac Disease Recently quit smoking (2.5 months ago)
Allergies: Cosmetics and fingernail polish - facial swelling and rashes
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Monday night, sore arm at injection site that kept me up all night anytime I turned the pain woke me up., Tuesday morning around 10 am - Started with stuffy clogged nose and dizziness, spacey feeling, then sore throat, then ear ache. Muscle and joint aches, fatigue quickly followed. Nauseas, Low grade fever 99.5 degrees. In about an hour after the first symptom was completely miserable - I felt really bad. Went to bed and stayed there until Wednesday morning. Feeling a little better. By Wednesday late afternoon felt normal again. Injection site still hurts as of today, Friday. This was my Booster - dose #3. Way worse & different side effects than my second shot.


VAERS ID: 1829483 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-26
Onset:2021-10-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Gait inability, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Hypoglycaemia (broad)

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

Write-up: She said after receiving she became weak and shaky unable to walk. ED visit. Today feeling much better still has some weakness, but back to normal activities.


VAERS ID: 1829494 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-10-26
Onset:2021-10-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 076C21A / 3 LA / SYR

Administered by: Senior Living       Purchased by: ?
Symptoms: Aphonia, Asthenia, Extra dose administered, Fatigue, Headache, Pruritus, Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Hypersensitivity (narrow), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: COVID Moderna Dose 1 (1-7-2021) - and Dose 2 (2-4-2021) (along with Dose 3 as well) - each time of the vaccine I have lost my vo
Other Medications: Allegra allergy medicine
Current Illness: no
Preexisting Conditions: no
Allergies: coconut
Diagnostic Lab Data: vitals - only
CDC Split Type: vsafe

Write-up: At 07:00 pm, I started to get a rash over 75% of my body. I took two Benadryl. Four hours later, the rash was still persistent and I took two more Benadryl. The next day my rash was gone but I was itchy. I lost my voice at 10:00 at night for 24 hours. The doctor said there was not anything they could do for me since it would mess with the vaccine. He said I could take Benadryl once a day. At 10:00 am on the 27th, I became so weak that I couldn''t even lift 3lbs and I went to the doctor - the clinic at the hospital - to see if anything was wrong. Again, they said there was nothing they could do and just to rest. They had checked to see if my breathing was okay and all my vitals seemed normal enough for me to go home. They said if anything happened to come back. I also spiked a fever at 08:00 pm at night and when I woke up that next morning (28th) it was gone. By the time the fever spiked, I wasn''t feeling the itchiness anymore that I had been feeling. I was feeling weak but was able to keep going that day to go work. This morning, I just had a mild tiredness and I had a little bit of headache but other than that I''m fine for the most part today. I had the flu shot prior to this - the 14th of October, 2021. At place of employment. Injection in left arm. I don''t know the brand name of it. I had a sore left arm after that vaccine for about 24 hours.


VAERS ID: 1829510 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-10-24
Onset:2021-10-26
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -
FLU4: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE QUADRIVALENT) / SANOFI PASTEUR - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Carbon dioxide increased, Cough, Endotracheal intubation, Fall, Pneumonia, Pulmonary congestion, SARS-CoV-2 test negative, Urine analysis normal
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Eosinophilic pneumonia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), COVID-19 (broad)

Life Threatening? Yes
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: Simvastatin & lisinopril.
Current Illness: None
Preexisting Conditions: Myotonic Dystrophy type 2 (DM2).
Allergies: None known
Diagnostic Lab Data: Pneumonia (left lung) and COVID-Negative. No Fever. Other tests were run (UTI check) with no positive results reported to me.
CDC Split Type:

Write-up: on 10/27/21 My mother had fallen and while helping her up she had heavy chest congestion, was very weak and bad cough. I called 911 and ambulance took her to Hospital emergency. Hospital confirmed normal temperature, Pneumonia (left lung) and COVID-Negative. While on O2 and IV my mothers CO2 climbed very high and she had to be intubated today at 1:30PM.


VAERS ID: 1829517 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-10-25
Onset:2021-10-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 058F21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Feeling abnormal, Palpitations, SARS-CoV-2 test negative
SMQs:, Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Cardiomyopathy (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: not aware
Current Illness: Had Covid in August
Preexisting Conditions: Complained of chest tightness - prior to first shot and after first shot. Patient had Covid In August 2021, had first Moderna shot: 9/20/2021. She went to Urgent care on 10/27/2021. they tested for Covid and came back Negative.
Allergies: No Known Allergies
Diagnostic Lab Data: - Tested NEGATIVE for Covid
CDC Split Type:

Write-up: 10/25/2021 had 2nd Moderna shot. 10/26/2021 patient complained of palpitations that evening. 10/27/2021 patient stated she felt better. 10/28/2021 -Patient stated took a long walk and didnt feel good so went to Urgent Care. -She tested -NEGATIVE- for Covid at urgent care. -she said they did several tests and mentioned it was idiopathic and it was to much to say over the phone. But, she would follow up with her doctor. -I spoke with her at 2pm and she was home and would schedule an appointment with her doctor


VAERS ID: 1829523 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-10-23
Onset:2021-10-26
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012F21A / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: patient was on course of bactrim
Current Illness: some kind of bacterial infection
Preexisting Conditions: unknown
Allergies: at time of vaccination only levaquin
Diagnostic Lab Data: unknown
CDC Split Type:

Write-up: patient was fine until tuesday night and then developed high fever, ha, nausea, muscle aches. then wednesday she had itching that started at sites other than where the imz was given. i spoke with her and she states that she is on bactrim too which we thought this may be a reaction to the antibiotic. she contacted her dr''s office and they wanted her to come in for an appointment on thursday. she went to appointment on thursday and the provider thought it may be a reaction to the bactrim due to the type of rash but was unsure about the delayed high fever and nausea which could be attributed to the shot.


VAERS ID: 1829532 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-10-25
Onset:2021-10-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA C38C21A / 3 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Electrocardiogram normal, Fatigue, Heart rate increased, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Dehydration (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: 2nd dose of Moderna - 2/2/2021 - Increased heart rate; fever; chest pain. I missed work. Those lasted two days and then I was f
Other Medications: prescription medication - Amdotripolene; Gabapentin; Meloxicam; Birth Control
Current Illness: no
Preexisting Conditions: fibromyalgia; migraines; Raynaud''s
Allergies: penicillin; latex
Diagnostic Lab Data: Wednesday - Family Health Center - EKG - normal sinus rhythm
CDC Split Type: vsafe

Write-up: I had increased heart rate and chest pain. I had fatigue and it was pretty moderate. I had muscle aches. The chest pain and the rapid heart rate, I got an EKG done. I still have the chest pain but it''s gotten less frequent and less intense. Today is the first day that I haven''t the increase heart rate and pretty severe fatigue. I still have some muscles aches - they are mild now. No treatment. Mostly recovered. Flu shot was received: I think it was the first week in October, 2021. I don''t remember the day. That was in my left deltoid. Received it at a Family Health Center.


VAERS ID: 1829549 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-05-11
Onset:2021-10-26
   Days after vaccination:168
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Blood creatinine increased, Blood urea increased, COVID-19, Chest pain, Cough, Dyspnoea, Fibrin D dimer increased, Hypoxia, Prohormone brain natriuretic peptide increased, SARS-CoV-2 test positive, Troponin
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Cardiac failure (broad), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Haemorrhage laboratory terms (broad), Retroperitoneal fibrosis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Tumour lysis syndrome (broad), 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? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: atorvastatin, magnesium oxide, metoprolol tartrate, omeprazole
Current Illness:
Preexisting Conditions: Chronic left ventricular systolic dysfunction, hypertension, type 2 diabetes mellitus, COPD, Obesity BMI 42.7, congestive heart failure, dyslipidemia, cardiac hypertrophy
Allergies: NKA
Diagnostic Lab Data: 10/29/21 COVID-19 rapid: positive D-dimer: 1.88 Pro-BNP: 738 Troponin, high sensitivity: 46 SCr: 2.19; BUN: 47
CDC Split Type:

Write-up: Patient started having symptoms of cough, shortness of breath, and chest pain 4 days prior to ED presentation. On initial presentation, patient was hypoxic to 84% on room air. He is currently 93% with 15L O2 by nonrebreather. The patient is positive for COVID-19 by rapid test. The patient has been given 6 mg dexamethasone PO and 2 g magnesium sulfate IV. Patient is being admitted to the hospital.


VAERS ID: 1829637 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-10-25
Onset:2021-10-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site haemorrhage, Musculoskeletal stiffness, Neck pain, Pyrexia
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Profuse bleeding from injection site. Sore stiff neck muscles for 4 days Fever after 2 days for 8 hours 100F


VAERS ID: 1829862 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-10-15
Onset:2021-10-26
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Deep vein thrombosis, Ultrasound Doppler abnormal
SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Cardiomyopathy (broad)

Life Threatening? Yes
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: dilaudid
Diagnostic Lab Data: Ultrasound right lower extremity 10/29/2021
CDC Split Type:

Write-up: Right lower extremity DVT


VAERS ID: 1829863 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-10-26
Onset:2021-10-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011F21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site pain, Injection site rash, Injection site swelling, Rash erythematous, Sensitive skin
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: .0375 mg Estrogen patch 100 mg Progesterone
Current Illness: None
Preexisting Conditions: GERD
Allergies: Welbutrin Darvon
Diagnostic Lab Data: None
CDC Split Type:

Write-up: IM injection given at 1 pm on 10/26. Approximately 8 pm sharp pain abruptly began at injection site along with oval red rash, initially 1" in size then enlarged to approximately 3.5" in length. Domed swelling at and around injection site, very sensitive to touch. Swelling and pain gone by 10/28, red rash began to fade on 10/28 and continued fading through 10/29. No fever, nausea, vomiting, aches or other systemic symptoms occurred.


Result pages: prev   1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131 132 133 134 135 136 137 138 139 140 141 142 143 144 145 146 147 148 149 150 151 152 153 154 155 156 157 158 159 160 161 162 163 164 165 166 167 168 169 170 171 172 173 174 175 176 177 178 179 180 181 182 183 184 185 186 187 188 189 190   next

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?EVENTS=ON&PAGENO=91&PERPAGE=100&ESORT=ONSET-DATE&REVERSESORT=ON&VAX=COVID19&DIED=No


Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166