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

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



Case Details (Reverse Sorted by Onset Date)

This is page 93 out of 8,010

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VAERS ID: 1782299 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-02-25
Onset:2021-09-27
   Days after vaccination:214
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9266 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7534 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Chest X-ray abnormal, Computerised tomogram thorax, Depersonalisation/derealisation disorder, Diarrhoea, Dyspnoea, Hypoxia, Lethargy, Lung infiltration, Lung opacity, Mental status changes, Nausea, Oxygen saturation decreased, PO2 decreased, Pyrexia, SARS-CoV-2 test positive, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Asthma/bronchospasm (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Noninfectious diarrhoea (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Tested positive on 9/11/2021 at unknown location
CDC Split Type:

Write-up: Chief Complaint covid + on the 11th, arrived via ems c/o increased lethargy, n/v, and "not acting like himself" per family. recieved monoclonal antibodies at hospital recently. 88%RA - 96%2L History of Present Illness 75-year-old male presents emergency room complaining of shortness of breath fever for the past couple weeks. Patient was diagnosed with COVID on 09/11/2021. He is unsure as to how long he had had symptoms prior to this time. Patient states that he has had nausea vomiting and diarrhea over that period of time. Patient is a very vague historian. I am suspicious that he has some element of dementia but he currently seems oriented to time place and person. He states that he did receive History has been obtained from the emergency room physician that the patient received monoclonal antibody therapy last week. When asked about this the patient did not know what I was talking about but does remember receiving 4 subcutaneous injections in his abdomen which he thinks was at the 1st of the week. The patient''s wife was admitted earlier in the day after a fall. The patient is hypoxic in the emergency room with pulse ox readings of 89% on room air. On ABG the patient has a PO2 of 50 on room air. Patient has a past history of diabetes mellitus type 2, hyperlipidemia, hypertension, BPH. Review of Systems Constitutional: [Patient denies fever, chills, sweats, and weight changes.] Eyes: [Patient denies any visual symptoms] ENT: [No difficulties with hearing. No symptoms of rhinitis or sore throat.] Cardiovascular: [Patient denies any chest pain, palpitations, orthopnea, or PND.] Pulmonary: As in HPI Gastrointestinal: As in HPI GU: [No urinary hesitancy or dribbling. No nocturia or urinary frequency. No abnormal urethral discharge.] Musculoskeletal: [No myalgias or arthralgias. No hot, swollen joints.] Neurologic: [No headaches, no seizures. Patient denies numbness, tingling, or weakness on either side of the body. There are no visual symptoms.] Psychiatric: [Patient denies problems with mood disturbance or anxiety.] Endocrine: [No excessive urination or excessive thirst noted. No heat or cold intolerance. No weight gain or changes in skin or hair.] Dermatologic: [Patient denies any rashes or skin changes.] Physical Exam Vitals & Measurements T: 99.8 ?F (Oral) HR: 68(Peripheral) HR: 74(Monitored) RR: 26 BP: 132/68 SpO2: 93% WT: 81 kg VITAL SIGN LAST CHARTED MINIMUM MAXIMUM Blood Pressure 132/68 (09/27 00:45) 125/76 (09/26 22:45) 149/76 (09/26 22:00) Heart Rate 68 (09/27 00:45) 68 (09/27 00:45) 85 (09/26 20:48) Respirations 26 (09/27 00:45) 20 (09/26 20:48) 27 (09/27 00:00) Temperature 99.8 (09/26 20:48) 99.8 (09/26 20:48) 99.8 (09/26 20:48) SpO2 93 (09/27 00:45) 89 (09/27 00:00) 96 (09/26 21:45) O2 Flow Rate 4 (09/27 00:45) 2 (09/27 00:15) 4 (09/27 00:45) Weight 81 (09/26 20:48) 81 (09/26 20:48) 81 (09/26 20:48) DIAGNOSTIC STUDIES: 1. Multiple chest x-rays showing patchy perihilar left-sided airspace disease. 2. CT angiogram of the chest showing bilateral patchy airspace opacities. HOSPITAL COURSE: A 75-year-old male, primary care patient of Dr., presented to the emergency room with shortness of breath. He actually states he was feeling fine and did not want to come to the ER, but his son insisted and dropped him off. In the ER, he was COVID positive with infiltrates on x-ray and was 89% saturating on room air. He was therefore admitted, was started on supplemental oxygen. He was not given any specific treatments and monitored and did not have any worsening of his oxygenation. He was saturating 93% to 94% on room air at the time of discharge. With ambulation his oxygen saturation went down to 84% and so he did qualify for home oxygen temporarily. It is felt to be stable for discharge home on this. Dexamethasone was withheld due to non-severe disease and his already profound hyperglycemia from diabetes. DISCHARGE DISPOSITION: CONDITION: Stable.


VAERS ID: 1782549 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-09-26
Onset:2021-09-27
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6198 / 3 - / -

Administered by: Private       Purchased by: ?
Symptoms: Hallucination, auditory, Salivary hypersecretion
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Psychosis and psychotic disorders (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (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: Hyzaar Synthroid
Current Illness: none
Preexisting Conditions: Hypertension Hypothryroidism
Allergies: Sulfa. Mold
Diagnostic Lab Data: Referred for pych eval and ENT consult after being seen in the ED
CDC Split Type:

Write-up: Patient began having excessive salivation and haaring voices in her head telling them that they were going to harm her.


VAERS ID: 1782586 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-11
Onset:2021-09-27
   Days after vaccination:200
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048A21A / UNK LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036B21A / UNK LA / IM

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

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

Write-up: COVID-19


VAERS ID: 1782638 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-09-22
Onset:2021-09-27
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Dyspnoea, Fatigue, Feeling abnormal, Hypoaesthesia
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Sexual dysfunction (broad)

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

Write-up: Tiredness since first vaccine, numbness in ankles and arms spacing out. Difficulties breathing


VAERS ID: 1782715 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-24
Onset:2021-09-27
   Days after vaccination:187
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047A21A / UNK LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037B21A / UNK RA / 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: COVID-19


VAERS ID: 1782984 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-09-10
Onset:2021-09-27
   Days after vaccination:17
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, Brachial plexopathy, Electromyogram abnormal, Muscular weakness, Nerve conduction studies abnormal, Neuralgic amyotrophy
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Arthritis (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None reported
Preexisting Conditions: Frequent urinary tract infections
Allergies: Seasonal allergies, otherwise NKDA
Diagnostic Lab Data: electromyography, nerve conduction study of right upper extremity
CDC Split Type:

Write-up: Right shoulder pain, right arm weakness. Clinically consistent with brachial plexopathy/parsonage turner syndrome. EMG/NCS done today confirms upper/middle trunk brachial plexopathy.


VAERS ID: 1783091 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-07
Onset:2021-09-27
   Days after vaccination:143
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009C21A / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Guillain-Barre syndrome
SMQs:, Peripheral neuropathy (narrow), Guillain-Barre syndrome (narrow), Demyelination (narrow), Immune-mediated/autoimmune disorders (narrow)

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

Write-up: Guillain Barre syndrome


VAERS ID: 1783183 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-09-26
Onset:2021-09-27
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 2 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Rash, Rash pruritic, Rash vesicular
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: xanax, remeron, celexa, vitamin D, temazeoam
Current Illness: No.
Preexisting Conditions: No.
Allergies: No known allergies.
Diagnostic Lab Data: none ordered.
CDC Split Type:

Write-up: Patient received first pfizer vaccine on 09/05/2021, in the left arm. It was very painful, and the pain lasted for three weeks. She then got her second vaccine in the right on on 09/26/2021. A painful, blistering, and itchy rash broke out on her left arm at the site of the first injection


VAERS ID: 1784803 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-09-27
Onset:2021-09-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF 2589 / 3 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Back pain, Condition aggravated, Dysuria, Erythema, Fatigue, Headache, Neutrophil count, Pain in extremity, Pyrexia, Urinary tract infection, Urine analysis abnormal, White blood cell count
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (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: Adderall XR 20 mg., Losartin 50 mg., Celexa 10 mg.
Current Illness: N/A
Preexisting Conditions: High Blood Pressure
Allergies: Penicillin, Sulfa, Macrodantin
Diagnostic Lab Data: As noted above, did a clean catch AZO urine test and consulted with my PCP electronically after sending her a picture of the result.
CDC Split Type:

Write-up: I initially experienced arm redness and soreness. Then headache and fatigue set in and increased on Day 4. Ran fever of 100.5 on 9/30. Experienced painful urination/back pain on Day 5. Contacted PCP after doing AZO urine test that was positive for leuckocytes and neutrophils. Sent photo of result and had an on-line appointment with PCP. Started CIPRO on day 5--500 mg/BID. Began feeling better after 4 doses of antibiotic. I have had recurring UTI''s over the past couple of years and think it was probably coincidence that this one occured after receiving the vaccine. My arm redness and soreness got better after 5 days.


VAERS ID: 1784950 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-09-27
Onset:2021-09-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040C21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Heart rate abnormal, Heart rate increased
SMQs:, Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dehydration (broad)

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

Write-up: Patient said heart rate was elevated for 48 hours after vaccine and also had "heart fluctuations." Patient did not seek medical care


VAERS ID: 1785068 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-09-27
Onset:2021-09-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 035C21A / 1 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Condition aggravated, Discomfort, Fatigue, Headache, Hypoaesthesia, Loss of personal independence in daily activities, Migraine, Neck pain, Paraesthesia, Sensory disturbance
SMQs:, Peripheral neuropathy (narrow), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Arthritis (broad), Sexual dysfunction (broad)

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

Write-up: Within 10-15 minutes my left side went numb, mostly in my left arm/wrist/hand and left leg/foot. It was tingly sensation at first and then I lost feeling completely. This lasted for about thirty minutes and the nurses had me stay to keep an eye on me. I was exhausted the rest of the day and unable to function normally. However, the next morning I woke up with a searing pain in the left side of my head/neck, and again numbness and nervy-tingling pain in my left arm and leg. This was present the entire day, and in the afternoon I contacted my Doctor who prescribed 600 mg Ibuprofen and determined that it was similar to an ocular migraine I had had in the past (when pregnant). The ibuprofen eventually helped. On the 29th and 30th I also experienced headaches, and bizarre sensations only on my left side. These sensations can be described as intense internal (vascular?) pressure . I again contacted a FNP to ask if I should be worried about it or if it was something I should bring up to my Doctor, as it was so consistent and in random places, I mostly was concerned if it could be another blood clot (infarct blood clot in my lung in 2018), she said that it was not symptoms of a blood clot but to continue to pay attention. Those feelings are still occurring periodically.


VAERS ID: 1785196 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-01
Onset:2021-09-27
   Days after vaccination:26
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Headache, Heavy menstrual bleeding, Injection site bruising, Menstrual disorder, Pain, Paraesthesia, Pyrexia
SMQs:, Peripheral neuropathy (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Plaquenil 200 mg black seed oil
Current Illness:
Preexisting Conditions: Lupus
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 9/2 experienced stinging and pins and needle feeling in my lower face (chin and cheek area) when touched. Experienced off and on for a few weeks. Monthly period started a week early 9/27. Bled heavily for a week. Was off of my period for a week and started again with heavy bleeding 10/11. Extremely heavy flow for the past few days, feeling feverish, with headache and tired. I still have a slight bruise on my arm where the vaccine was administered a month and a half ago.


VAERS ID: 1785266 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-08-29
Onset:2021-09-27
   Days after vaccination:29
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Metabolic function test, Physical examination normal, Vertigo, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Fluoxetine, atorvastatin,testim, myrbetriq, solifenicin, cargadora/levodopa, omeprazole, Victoza, tamsulosin, loperamide, melatonin, folate, vit D, modafinil
Current Illness: No
Preexisting Conditions: Parkinson disease
Allergies: Metronidazole, mollusks
Diagnostic Lab Data: Physical exam . Metabolic panel - was normal
CDC Split Type:

Write-up: Sudden vertigo and vomiting. No fever. Resolved slowly over 3 weeks


VAERS ID: 1785458 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-01-19
Onset:2021-09-27
   Days after vaccination:251
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK5730 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1283 / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Body temperature increased, COVID-19, Chills, Cough, Diarrhoea, Headache, Malaise, Myalgia, Nausea, Oropharyngeal pain, Respiratory tract congestion, Rhinorrhoea, SARS-CoV-2 test positive, Throat irritation
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Pseudomembranous colitis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: Complaint of cough, chills, elevated temperature (102), sore/scratchy throat, headache, runny nose/congestion, myalgia, malaise, diarrhea, and nausea.


VAERS ID: 1785475 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-03-19
Onset:2021-09-27
   Days after vaccination:192
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Ageusia, Anosmia, COVID-19, Malaise, Myalgia, Nasal congestion, Oropharyngeal pain, Rhinorrhoea, SARS-CoV-2 test positive, Throat irritation
SMQs:, Rhabdomyolysis/myopathy (broad), Taste and smell disorders (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

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

Write-up: Complaint of sore/scratchy throat, runny nose/congestion, lose of taste and smell, myalgia and malaise


VAERS ID: 1785603 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-25
Onset:2021-09-27
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: h/o endometrial cancer
Allergies: cipro
Diagnostic Lab Data:
CDC Split Type:

Write-up: Bell''s Palsy 48 hours after receiving vaccine


VAERS ID: 1785708 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-02-04
Onset:2021-09-27
   Days after vaccination:235
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EH9899 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 2 - / IM

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

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

Write-up: Complaint of elevated temperature, headache and runny nose/congestion.


VAERS ID: 1786661 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-03-15
Onset:2021-09-27
   Days after vaccination:196
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory failure, Ageusia, Anosmia, Antiplatelet therapy, Aspartate aminotransferase increased, Atrial fibrillation, Blood albumin decreased, Brain natriuretic peptide normal, COVID-19, COVID-19 pneumonia, Chest X-ray abnormal, Chills, Condition aggravated, Cough, Dehydration, Diarrhoea, Dyslipidaemia, Dyspnoea, Exposure to SARS-CoV-2, Full blood count normal, Headache, Hypochloraemia, Hyponatraemia, Hypoxia, Insulin-requiring type 2 diabetes mellitus, Liver function test abnormal, Lung infiltration, Lung opacity, Metabolic function test abnormal, Nasal congestion, Oropharyngeal pain, Productive cough, Pyrexia, Respiratory viral panel, Rhinorrhoea, SARS-CoV-2 test positive, Sinus disorder, Sputum discoloured, Troponin normal, Vomiting, Wheezing
SMQs:, Liver related investigations, signs and symptoms (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Asthma/bronchospasm (broad), Dyslipidaemia (narrow), Hyperglycaemia/new onset diabetes mellitus (narrow), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Supraventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Pseudomembranous colitis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hyponatraemia/SIADH (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Lipodystrophy (broad), Chronic kidney disease (broad), Hypersensitivity (broad), Noninfectious diarrhoea (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (narrow), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen (TYLENOL) 500 mg tablet albuterol HFA (PROVENTIL;VENTOLIN) 90 mcg/actuation inhaler amLODIPine (NORVASC) 5 mg tablet atorvastatin (LIPITOR) 40 mg tablet BD ULTRA-FINE NANO PEN NEEDLE 32 gauge x 5/32" needle chlorhexidine
Current Illness:
Preexisting Conditions: Respiratory Acute hypoxemic respiratory failure due to COVID-19 (CMS/HCC) Digestive Unspecified protein-calorie malnutrition (CMS/HCC)
Allergies: NKA
Diagnostic Lab Data: Collected Procedure 10/04/2021 1152 Respiratory virus detection panel Collected: 10/04/21 1152 | Final result | Specimen: Swab from Nasopharynx Adenovirus Not Detected Mycoplasma pneumoniae Not Detected Chlamydophila pneumoniae Not Detected Parainfluenza Not Detected COVID-19 SARS-CoV-2 Overall Result Detected Critical Enterovirus/Rhinovirus Not Detected Coronavirus Not Detected Respiratory Syncytial Virus Not Detected Influenza A Not Detected Bordetella pertussis Not Detected Influenza B Not Detected Bordetella parapertussis Not Detected Metapneumovirus Not Detected Procedure Component Value Ref Range Date/Time X-ray chest 1 view - Portable Resulted: 10/04/21 2245 Order Status: Completed Updated: 10/04/21 2245 Narrative: XR CHEST 1 VW PORT IMPRESSION: Patchy bilateral opacities. Compatible with COVID pneumonia, in correlation with the history. END OF IMPRESSION: INDICATION: shortness of breath. COVID positive. TECHNIQUE: Portable AP projection of the chest was acquired. COMPARISON: PA chest 12/15/2005. FINDINGS: Sternotomy wires and CABG clips are new since 2005. The heart size is normal. The vascular distribution is normal. The hilar and mediastinal silhouettes appear unremarkable. Patchy mixed bilateral interstitial and airspace opacities project over the mid to lower lung bilaterally. These are newly seen. No pleural effusion is identified. There is no evidence of pneumothorax. There are no significant bony findings.
CDC Split Type:

Write-up: 09/30/2021 Chief Complaint Patient presents with ? Nasal Congestion sx started Monday ? Sinus Problem ? Vomiting ? Diarrhea ? Chills ? Cough 79 year old patient presents with 3 days of N/V/D, cough, nasal congestion, wheezing, rhinorhea, and chills. Has been vaccinated in 4/2021 with Pfizer. Went camping over the weekend and found out that 43 of his friends tested (+) for COVID 19 who he was camping with. Taking:Albuterol inhaler. Tylenol BID. FLonase daily Outpatient COVID-19 Testing Provider Testing Criteria Decision Support Symptoms: (X ) Fever (X ) Shortness of breath (X ) Cough (X ) Sore throat (X ) Diarrhea ( ) Loss of taste/smell ( X) Other N/V, rhinorrhea, HA, wheezing ( ) None When did symptoms start? 3 days ED to Hosp-Admission Discharged 10/4/2021 - 10/9/2021 (5 days) Acute hypoxemic respiratory failure due to COVID-19 (CMS/HCC) Principal problem Hospital Problems POA * (Principal) Acute hypoxemic respiratory failure due to COVID-19 (CMS/HCC) Yes Plan Chief Complaint Patient presents with ? Shortness of Breath 1. Acute hypoxemic respiratory failure secondary to COVID-19 pneumonitis. Admit to general medical floor. Start patient on IV remdesivir, Decadron therapy. Check procalcitonin, inflammatory markers. Wean supplemental oxygen as tolerated to keep SaO2 greater than 90. Encourage proning. 2. Hyponatremia. Given concurrent hypochloremia, likely represents dehydration. Gentle IV hydration x24 hours. Monitor BMP. 3. Hypertension. Blood pressures appear well controlled, continue home regimen. 4. Atrial fibrillation. On Eliquis for anticoagulation, continue beta-blocker. Monitor on telemetry. 5. Dyslipidemia. Continue statin therapy. 6. Type 2 diabetes. Continue long-acting insulin per home regimen. Hold oral hypoglycemics. Will place on insulin sliding scale and Accu-Cheks per protocol. History of Present Illness Patient is an 79 y.o. male. With past medical history significant for A. fib on Eliquis, hypertension, dyslipidemia, diabetes presented to the emergency room for evaluation of hypoxia. Home health nurse found the patient to be hypoxic, oxygen saturation in the 80s on room air today. Patient was diagnosed with Covid about 13 days ago, does not use any oxygen at baseline. Denies any associated fevers, nausea or vomiting. Does endorse chest tightness, abdominal discomfort, particularly with coughing. Cough is productive of gray sputum. Initial work-up in the emergency room includes CBC within normal limits, BMP with evidence of hyponatremia, hypochloremia. Troponin negative x1 set, LFTs show mildly abnormal AST 55, albumin 3.2. BNP normal. Respiratory viral panel confirms SARS-CoV-2 infection. A 1 view chest x-ray shows bilateral infiltrates, consistent with COVID-19 infection. Patient has been administered 6 mg IV Decadron in the ER, and endorsed for hospitalization for further management of acute hypoxic respiratory failure from Covid 19 infection.


VAERS ID: 1768812 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-09-27
Onset:2021-09-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821286 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Chills, Injection site induration, Injection site mass, Injection site pain, Injection site warmth, Lymph node pain, Nausea, Pain, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Flu vaccine - approx 2009? Anaphylactic reaction; advised not to receive again.
Other Medications: Candesarten Lipitor Tresiba Fiasp Multivitamin
Current Illness:
Preexisting Conditions: Clear cell renal cell carcinoma Glomerulonephritis Type I Diabetes hypertension hyperlipidemia
Allergies: Biaxin banana almonds kiwi ethanol alcohol shellfish
Diagnostic Lab Data:
CDC Split Type:

Write-up: Nausea, joint pain, localized site pain with a hard lump at injection site, location site painful x 11 days (currently), and hot. Fever - temperature of 102.9-103.1 for 2+ days, lymph node tenderness, body aches, chills


VAERS ID: 1771021 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-09-27
Onset:2021-09-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Dizziness, Influenza, Oropharyngeal pain, Rash, SARS-CoV-2 test
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Vestibular disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Asthma; Suspected COVID-19
Preexisting Conditions: Medical History/Concurrent Conditions: Immunodeficiency (Has an illness or condition, not listed above, which reduces the immune response (e.g. immunodef...)
Allergies:
Diagnostic Lab Data: Test Name: COVID-19 virus test; Test Result: Inconclusive ; Result Unstructured Data: Inconclusive test
CDC Split Type: GBMODERNATX, INC.MOD20213

Write-up: sore throat; dizzy; flu; Rash; This case was received via regulatory authority (Reference number: GB-MHRA-ADR 26008838) on 30-Sep-2021 and was forwarded to Moderna on 30-Sep-2021. This regulatory authority case was reported by a consumer and describes the occurrence of RASH (Rash), OROPHARYNGEAL PAIN (sore throat), DIZZINESS (dizzy) and INFLUENZA (flu) in a 14-year-old male patient who received mRNA-1273 (Moderna CoviD-19 Vaccine) for COVID-19 vaccination. The patient''s past medical history included Immunodeficiency (Has an illness or condition, not listed above, which reduces the immune response (e.g. immunodef...). Concurrent medical conditions included Asthma and Suspected COVID-19 since 27-Sep-2021. On 27-Sep-2021, the patient received first dose of mRNA-1273 (Moderna CoviD-19 Vaccine) (unknown route) 1 dosage form. On 27-Sep-2021, the patient experienced RASH (Rash) (seriousness criterion medically significant). On an unknown date, the patient experienced OROPHARYNGEAL PAIN (sore throat) (seriousness criterion medically significant), DIZZINESS (dizzy) (seriousness criterion medically significant) and INFLUENZA (flu) (seriousness criterion medically significant). On 29-Sep-2021, RASH (Rash) had not resolved. At the time of the report, OROPHARYNGEAL PAIN (sore throat), DIZZINESS (dizzy) and INFLUENZA (flu) had resolved. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On an unknown date, SARS-CoV-2 test: not provided (Inconclusive) Inconclusive test. The action taken with mRNA-1273 (Moderna CoviD-19 Vaccine) (Unknown) was unknown. Patient waiting on PCR as sons has asthma and I has to multi-dose him as coughing non stop, rash spreading daily, sore throat, flu, dizzy etc was fit n well before 1st vaccine n a complete state. Company comment: This case concerns a 14 year-old male patient with history of asthma, suspected COVID-19, and immunodeficiency, who experienced the unexpected serious events of Oropharyngeal pain, Dizziness, Influenza, and Rash. The events occurred an unknown number of days after the first dose of mRNA-1273 vaccine. The benefit-risk relationship of mRNA-1273 vaccine is not affected by this report. The history of asthma, suspected COVID-19 and immunodeficiency may have contributed to the events. Seriousness criteria of Medically significant maintained for events for consistency with RA report, however the source document does not include information that supports seriousness criteria.; Sender''s Comments: This case concerns a 14 year-old male patient with history of asthma, suspected COVID-19, and immunodeficiency, who experienced the unexpected serious events of Oropharyngeal pain, Dizziness, Influenza, and Rash. The events occurred an unknown number of days after the first dose of mRNA-1273 vaccine. The benefit-risk relationship of mRNA-1273 vaccine is not affected by this report. The history of asthma, suspected COVID-19 and immunodeficiency may have contributed to the events. Seriousness criteria of Medically significant maintained for events for consistency with RA report, however the source document does not include information that supports seriousness criteria.


VAERS ID: 1777519 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-09-27
Onset:2021-09-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / UNK - / OT

Administered by: Other       Purchased by: ?
Symptoms: Anaphylactic reaction
SMQs:, Anaphylactic reaction (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypersensitivity (narrow)

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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: FIPFIZER INC202101314021

Write-up: Anaphylaxis; This is a spontaneous report from a contactable physician downloaded from the regulatory authority number FI-FIMEA-20215116. A 14-years-old female patient received bnt162b2 (COMIRNATY), intramuscular on 27Sep2021 (Batch/Lot Number: UNKNOWN) at age of 14 years old as DOSE NUMBER UNKNOWN, SINGLE for covid-19 immunisation. The patient medical history and concomitant medications were not reported. The patient experienced anaphylaxis on 27Sep2021 with outcome of recovering. Immediately after the vaccination symptoms as in anaphylaxia, that is flushing of the face, malaise, swelling of the throat. The patient immediately received adrenaline 0.5 mg, after which the symptoms eased. No follow-up attempts are possible; information about lot/batch number cannot be obtained. No further information is expected.


VAERS ID: 1777865 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:0000-00-00
Onset:2021-09-27
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Back pain, Blood glucose abnormal, Blood pressure measurement, Coma, Haemorrhage, Leg amputation, Platelet count, Thrombocytopenia, Thrombosis
SMQs:, Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Retroperitoneal fibrosis (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Smoker (on and off. Had been stopped for long time and started again in last few years)
Preexisting Conditions: Medical History/Concurrent Conditions: Hernia (had a hernia operation some time in the past); Comments: No prior problems, medication or labs relating to hypercoagulability, no risk factors of Deep vein thrombosis (DVT)
Allergies:
Diagnostic Lab Data: Test Name: Platelet count; Result Unstructured Data: Low; Test Name: Blood sugar abnormal; Result Unstructured Data: Normal; Test Name: Blood pressure; Result Unstructured Data: Little high
CDC Split Type: GBJNJFOC20211004127

Write-up: LOST A LOT OF BLOOD; COMA; THROMBOCYTOPENIA; CATASTROPHIC BLOOD CLOT IN THE BACK OF THE KIDNEY NEXT TO ABDOMINAL CAVITY/ CATASTROPHIC BLOOD CLOT IN GROIN AREA/ BLOOD CLOT IN LEG; LOSS OF LEG ABOVE THE KNEE; BACK ACHES; This spontaneous report received from a health care professional concerned a 68 year old male of an unspecified race and ethnic origin. The patient''s height and weight were not reported. The patient''s past medical history included that had a hernia operation some time in the past and concurrent conditions included: smoker (on and off, stopped for a long time but started again in the last few years) and other pre-existing medical conditions included no prior problems, medication or labs relating to hypercoagulability, no risk factors of deep vein thrombosis (DVT). The patient received Covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown, expiry: unknown) dose was not reported, frequency time 1 total administered on JUL-2021 for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported but he occasionally took a proton-pump inhibitors (PPI). On an unspecified date, the patient started having back aches for which he went for a checkup and physician found that he had thrombocytopenia which was treated with Vitamin B12 (cyanocobalamin) or Folic acid. During WellMan health check, he underwent laboratory test which included Platelet count (NR: not provided) was found to be low and Blood sugar abnormal (NR: not provided) was found to be normal. He also performed Blood pressure (NR: not provided) which was noted to be a little high. He experienced pain in the back & abdomen, the pain felt a little similar to sciatica/previous hernia. When terrible pain developed he sought medical help. On 27-SEP-2021 (within 24 hours), he had a series of blood clots. The patient had catastrophic blood clot in the back of the kidney, next to his abdominal cavity. It was completely occluded and had to do an emergency operation. He was hospitalized on same day for operation. He came out ok and recovered but then he had another catastrophic clot in his groin area. For this second clot, they had to do a 7 hour operation. He came out bound again. After that he had a third clot and he lost his leg above the knee. After the third operation (On an unspecified date), the patient was on life support, He had three levels of anesthesia and has lost a lot of blood but he was recovering. Then they administered heparin and it was an emergency and then an oral anticoagulant. He was out of coma and came off the ventilator yesterday but still on dialysis, not fully conscious / partially conscious. Discharge date was not provided. The action taken with Covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from coma and catastrophic blood clot in the back of the kidney next to abdominal cavity/ catastrophic blood clot in groin area/ blood clot in leg, was recovering from lost a lot of blood and the outcome of thrombocytopenia, back aches and loss of leg above the knee was not reported. This report was serious (Hospitalization Caused / Prolonged, Other Medically Important Condition, Life Threatening, and Disability Or Permanent Damage). This case, from the same reporter is linked to 20211004138.; Sender''s Comments: V0: 20211004127-COVID-19 VACCINE AD26.COV2.S- Lost a lot of blood, coma, loss of leg above the knee. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s). 20211004127-COVID-19 VACCINE AD26.COV2.S-Thrombocytopenia, catastrophic blood clot in the back of the kidney next to abdominal cavity/catastrophic blood clot in groin area/blood clot in leg. This event(s) is labeled per RSI and is therefore considered potentially related.


VAERS ID: 1780501 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-09-27
Onset:2021-09-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8222 / 1 - / -

Administered by: Other       Purchased by: ?
Symptoms: Facial paralysis, Hypoaesthesia, Paraesthesia, SARS-CoV-2 test
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Hearing impairment (broad), COVID-19 (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Name: COVID-19 virus test; Test Result: Negative ; Comments: No - Negative COVID-19 test
CDC Split Type: GBPFIZER INC202101287276

Write-up: tingling; Facial droop; Numbness facial; This is a spontaneous report from a contactable consumer or other non-health care professional (Patient). This is a report received from the Regulatory Authority (RA). The regulatory authority report number is GB-MHRA-WEBCOVID-202109281737451290-HDUA4. Safety Report Unique Identifier is GB-MHRA-ADR 26005949. A 38-year-old male patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, solution for injection, Lot Number: FF8222), via an unspecified route of administration on 27Sep2021 (At the age of 38-year-old) as dose 1, single for COVID-19 immunisation. The patient medical history and concomitant medications were not reported. On 27Sep2021 patient experienced tingling, facial droop, numbness facial. It was reported that numbness to the face started within 20 minutes. Within an hour the left side of his face was tingling. Within 3hrs the patient had started to show symptoms of drooping. The patient underwent lab tests which included covid-19 virus test: negative on an unspecified date, No - Negative COVID-19 test. Patient has not tested positive for COVID-19 since having the vaccine. Patient is not enrolled in clinical trial. Patient has not had symptoms associated with COVID-19. The outcome of the events was not recovered. No follow-up attempts are needed. No further information is expected.


VAERS ID: 1784166 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-09-27
Onset:2021-09-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH0161 / 2 LA / OT

Administered by: Other       Purchased by: ?
Symptoms: Pain in extremity, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: ITPFIZER INC202101307082

Write-up: syncope on the evening of the vaccine; acute leg pain; This is a spontaneous report from a contactable physician downloaded from the regulatory authority-WEB, regulatory authority number IT-MINISAL02-793271. A 15-years-old female patient received second dose of BNT162B2 (COMIRNATY, Solution for injection with Lot Number: FH0161; Expiration Date: Dec2021), via intramuscular route of administration, administered in Deltoid Left on 27Sep2021 12:00 (at 15 years of age) as a 30UG single dose for COVID-19 immunization. The patient''s medical history and concomitant medications were not reported. The historical vaccines include first dose of BNT162B2 (COMIRNATY, Solution for injection with Lot Number: unknown), via an unspecified route of administration on 06Sep2021 12:00 (at 15 years of age) as a single dose for COVID-19 immunization. On 27Sep2021, the patient experienced syncope on the evening of the vaccine, and acute leg pain. The event syncope was assessed as serious (medically significant). The outcome of the events was recovered on 28Sep2021. No follow-up attempts possible. No further information expected.


VAERS ID: 1784295 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-09-27
Onset:2021-09-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ7489 / 1 - / -

Administered by: Other       Purchased by: ?
Symptoms: Blood pressure decreased, Blood pressure measurement, Body temperature, Bradycardia, Cold sweat, Electrocardiogram, Feeling abnormal, Heart rate, Oxygen saturation, Presyncope, Tension
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: List of non-encoded Patient Relevant History: Patient Other Relevant History 1: None
Allergies:
Diagnostic Lab Data: Test Date: 20210927; Test Name: BP; Result Unstructured Data: Test Result:83/37; Comments: 14:27; Test Date: 20210927; Test Name: BP; Result Unstructured Data: Test Result:61/36; Comments: 14:32; Test Date: 20210927; Test Name: BP; Result Unstructured Data: Test Result:90/49; Comments: 15:09; Test Date: 20210927; Test Name: body temperature; Result Unstructured Data: Test Result:36.2 Centigrade; Comments: before vaccination; Test Date: 20210927; Test Name: electrocardiogram; Result Unstructured Data: Test Result:HR 50, bradycardia, ST-T no change; Test Date: 20210927; Test Name: P; Result Unstructured Data: Test Result:49; Comments: 14:27; Test Date: 20210927; Test Name: P; Result Unstructured Data: Test Result:55; Comments: 14:32; Test Date: 20210927; Test Name: P; Result Unstructured Data: Test Result:71; Comments: 15:09; Test Date: 20210927; Test Name: SPO2; Test Result: 98 %; Comments: 14:27; Test Date: 20210927; Test Name: SPO2; Test Result: 99 %; Comments: 14:32; Test Date: 20210927; Test Name: SPO2; Test Result: 98 %; Comments: 15:09
CDC Split Type: JPPFIZER INC202101289510

Write-up: bradycardia, P 49; BP 83/37; Vasovagal reflex; floating feeling/Feels poorly; cold sweat; vaccination tension; This is a spontaneous report from a contactable physician received from the regulatory authority. Regulatory authority report number is v21128073. The patient was an 18-year and 7-month-old female. Body temperature before vaccination was 36.2 degrees centigrade. The patient had no family history. There were no points to be considered on the vaccine screening questionnaire (primary diseases, allergies, vaccinations and illnesses within the last one month, medications the patient was taking, past adverse effect history, growth status) On 27Sep2021 at 14:25 (the day of vaccination), the patient received the first dose of bnt162b2 (COMIRNATY solution of injection, Lot number FJ7489, Expiration date 31Jan2022) via an unspecified route of administration as a single dose, at the age of 18-year and 7-month-old of vaccination, for COVID-19 immunization. On 27Sep2021 at 14:27 (2 minutes after the vaccination), the patient experienced vasovagal reflex. On 27Sep2021 (the day of the vaccination), the outcome of the event was recovering. The course of the event was as follows: At 14:25, the patient received the vaccine. At 14:27 the patient experienced floating feeling, cold sweat. BP 83/37, P 49, SPO2 98%, blood pressure decreased, bradycardia, the patient laid in bed quietly in doctor''s office. At 14:32, BP61/36, P 55, SOP2 99%. There was no decreased consciousness level. From electrocardiogram, HR 50, bradycardia, ST-T no change. The patient laid in bed and was watched for the progress. At 15:09, BP 90/49, P 71, SPO2 98%. Feels poorly was recovering. At 15:22, the patient went back home. The outcome of the events was resolving at the time of reporting. The reporting physician classified the event vasovagal reflex as non-serious and assessed that the causality between the event and bnt162b2 as unassessable. There was no other possible cause of the event such as any other diseases. The reporter commented as follows: As the vaccination was a weak point, the patient said she experienced feels poorly. It was considered that there was high possibility of Vasovagal reflex due to vaccination tension. Follow up attempts are completed. Further information is not expected.


VAERS ID: 1785867 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Foreign  
Vaccinated:0000-00-00
Onset:2021-09-27
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Arthralgia, Back pain, Blindness, Dyspnoea, Ear pain, Gait inability, Headache, Muscle spasms, Myalgia, Palpitations, Physical disability, Pyrexia, Respiratory disorder, Sensory loss, Tremor, Vision blurred
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Peripheral neuropathy (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Dystonia (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Glaucoma (broad), Optic nerve disorders (broad), Cardiomyopathy (broad), Lens disorders (broad), Eosinophilic pneumonia (broad), Retinal disorders (broad), Arthritis (broad), Respiratory failure (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:
Current Illness:
Preexisting Conditions: Comments: Nothing
Allergies:
Diagnostic Lab Data:
CDC Split Type: BEJNJFOC20211024389

Write-up: PHYSICAL IMPAIRMENT; PAINFUL ANKLE; SENSATION LOSS; BACK PAIN; EAR PAIN; VISION LOSS; RESPIRATORY DISORDER; BREATHING DIFFICULT; PALPITATIONS; HEADACHE; GAIT INABILITY; VISION BLURRED; WRIST PAIN; MYALGIA; TREMBLING; FEVER; SPASMS; This spontaneous report received from a health care professional via regulatory authority (regulatory authority, BE-FAMHP-DHH-N2021-107211) on 12-OCT-2021 concerned a 45 year old female. The patient''s weight was 70 kilograms, and height was 165 centimeters. The patient had no pre-existing medical conditions. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, intramuscular, batch number: XE395 expiry: unknown) dose was not reported, 1 total, administered on 27-SEP-2021 for covid-19 immunisation. No concomitant medications were reported. On 27-SEP-2021, about 8 hours after the injection, the patient experienced physical impairment (degradation of physical condition in a few minutes), painful ankle (very strong pain in ankles), sensation loss (loss of sensation in the lower limbs), back pain (very strong pain in back ), ear pain (very strong pain in ears), vision loss (no more eyesight), respiratory disorder (heavy breathing, sometimes stops), breathing difficulty which sometimes stops, palpitations (heart palpitations), headache (very strong pain in head), gait inability (almost impossible to walk without support), vision blurred, wrist pain (very strong pain in wrists), myalgia (pain when touching all muscles), trembling (violent anarchic tremors of the body for several hours), fever (over 40 degrees of fever as peak and over 38.5 degrees all night), and spasms (spasms of the body for several hours). The events calmed down but patient was still in bed without being able to get up without help. Treatment medications included: paracetamol (date unspecified) for unknown indication. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient was recovering from physical impairment, painful ankle, sensation loss, back pain, ear pain, vision loss, respiratory disorder, breathing difficult, palpitations, headache, gait inability, vision blurred, wrist pain, myalgia, trembling, fever, and spasms. This report was serious (Other Medically Important Condition).; REPORTER COMMENTS: Treatment - Yes Paracetamol Overnight supervision What else to do At the borderline of hospitalisation. Evolution of the ADR - Improving Situations - Drug abuse ADR description - I did my vaccine against Covid and it didn''t go well. For this reason and for your best information I send this message. Assessment of my ''''Janssen'''' citizenship duty: about 8 hours after the injection degradation of my physical condition in a few minutes, loss of sensation in the lower limbs, almost impossible to walk without support, very strong pain in ears, head, back, ankles,wrists, pain when touching all muscles, over 40 degrees of fever as peak and over 38,5 degrees all night, difficult and heavy breathing, sometimes stops (A companion was shaking me a bit to get me to react), heart palpitations, blurred vision, then no more eyesight (it was back again), spasms and violent anarchic tremors of the body for several hours. Then it calmed down, but I am still in bed without being able to get up without help. Thank you for your attention.


VAERS ID: 1735499 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-09-25
Onset:2021-09-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Neck pain, Tinnitus
SMQs:, Hearing impairment (narrow), Arthritis (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: Finasteride, aspirin, prilosec otc
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Wrist joint pain (both wrists), neck pain, shoulder joint pain, TINNITUS.


VAERS ID: 1735560 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-09-05
Onset:2021-09-26
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 1 RA / IM

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

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

Write-up: Pt returned to clinic on 9/26/21 for second dose of Pfizer COVID 19 vaccine and handed NP a vaccine card with a Janssen COVID vaccine admin on it. When questioned, pt states "I am going to be honest with you. I received a dose of Jannsen COVID 19 vaccine on 3/14/21, and a doctor told me that it was not keeping people from being intubated and to get the Pfizer also, so I signed up to received the Pfizer vaccine." informed patient that she could not received the second dose of Pfizer today and that it is not recommended to mix the vaccines or receive more than 1 vaccine series/ additional doses after being vaccinated with Janssen.


VAERS ID: 1735564 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-09-26
Onset:2021-09-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048FLIA / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Presyncope
SMQs:, Anticholinergic syndrome (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Near syncope minutes after injection


VAERS ID: 1735568 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-09-23
Onset:2021-09-26
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Diarrhoea
SMQs:, 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: Sertraline Fish oil Multivitamin
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Severe diarrhea starting less than 72 hours after 1st Pfizer Covid-19 vaccine


VAERS ID: 1735574 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-09-01
Onset:2021-09-26
   Days after vaccination:25
Submitted: 0000-00-00
Entered: 2021-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Night sweats
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Dutasteride0.5 mg, Pantoprazole40mg, Amlodipine2.5mg, Atorvastatin40mg,, Eliquis5mg, isosorbide mononitrate30mg,
Current Illness:
Preexisting Conditions: Heart murmur, triple bypass, herniated disc, stage 3 kidney disease, gall bladder removed.
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Night-sweats. No treatment. No after effects.


VAERS ID: 1735613 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-09-26
Onset:2021-09-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / 1 LA / IM
FLU4: INFLUENZA (SEASONAL) (FLUZONE QUADRIVALENT) / SANOFI PASTEUR UT7376JA / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood pressure decreased, Dehydration, Dizziness
SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Dehydration (narrow)

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: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: EMS stated that patient was dehydrated.
CDC Split Type:

Write-up: Pt felt dizzy and though he was going to pass out a couple of minutes after the shot. Blood pressure dropped to 109/63


VAERS ID: 1735615 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Kansas  
Vaccinated:2021-09-24
Onset:2021-09-26
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 023C21A / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dyspnoea exertional, Fatigue, Palpitations, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Pulmonary hypertension (broad), Cardiomyopathy (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: Carvedilol, Lisinopril, aspirin, farxiga, protonix, sertraline
Current Illness: None
Preexisting Conditions: Dilated cardiomyopathy, under control as of now
Allergies: Penicillin allergy
Diagnostic Lab Data: None yet
CDC Split Type:

Write-up: Fever and extreme fatigue day after shot. More important, and the reason to report, today I''ve been very short of breath with any exertion, and heart feels like it''s pounding.


VAERS ID: 1735625 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-26
Onset:2021-09-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021C21A / 2 LA / IM

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

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

Write-up: Patient developed upper torso pruritus and 3 cm rash on right antecubital. Is being treated with 50mg diphenhydramine PRN TID x 3 days.


VAERS ID: 1735647 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Louisiana  
Vaccinated:2021-09-26
Onset:2021-09-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 1 LA / IM

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

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

Write-up: Systemic: Dizziness / Lightheadness-Mild, Systemic: Fainting / Unresponsive-Mild, Systemic: Flushed / Sweating-Mild, Systemic: Weakness-Mild, Additional Details: a female that came in with patient, was with him in vaccine waiting area. Hollered for help. We called 911 and pharmacist went to patient. Patient was helped to the ground from his chair and when asked his name he was able to respond. He had a pulse and was answering questions. Patient felt like he was clammy. We tried to take his blood pressure but got an error on the machine. EMS arrived quickly and checked his vitals and his blood sugar.


VAERS ID: 1735652 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-09-25
Onset:2021-09-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301358A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site bruising, Nausea
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

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

Write-up: Site: Bruising at Injection Site-Severe, Systemic: Nausea-Mild


VAERS ID: 1735656 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-09-24
Onset:2021-09-26
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048F21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Dizziness, Dysphagia, Headache, Injection site erythema, Nausea, Throat tightness
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypersensitivity (broad), Arthritis (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: Redness at Injection Site-Medium, Systemic: Allergic: Difficulty Swallowing, Throat Tightness-Medium, Systemic: Dizziness / Lightheadness-Medium, Systemic: Headache-Medium, Systemic: Nausea-Mild, Additional Details: Sharp pain in left shoulder once


VAERS ID: 1735660 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-09-26
Onset:2021-09-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 3 LA / IM

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

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

Write-up: Error: Wrong Vaccine Formulation (ex. different manufact. initial and booster)-


VAERS ID: 1735666 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-09-26
Onset:2021-09-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Diarrhoea, Product preparation error
SMQs:, Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Medication errors (narrow)

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

Write-up: Patient was administered 0.3ml vaccine dose direct from vial (not diluted with NSS). The event was at 9:40am approximately and we were able to reach the patient at 2:30pm, which said she was ok, but experienced an episode of strong diarrhea. Doctor of patient will be called to be informed of the incident.


VAERS ID: 1735673 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-09-26
Onset:2021-09-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Extra dose administered, Interchange of vaccine products, No adverse event, Wrong product administered
SMQs:, Medication errors (narrow)

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

Write-up: Patient came in to get a high dose flu shot, but technician mistakenly gave Moderna vaccine. Patient already finished her Covid vaccination series, but patient got Pfizer. No symptoms or adverse reaction reported at the time given.


VAERS ID: 1735674 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-26
Onset:2021-09-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021A21A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017B21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest X-ray, Headache, Respiratory disorder
SMQs:, Acute central respiratory depression (broad), Respiratory failure (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: Metoprolol ER 50mg, pregabalin100mg,muti-B vit,aspirin 81mg, potassium 99mg
Current Illness: None
Preexisting Conditions: Asthma
Allergies: Adhesives
Diagnostic Lab Data: Chest x-rays
CDC Split Type:

Write-up: I have had a headache and respiratory problems ever since the second dose. And it seems to be getting worse. I have been given celebrex for the lungs and told to take tylenol for the headache. As of this date I still have both problems.


VAERS ID: 1735732 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Delaware  
Vaccinated:2021-09-26
Onset:2021-09-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blindness, Chest discomfort, Hallucination, Hyperhidrosis, Hypoaesthesia, Loss of consciousness, Seizure
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Convulsions (narrow), Psychosis and psychotic disorders (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Glaucoma (broad), Optic nerve disorders (broad), Retinal disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: prior history of seizures, no longer in need of seizure medication
Allergies: no known allergies
Diagnostic Lab Data: unknown at this time
CDC Split Type:

Write-up: Patient lost consciousness and had seizure activity. Upon regaining consciousness, patient became somewhat alert and reported loss of vision, which returned after a few minutes. He then reported hallucinations, numbness over whole body, and chest tightness. Could not find a radial pulse, but patient was breathing and fingernails remained pink. Patient was sweating through his shirt. 911 was called, responding within 10 minutes. Patient was transferred to a stretcher and taken to the hospital.


VAERS ID: 1735737 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-09-26
Onset:2021-09-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301458A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Feeling hot, Hyperhidrosis, Loss of consciousness
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), 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: NONE
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Patient Passed out immediately after giving vaccine, patient''s blood pressure was 68/47mmHg & pulse 52. Pt was sweating and hot. 911 was called and took her to the hospital for further check up.


VAERS ID: 1735738 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Nebraska  
Vaccinated:2021-09-26
Onset:2021-09-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822809 / 1 LA / IM

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

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

Write-up: Patient had vasovagal reaction. Fainted. Was able to communicate and give his mom''s phone number. Nurse, pharmacist and customer physician tended to the patient. He was still faint after 10 minutes so 911 was called and the squad took over patient care at that time.


VAERS ID: 1735740 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-26
Onset:2021-09-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 3 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Feeling abnormal, Paraesthesia oral
SMQs:, Dementia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad)

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

Write-up: Patient felt chills, Vitals were taken, Vitals within normal limits. Patient was in Obsveration for 60 mins, vitals still within normal limits, no chills/hot flashes, tingling sensation in mouth. Patient stated she has "cloudy" feeling. Patient able to tolerate foods and fliuds and able to communicate needs. NP visualize inside patients mouth/cleared. Patient was able to leave the clinc after 60 mins. patient is aware to follow up with MD if symtoms worsen.


VAERS ID: 1735765 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-26
Onset:2021-09-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dyspnoea, Erythema, Eye swelling, Hypersensitivity, Hyperventilation
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Asthma/bronchospasm (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: Fish, eggplant
Diagnostic Lab Data:
CDC Split Type:

Write-up: About 10 minutes after administration of Pfizer vaccine, patient started feeling shortness of breath and was hyperventilating. Her face was red and her eyes were swollen. Patient was administered Epipen 0.3mg in her right deltoid. Patient was driven by family member to Hospital to treat allergic reaction since it is 2 blocks away.


VAERS ID: 1735785 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-26
Onset:2021-09-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Chest discomfort, Chest pain, Pain in extremity, Panic attack
SMQs:, Anaphylactic reaction (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: 159/102 157/84 99% 95% 97hr 69hr
CDC Split Type:

Write-up: PT complained of leg pain, chest closing and chest pain. She also had 2 panic attacks and had to be transported to the hospital.


VAERS ID: 1735786 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Alabama  
Vaccinated:2021-09-26
Onset:2021-09-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 062E21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Blood glucose decreased, Blood pressure increased, Condition aggravated, Dizziness
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Hypertension (narrow), Vestibular disorders (broad), Hypoglycaemia (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: Modafanil, Glimiperide, Desvenlafaxine, Metformin, Lisinopril, Amlodipine, Dicyclomine, Atorvastatin, Tamsulosin, Levothyroxine,
Current Illness: None
Preexisting Conditions: Diabetes, hypercholesterolemia, hypothyroidism, hypertension, other psychiatric diagnosis
Allergies: No known allergies
Diagnostic Lab Data: The patient''s blood pressure was 186/89, pulse 80. Blood glucose on first check was 51, after eating and waiting about 15 minutes it had increased to 98.
CDC Split Type:

Write-up: Within approximately 10 minutes after receiving this vaccination the patient reported feeling lightheaded and weak. He said that he thought his blood glucose was low (he had experienced low glucose levels before and said that the symptoms he was experiencing are typical for him when his glucose is low). I checked his blood pressure and his blood glucose level. His blood pressure was a bit elevated and his glucose was indeed low. I had him sit quietly in our vaccination room and had him eat a cereal bar and drink some orange juice. I rechecked his glucose approximately 15 minutes later and it had increased and the patient said he was feeling much better.


VAERS ID: 1735790 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-08-27
Onset:2021-09-26
   Days after vaccination:30
Submitted: 0000-00-00
Entered: 2021-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test, Dizziness, Fatigue, Headache, Hypoaesthesia, Lymphadenopathy, Nausea, Neck pain
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sexual dysfunction (broad)

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

Write-up: swollen lymph nodes in the neck, chest, left side,. Dizzy, tired , nausea, left arm feels numb, headache that starts in the back of the neck and goes into my head.


VAERS ID: 1735801 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-09-26
Onset:2021-09-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Dizziness, Hyperhidrosis, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Dizzy, sweaty and tingling in both hands.


VAERS ID: 1735810 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-26
Onset:2021-09-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 3 LA / IM

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

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

Write-up: The patient received his primary series of Pfizer covid-19 vaccines on 04/01/2021 and 04/22/2021. He denied receiving any Covid-19 vaccine prior to the date of immunization on 9/26/2021. He received his booster dose less than six months after he received his primary series.


VAERS ID: 1735812 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-09-25
Onset:2021-09-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Full spectrum CBD 25mg gummies
Current Illness: None
Preexisting Conditions: Endometriosis
Allergies: CT contrast dye
Diagnostic Lab Data: None. Emergency room visit with visual exam
CDC Split Type:

Write-up: Throat swelling. Delayed 11 hours after vaccine


VAERS ID: 1735826 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-26
Onset:2021-09-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / 1 LA / IM

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

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

Write-up: Right after giving her the vaccination while she was waiting the 15 minutes, she had nausea. She got up and walked around and felt better. She said she was ok.


VAERS ID: 1735833 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-14
Onset:2021-09-26
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Other       Purchased by: ?
Symptoms: Anticoagulant therapy, Arterial disorder, C-reactive protein increased, Chest pain, Computerised tomogram thorax abnormal, Dyspnoea, Fibrin D dimer, Full blood count normal, Hyperhidrosis, Hypoxia, Intensive care, Lung disorder, Metabolic function test normal, Pallor, Pulmonary embolism, Respiratory viral panel, Scan with contrast abnormal, Viral test negative
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Embolic and thrombotic events, venous (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (broad), Hypoglycaemia (broad), Infective pneumonia (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: Morbid Obesity
Allergies: N/A
Diagnostic Lab Data: CBC and CMP were within normal limits. D-Dimer was 4,764.75, CRP 42.9, respiratory viral panel was negative. CT with contrast was obtained which revealed ''near occlusive filling defect in distal right main pulmonary artery, concerning for PE...clot burden extends into the RUL, RML, and RLL arteries.''
CDC Split Type:

Write-up: Patient reported to ED with 24 to 48 hour history of sudden onset chest pain and shortness of breath. On arrival patient was pale, diaphoretic, and hypoxic with O2 sats 60s-70s. Patient was placed on 15L HFNC. CT with contrast was obtained which revealed ''near occlusive filling defect in distal right main pulmonary artery, concerning for PE...clot burden extends into the RUL, RML, and RLL arteries.'' Heparin infusion was initiated and patient was transferred to PICU for higher level of care.


VAERS ID: 1735835 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-09-26
Onset:2021-09-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Head injury, Injection site haemorrhage, Syncope, Tremor, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Unknown details but patient expressed he experienced this with vaccines before but does not have a phobia of needles.
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received his first dose of Moderna in his left deltoid muscle. There was some bleeding but nothing substantial (one cotton ball-full). Patient stood up and was fine. He spoke for approximately 2 minutes before he said, "Oh, I''m starting to feel it now." He then fainted against the wall and hit his head. He was alert but very out of it and began shaking. His father grabbed him and sat him up. The patient then vomited onto the ground. His father was able to raise him up in a chair. He felt lightheaded and said this has happened before. We called 911 and he left with EMS and his family.


VAERS ID: 1735836 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-09-26
Onset:2021-09-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dizziness, Dysstasia, Hypoaesthesia
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (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? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: After the vaccine administration, when patient was about to go to the area of observation, she reports feeling dizzy and unable to get up. She reports her arm fell asleep.


VAERS ID: 1735843 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-26
Onset:2021-09-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Diarrhoea
SMQs:, 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: Vitamin D, magnesium, multivitamin, calcium, metoprolol, zoloft
Current Illness: None
Preexisting Conditions: Obesity
Allergies: No
Diagnostic Lab Data:
CDC Split Type:

Write-up: Diarrhea


VAERS ID: 1735844 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-09-26
Onset:2021-09-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Tachycardia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dehydration (broad)

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

Write-up: Tachycardia


VAERS ID: 1735849 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-09-26
Onset:2021-09-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Aurovela Fe 1/20
Current Illness: None.
Preexisting Conditions: None.
Allergies: None.
Diagnostic Lab Data:
CDC Split Type:

Write-up: I went to go get my flu vaccine and was accidentally administered a Pfizer COVID vaccine. I already received my first two doses of Pfizer 02/12/2021 and 03/12/2021. Although I do not expect to have any major issues. This was an error.


VAERS ID: 1735851 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-26
Onset:2021-09-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Loss of consciousness, Malaise, Nausea, Somatic symptom disorder
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? 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: Right after vaccine was given, patient started complaining of feeling nauseated. She then stated she wasn''t feeling well and began to slump in the chair. Patient passed out. Ambulance was called. Patient was alert before the ambulance arrived and was coherent. EMTs took patient''s vitals and determined issue was due to her not eating before getting vaccinated and having a normally low blood pressure. Vitals : bp - 112/78, pulse - 54 ( normal for patient), and oxygen - 99. EMTs observed patient until 12:22 pm and then advise patient to rest at home. I checked on patient at 6:45 pm. -- patient was feeling much better.


VAERS ID: 1735853 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-26
Onset:2021-09-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Immunisation, Product leakage, Syringe issue, 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: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Client received first dose of COVID-19 pfizer vaccine in left deltoid at 3:22 PM. Vaccinator activated the plunger on the vanish point syringe which made an unusual clicking sound. When vaccinator withdrew syringe from client''s arm, the actual vaccine fluid out of the client''s arm. Vaccinator believed there was less than 50% of the dose still in the client''s arm as a lot of the vaccine squirted out of the client''s arm. Vaccinator alerted me of the situation as I was the co-lead of the site. I then notified our clinical care coordinator that gave the CDC guidance of revaccinating the client today if there was less than 50% of the first attempt administered. Client along with parents were notified of the situation and client was in agreement of revaccination.


VAERS ID: 1735858 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-09-26
Onset:2021-09-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / UNK - / IM

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

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

Write-up: Patient fainted approximately less than 5 minutes after dose, Patient regained consciousness within 60 seconds and was taken by ambulance for observations. Patient stated nervousness with needles after event


VAERS ID: 1735862 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-09-25
Onset:2021-09-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Lethargy, Loss of consciousness, Malaise, Pyrexia
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), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (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: Acetyl-CH, Adaptacrine, Vitamin B-12, vit. D
Current Illness: N/A
Preexisting Conditions: None
Allergies: Cipr0, Amoxicillin, Diamox
Diagnostic Lab Data:
CDC Split Type:

Write-up: general malaise 9/25/2021 a few hours after receiving the 2nd shot, starting at 4:00 am 9/26/2021 Fever of 101.4 lasting all day, lethargic, passed out most of the day. It is 4:00 at night now and I still have the fever. With the first shot, I went home and 15 minutes later passed out on the front porch and was not able to get up for 20 hours.


VAERS ID: 1735875 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-09-26
Onset:2021-09-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

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

Write-up: Chills, feeling of being cold without relief


VAERS ID: 1735888 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-09-26
Onset:2021-09-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Inappropriate schedule of product administration, No adverse event
SMQs:, Medication errors (narrow)

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

Write-up: Patient received 2nd dose of Pfizer vaccine 14 days after 1st dose instead of earliest possible day (day 17). Pt did not experience any adverse events from the vaccine after the dose that we are aware of.


VAERS ID: 1735897 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-09-26
Onset:2021-09-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Inappropriate schedule of product administration, No adverse event
SMQs:, Medication errors (narrow)

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

Write-up: Patient received 2nd dose of Pfizer vaccine 14 days after 1st dose instead of the earliest possible day (day 17). No adverse reaction occurred that we are aware of.


VAERS ID: 1735903 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-24
Onset:2021-09-26
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Erythema, Lymphadenopathy, Pain, Swelling, Tenderness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Sore Lt Shoulder with redness and slight swelling then very tender Left arm with swollen lymph nodes and ache with arm movement.


VAERS ID: 1735926 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-09-25
Onset:2021-09-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Headache, Pain in extremity, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (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: Adverse reaction to Gardasil 15 years ago
Other Medications:
Current Illness:
Preexisting Conditions: Obesity
Allergies: Doyxycline
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fatigue, tingling of fingertips, sore L arm, headache


VAERS ID: 1735942 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-09-25
Onset:2021-09-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site pain, Maternal exposure during breast feeding, Nausea
SMQs:, Acute pancreatitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Neonatal exposures via breast milk (narrow)

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

Write-up: Pain in injection site Nausea 4 hours after vaccination that subsided alone Breastfed 20 month old increased breastfeeding following day, experienced low grade fever and fussiness starting 24 hours after vaccination. Unknown if related to mother''s vaccination.


VAERS ID: 1735953 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-09-26
Onset:2021-09-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 019F21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: none
CDC Split Type:

Write-up: Patient came to the pharmacy to ask for 1st dose of Moderna. Patient denied of having any previous COVID-19 vaccine previously. After counseled patient on Moderna vaccine, and the vaccine was administered, pharmacist found out that patient had Johnson & Johnson vaccine via vaccine records in March 20, 2021. Even though patient was counseled by the pharmacist that J&J and Moderna haven''t been approved for any booster, patient didn''t disclose to the pharmacist that patient had J&J already. Patient and his spouse admitted that they did some research on J&J that wasn''t effective to protect them from the variant, so both of them decided to get Moderna, even pharmacist mentioned at consultation . No symptoms and adverse effects were reported at this point.


VAERS ID: 1735966 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-09-26
Onset:2021-09-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 019F21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Patient came to the pharmacy to ask for 1st dose of Moderna. Patient denied of having any previous COVID-19 vaccine previously. After counseled patient on Moderna vaccine, and the vaccine was administered, pharmacist found out that patient had Johnson & Johnson vaccine via vaccine records in March 20, 2021. Even though patient was counseled by the pharmacist that J&J and Moderna haven''t been approved for any booster, patient didn''t disclose to the pharmacist that patient had J&J already. Patient and her spouse admitted that they did some research on J&J that wasn''t effective to protect them from the variant, so both of them decided to get Moderna . No symptoms and adverse effects were reported at this point.


VAERS ID: 1735977 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-26
Onset:2021-09-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Heavy menstrual bleeding, Hormone level abnormal, Menstruation irregular, Mood swings, Vaginal haemorrhage
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Dementia (broad), Depression (excl suicide and self injury) (broad), Fertility disorders (broad)

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

Write-up: Hormonal Imbalance. Frequent bleeding every month in between periods lasting from ovulation through period. Periods now coming twice a month. Heavier periods. Mood swings. Linea nigra appeared (not pregnant).


VAERS ID: 1735993 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-26
Onset:2021-09-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH I / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Diarrhoea
SMQs:, 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Diarrhea.


VAERS ID: 1736010 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: Nebraska  
Vaccinated:2021-09-25
Onset:2021-09-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH #0.3 / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Omeprezole, stool softner, zertec
Current Illness: None
Preexisting Conditions: CAD, dysthemia, also have a pace maker
Allergies: Dog and cat dander, arborvitae
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Headache, nausea, chills, muscle aches and tiredness. Treating it with naproxen, 22o mg tid


VAERS ID: 1736016 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-25
Onset:2021-09-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 RA / IM
FLU4: INFLUENZA (SEASONAL) (FLULAVAL QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS - / 1 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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Headache, fever, soreness at injection site, fatigue beginning at 0100. Managed with rest, fluids, and ibuprofen.


VAERS ID: 1736055 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-26
Onset:2021-09-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301358A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Dyspnoea, General physical condition abnormal, General physical health deterioration, Hyporesponsive to stimuli, Neurological symptom, Pallor, Throat irritation, Tremor, Unresponsive to stimuli, Visual brightness, Visual impairment
SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Glaucoma (broad), Optic nerve disorders (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (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:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pfizer 0.3 mL covid-19 (NDC 59267-1000-01 lot 301358A exp 11/21) was administered to the patient. About 5 minutes after administrating the shot, the patient complained of vision changes, seeing a bright light, burning throat, weakness, shortness of breathe. When I talked to the patient he had a delay in response compared to before the shot was administered, I had the EPI pen ready as the patient was declining in condition, I decided to give 10ml of Benadryl after calling 911, I took the patients blood pressure and did not note hypotension. The fire department arrived and took patients vitals everything looked ok, but the patient did not look okay, the gentleman from the fire department agreed the patient did not look good, patient looked pale, and not responding. Patient developed shaking in his right hand. The fire department asked the wife if she wanted to drive him, or should they call EMS. Wife requested an ambulance. Patient was taken by ambulance to destination chosen by EMS. Patients wife showed up after I closed the pharmacy and informed me the patient went to medical center and emergency room doctor sent her back to the pharmacy to get aspirin 81mg per patients wife emergency room doctor said patient had a neurological even after the vaccine, I talked to patients wife about the aspirin dose and formulation patients wife was a very nice lady as well as patient.


VAERS ID: 1736138 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-01-18
Onset:2021-09-26
   Days after vaccination:251
Submitted: 0000-00-00
Entered: 2021-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1686 / 2 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1685 / 1 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 covid positive despite being fully vaccinated.


VAERS ID: 1736151 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-19
Onset:2021-09-26
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prenatal vitamin, sunflower let chin, fish oil, iron
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Redness, swelling, itching. Did not occur until 7 days post injection


VAERS ID: 1736152 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-09-25
Onset:2021-09-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050E / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anxiety, Headache, Peripheral swelling, Skin warm
SMQs:, Cardiac failure (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypoglycaemia (broad)

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

Write-up: Major anxiety attack (only 1 x in past history 2001 when given procardia after birth) Anxiety attack lasted 4 hours. Headache all day , sore arm (hot swollen ).


VAERS ID: 1736160 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-09-26
Onset:2021-09-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Seizure, Tachycardia
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Zyrtec 10mg daily Multi vitamin daily Zofran PRN Imitrex 50mg PRN Hydroxyzine 50mg PRN
Current Illness: None
Preexisting Conditions: Migraines PTSD Anxiety Ehler?s Danlos Hyper mobility Joint Syndrome Conversion Syndrome Pseudoseizures
Allergies: Keflex-hives Amoxicillin-hives PCN-hives Lisinopril-tachycardia and decreased BP Zosinamide-manic, left eye closure, dry mouth, irritability, anger Shrimp-hives Dialaudid -anaphylaxis Vancomycin-anaphylaxis Propranolol-muscle pain, urine retention Cymbalta-auditory/visual hallucinations Paxil- SI Topimax- non-epileptic seizures Pollen, trees, grass- per allergist Tape/Bandages
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Tachycardia started approximately 30 minutes after receiving dose. Seizures began approximately 6 hours after receiving dose


VAERS ID: 1736161 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-25
Onset:2021-09-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301408A / 3 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, Chills, Fatigue, Injection site pain, Myalgia, Tachycardia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Extravasation events (injections, infusions and implants) (broad), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Dehydration (broad)

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

Write-up: Tachycardia Fatigue Chills Muscle aches Joint pain Site pain


VAERS ID: 1736457 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-26
Onset:2021-09-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 061E21A / 3 LA / IM

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

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

Write-up: Error: Wrong Vaccine Formulation (ex. different manufact. initial and booster)-


VAERS ID: 1736468 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-09-26
Onset:2021-09-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / 1 LA / IM

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

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

Write-up: Systemic: Headache-Severe, Systemic: Nausea-Severe, Systemic: Vomiting-Severe, Additional Details: advised pt mom to get tylenol and emetrol. if problems persist, recommended to go to urgent care


VAERS ID: 1736480 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-09-21
Onset:2021-09-26
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Irritability, Menstruation delayed, Muscle spasms
SMQs:, Dystonia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Fertility 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: None
Current Illness: None
Preexisting Conditions: None
Allergies: Penecilin sensitivity only known allergy besides seasonal allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Period/cycle came 5 days after the second dose. Cramping started within 48 hours of the shot along with irritability.


VAERS ID: 1736484 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-26
Onset:2021-09-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 061E21A / 2 RA / IM

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

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

Write-up: Site: Swelling at Injection Site-Severe, Additional Details: arm very swollen - entire length arm. no other side effects.


VAERS ID: 1736487 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-09-26
Onset:2021-09-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Ear discomfort, Fatigue, Flushing, Hyperhidrosis, Hypoaesthesia, Lethargy, Malaise, Pallor, Paraesthesia, Syncope, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Hypoglycaemia (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? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Systemic: Dizziness / Lightheadness-Severe, Systemic: Exhaustion / Lethargy-Mild, Systemic: Fainting / Unresponsive-Medium, Systemic: Flushed / Sweating-Mild, Systemic: Numbness (specify: facial area, extremities)-Mild, Systemic: Tingling (specify: facial area, extemities)-Mild, Additional Details: Pt recieved flu then covid vaccine, said she didnt feel good and fainted. LOC for 6 seconds, woke up with nausea. Pt given juice and water and ice pack. Pt felt better after 15 minutes. Pt reported N/V, tinginling in fingers, flushing of face, loss of color to face, and ears felt on fire.


VAERS ID: 1736490 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-03-26
Onset:2021-09-26
   Days after vaccination:184
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8730 / 2 LA / IM

Administered by: Private       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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: hospitalization (non-ICU)


VAERS ID: 1736494 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-09-25
Onset:2021-09-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, Chills, Headache, Nausea, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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: Xyzal
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever of 103 degrees for roughly 3 hours followed by fever lowering to 100 degrees for roughly 16 hours with severe headache, nausea, and vomiting. Strong soreness in joints from shivering with fever.


VAERS ID: 1736658 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-03-17
Onset:2021-09-26
   Days after vaccination:193
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER2613 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Unevaluable event
SMQs:

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

Write-up: hospitalization (non-ICU)


VAERS ID: 1736667 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Unknown  
Location: Florida  
Vaccinated:1972-12-28
Onset:2021-09-26
   Days after vaccination:17804
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: lip swelling


VAERS ID: 1736672 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-09-25
Onset:2021-09-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD0809 / 3 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Back pain, Chills, Diarrhoea, Faeces discoloured, Hyperhidrosis, Nausea
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Tylenol 3 with codeine ? synthroid ? metoprolol? chlorathalidone ?lorazepam ? protonix tabs amiodipine ? magnesium oxide?potassium
Current Illness: Ademna in legs
Preexisting Conditions: Mitral valve disorder?hypothyroidism?overactive bladder osteoarthritis
Allergies: Demerol ? beef?grass?pollen?grass & trees ? macrobid ? milk ? mold
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Back ache- nausea-diarrhea (black)-sweats-chills


VAERS ID: 1736703 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-09-25
Onset:2021-09-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017E21A / 1 RA / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 049E21A / 1 RA / SYR

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

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

Write-up: Broke out in hives one day following 2nd injection of Moderna. Hives started on neck and chest and continue to move upwards towards my right and left side of neck, and down the right side of my arm (side the injection was given).


VAERS ID: 1736720 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-03-12
Onset:2021-09-26
   Days after vaccination:198
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1802072 / 1 AR / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, COVID-19 pneumonia
SMQs:, Anaphylactic reaction (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient had COVID vaccine on 3/12/21(Janssen), and is hospitalized now (admitted 9/26/21) with acute hypoxic rerspiratory failure secondary to COVID pneumonia (expected D/C is not for 3 or 4 more days)


VAERS ID: 1736759 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-09-25
Onset:2021-09-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Prenatal vitamin, famotidine
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Normal urinalysis, fetal heart rate monitoring and tocometer
CDC Split Type:

Write-up: I am 32 weeks pregnant with my second pregnancy (first ended in miscarriage at 7 weeks). I started feeling contractions in the date specified. These became more frequent over the course of two hours. I called the nurse triage line and was told to present to the hospital where I was observed overnight and given medication to stop them. My cervix was unchanged so I was able to get sent home with nifedipine for any continued contractions.


VAERS ID: 1736814 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-03-30
Onset:2021-09-26
   Days after vaccination:180
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7533 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Catheterisation cardiac normal, Chest discomfort, Dyspnoea, Echocardiogram normal, Electrocardiogram, Myocarditis, Syncope, Troponin increased
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Citalopram and levothyroxine
Current Illness:
Preexisting Conditions: Anxiety, hypothyroidism
Allergies: latex, sulfonamide antibiotics
Diagnostic Lab Data: Hospital admission 9/26 through 9/27 EKG, troponin testing (elevated), echocardiogram (normal), cardiac catheterization (no obstructive CAD)
CDC Split Type:

Write-up: Patient reports feeling short of breath since receiving COVID vaccine in March. In September had a syncopal episode and had some chest discomfort, was hospitalized and diagnosed with myopericarditis. Patient feels this is related to her COVID vaccine. Resolved within 24 hours with pericarditis therapy.


VAERS ID: 1736815 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-23
Onset:2021-09-26
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Blood fibrinogen decreased, Exposure during pregnancy, Foetal death, Foetal heart rate abnormal, Foetal hypokinesia, International normalised ratio abnormal, Prothrombin level abnormal, Ultrasound antenatal screen abnormal
SMQs:, Liver-related coagulation and bleeding disturbances (narrow), Haemorrhage laboratory terms (broad), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Foetal disorders (narrow), Termination of pregnancy and risk of abortion (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: Gestational diabetes
Allergies: Penicillin
Diagnostic Lab Data: Coagulation panel showed critically low fibrinogen, abnormal findings for PT and INR. Pt transferred to higher level of care for treatment of possible disseminated intravascular coagulation.
CDC Split Type:

Write-up: Pt came to hospital for decreased fetal movement. Ultrasound verified no cardiac activity in fetus, diagnosed intrauterine fetal demise at 34 weeks, 2 days gestation. Pt reported she had received her second covid vaccine on 9/23/21, after it was mandated for her job. She reported last feeling baby move on 9/25/21.


VAERS ID: 1736829 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-09-12
Onset:2021-09-26
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / SYR

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

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

Write-up: Red rash all over body. Took Benadryl


VAERS ID: 1736855 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Utah  
Vaccinated:2021-09-24
Onset:2021-09-26
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Diarrhoea, Dysphagia, Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)

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

Write-up: Severe Nausea, Vomitting, and diarrhea that lasted for approximately 5 hours. Could not keep water down.


VAERS ID: 1736857 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-26
Onset:2021-09-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / IM

Administered by: Other       Purchased by: ?
Symptoms: Arthralgia
SMQs:, Arthritis (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: penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Joint Pain in wrist


VAERS ID: 1736858 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-09-26
Onset:2021-09-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301358A / 3 RA / IM

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

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

Write-up: Patient was supposed to be receiving a flu shot but Pfizer Covid-19 was inadvertently grabbed and given to patient Patient is currently on way for treatment


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