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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 97 out of 8,010

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VAERS ID: 1766336 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-05-05
Onset:2021-09-26
   Days after vaccination:144
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test normal, Deep vein thrombosis, Pain in extremity, Ultrasound scan normal
SMQs:, Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Nope none
Current Illness: None
Preexisting Conditions: Nope
Allergies: Nope
Diagnostic Lab Data: Gave me ultrasound. Ran lots of blood work and all blood work came back normal so far. Still running blood work.
CDC Split Type:

Write-up: Starting early last week I was having awful pain in calf. Went to ER and they gave me an ultrasound. Diagnosed with dvt. I?m not for sure saying it is from the vaccine just that I definitely think it could be as I have no other factors that would make sense of why me, a young 26 year old healthy girl has a blood clot.


VAERS ID: 1766952 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-08-28
Onset:2021-09-26
   Days after vaccination:29
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020F21A / 1 RA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Blood pressure fluctuation, Blood pressure measurement, Feeling abnormal
SMQs:, Neuroleptic malignant syndrome (broad), Dementia (broad), Hypertension (broad), Cardiomyopathy (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
Current Illness: Blood pressure high
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210926; Test Name: Blood pressure; Result Unstructured Data: was up (could not remember the numbers).; Test Date: 20210928; Test Name: Blood pressure; Result Unstructured Data: at 2 o''clock BP was 140/98; Test Date: 20210928; Test Name: Blood pressure; Result Unstructured Data: a little while ago it was down to 123/87; Test Date: 20210928; Test Name: Blood pressure; Result Unstructured Data: a little while ago it was down to 124/88
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: blood pressure was up, at 2 o''clock her BP was 140/98, was down to 123/87 and 124/88; Didn''t feel good/felt fuzzy; This spontaneous case was reported by a consumer and describes the occurrence of BLOOD PRESSURE FLUCTUATION (blood pressure was up, at 2 o''clock her BP was 140/98, was down to 123/87 and 124/88) and FEELING ABNORMAL (Didn''t feel good/felt fuzzy) in a 69-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 051E21A and 020F21A) for COVID-19 vaccination. Concurrent medical conditions included Blood pressure high. Concomitant products included AMLODIPINE for Blood pressure high. On 28-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 25-Sep-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 26-Sep-2021, the patient experienced BLOOD PRESSURE FLUCTUATION (blood pressure was up, at 2 o''clock her BP was 140/98, was down to 123/87 and 124/88) and FEELING ABNORMAL (Didn''t feel good/felt fuzzy). At the time of the report, BLOOD PRESSURE FLUCTUATION (blood pressure was up, at 2 o''clock her BP was 140/98, was down to 123/87 and 124/88) and FEELING ABNORMAL (Didn''t feel good/felt fuzzy) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 26-Sep-2021, Blood pressure measurement: high (High) was up (could not remember the numbers).. On 28-Sep-2021, Blood pressure measurement: 140/98 (High) at 2 o''clock BP was 140/98, 123/87 (High) a little while ago it was down to 123/87 and 124/88 (High) a little while ago it was down to 124/88. No treatment information was provided by the reporter.


VAERS ID: 1766969 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-21
Onset:2021-09-26
   Days after vaccination:36
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 015E21A / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Lymphadenopathy, Vaccination site erythema, Vaccination site pruritus
SMQs:, Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Area around the injection site very red; Area around the injection site very, very itchy; Lymph nodes under left arm swollen; This spontaneous case was reported by a patient and describes the occurrence of VACCINATION SITE ERYTHEMA (Area around the injection site very red), VACCINATION SITE PRURITUS (Area around the injection site very, very itchy) and LYMPHADENOPATHY (Lymph nodes under left arm swollen) in a 59-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 047C21A and 015E21A) for COVID-19 vaccination. No Medical History information was reported. On 21-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 25-Sep-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 26-Sep-2021, the patient experienced VACCINATION SITE ERYTHEMA (Area around the injection site very red), VACCINATION SITE PRURITUS (Area around the injection site very, very itchy) and LYMPHADENOPATHY (Lymph nodes under left arm swollen). At the time of the report, VACCINATION SITE ERYTHEMA (Area around the injection site very red), VACCINATION SITE PRURITUS (Area around the injection site very, very itchy) and LYMPHADENOPATHY (Lymph nodes under left arm swollen) outcome was unknown. No Concomitant medication reported. No treatment medication reported This case was linked to MOD-2021-335046 (Patient Link).


VAERS ID: 1767005 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-08-01
Onset:2021-09-26
   Days after vaccination:56
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 091D21A / 1 RA / OT

Administered by: Unknown       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? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Bell''s Palsy on the right side of his face; This spontaneous case was reported by a consumer and describes the occurrence of BELL''S PALSY (Bell''s Palsy on the right side of his face) in a 58-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 058E21A and 091D21A) for COVID-19 vaccination. No Medical History information was reported. On 01-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 29-Aug-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 26-Sep-2021, the patient experienced BELL''S PALSY (Bell''s Palsy on the right side of his face) (seriousness criterion medically significant). At the time of the report, BELL''S PALSY (Bell''s Palsy on the right side of his face) outcome was unknown. Concomitant product use was not provided by the reporter. No treatment information was provided. Wife is calling to report that her 58-year-old husband received the first dose of Moderna COVID-19 vaccine on 01AUG2021 in the Right arm (Lot# 091D21A & Exp. Date: Unknown). He had the second Moderna COVID-19 vaccine on 29AUG2021, in the left arm (Lot# 058E21A & Exp. Date: Unknown ). Wife states that on 26SEP2021, He developed Bell''s Palsy on the right side of his face (Not confirmed by HCP). Wife states that they have not informed his doctor yet and have not called VAERS. Company comment: This case concerns a 58 year old male with no relevant medical history who experienced Serious expected event of Bell''''s palsy approximately a less than a month after receiving the second dose of Moderna Covid 19 vaccine. Rechallenge was not applicable. The benefit-risk relationship is not affected by this report.; Sender''s Comments: This case concerns a 58 year old male with no relevant medical history who experienced Serious expected event of Bell''''s palsy approximately a less than a month after receiving the second dose of Moderna Covid 19 vaccine. Rechallenge was not applicable. The benefit-risk relationship is not affected by this report.


VAERS ID: 1767049 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: California  
Vaccinated:2021-02-20
Onset:2021-09-26
   Days after vaccination:218
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041L20A / 2 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Back disorder, Discomfort, Musculoskeletal discomfort, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Knocked her on her back; knot in her shoulder; a little discomfort; low grade fever; This spontaneous case was reported by a consumer and describes the occurrence of BACK DISORDER (Knocked her on her back), MUSCULOSKELETAL DISCOMFORT (knot in her shoulder), DISCOMFORT (a little discomfort) and PYREXIA (low grade fever) in a 74-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 041L20A) for COVID-19 vaccination. No Medical History information was reported. On 20-Feb-2021, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 26-Sep-2021, received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On 26-Sep-2021, the patient experienced BACK DISORDER (Knocked her on her back), MUSCULOSKELETAL DISCOMFORT (knot in her shoulder), DISCOMFORT (a little discomfort) and PYREXIA (low grade fever). At the time of the report, BACK DISORDER (Knocked her on her back), MUSCULOSKELETAL DISCOMFORT (knot in her shoulder), DISCOMFORT (a little discomfort) and PYREXIA (low grade fever) outcome was unknown. No concomitant medication details was reported. No treatment medication details was reported.


VAERS ID: 1767115 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-08-30
Onset:2021-09-26
   Days after vaccination:27
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 3004960 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Abdominal pain, Abdominal tenderness, Alanine aminotransferase increased, Arthralgia, Aspartate aminotransferase increased, Back pain, Biopsy skin, Blood albumin, Blood creatinine increased, Blood fibrinogen normal, Blood magnesium decreased, Blood potassium normal, Blood sodium decreased, Calcium ionised decreased, Chest X-ray normal, Cholelithiasis, Chromaturia, Computerised tomogram abdomen abnormal, Cryptorchism, Decreased appetite, Echocardiogram, Ejection fraction, Electrocardiogram normal, Erythema, Gastrointestinal oedema, Glucose urine absent, Haematocrit normal, Haemoglobin increased, Hepatitis B surface antibody, Hepatitis B surface antigen, Lip dry, Lipase, Lymphocyte count, Malaise, Mucosal hypertrophy, Myalgia, Neutrophil count, Oedema, Oedema peripheral, Pain, Papule, Petechiae, Platelet count normal, Protein total, Protein urine absent, Rash, Red blood cell sedimentation rate increased, Red blood cells urine, Scan with contrast abnormal, Skin plaque, Urinary sediment present, Vasculitis, White blood cell count normal, White blood cells urine positive
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Cardiac failure (broad), Liver related investigations, signs and symptoms (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Haemorrhage terms (excl laboratory terms) (narrow), Retroperitoneal fibrosis (broad), Congenital, familial and genetic disorders (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Gallbladder related disorders (narrow), Gallstone related disorders (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hyponatraemia/SIADH (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Vasculitis (narrow), Chronic kidney disease (broad), Hypersensitivity (narrow), Arthritis (broad), Tumour lysis syndrome (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: NONE
Diagnostic Lab Data:
CDC Split Type:

Write-up: 4 days prior to admission, patient suddenly noted bipedal edema, pitting in character along with petechial rashes on the bilateral feet. Rashes were non ? tender and non ? pruritic. No other associated signs and symptoms. No medications taken. No consult done. 3 days prior to admission, bipedal edema persisted and rashes progressed above the knee. The patient experienced joint and muscle pains which were intermittent and migratory. It would occur on the knees or the elbows or on the low back area. No fever noted. No consult done. 1 day prior to admission, symptoms persisted, hence teleconsult was done and was requested the following labs: Urinalysis: yellow, clear, acidic, negative protein and sugar, 0-1RBC, 0-1WBC, 0-1 pus, few epithelial cells Crea 70.72 SGPT 230 (increased) ESR 37 (increased) HBsAg and AntiHBs non-reactive Before being able to follow up, the patient developed severe generalized abdominal pain, crampy in character, 10/10 on the pain score which would last for a few minutes to hours then will spontaneously resolve. This was not aggravated by food intake. Few hours prior to the admission, the pain was no longer bearable, hence consult at the ER and subsequent admission. ROS: (+) chronic low back pain, work up showed normal results (-) Anosmia, ageusia, lower urinary tract symptoms, BM changes (-) Chest pain, palpitations, orthopnea, edema Past Medical History: Unremarkable Injected with 1st dose of COVID Vaccine (Moderna) last August 30, 2021 Family History: Unremarkable Social History: Non-smoker, non-alcoholic beverage drinker, denies illicit drug use Patient is a Pastor. He lives with pregnant wife and 2 toddlers in a studio-type apartment. Upon arrival at the ER, he was awake, in severe pain Vital Signs: BP 100/80 HR 71 RR 22 Temp: 36.2 O2 sat: 98% at RA Anicteric sclerae, pink palpebral conjunctivae, no CLADS Nondistended neck veins, dry lips and moist oral mucosa Clear breath sounds Normal rate regular rhythm, no murmurs Soft abdomen with normoactive bowel sounds, (+) tenderness on all quadrants more prominent on the right hemiabdomen Full pulses, grade 1 bipedal and bilateral hand edema (+) Multiple, dusky erythematous, well-defined, round non-blanchable papules and plaques on the lower extremities Course in the Wards: The patient was admitted as a possible case of COVID Vaccine Induced HSP given the timeline of events. He was referred to the Nephrology, Rheumatology, Gastroenterology, Hematology and Infectious Disease Services. Work up was done. Steroids were started along with pain medications. Due to difficulty of eating due to the feeling of unwellness, patient was started on IV hydration. After initiation of steroids, there was significant decrease in abdominal pain. On the 1st hospital day, the patient is stable with less abdominal pain. He was referred to the Dermatology service and biopsy of the skin lesions were done. Results are still pending. CT Scan of the whole abdomen with IV contrast was also done and showed gastric and bowel wall edema, irregular mucosal thickening and undue enhancement with fat stranding and adjacent prominent sub centimeter lymph nodes which may be secondary to a non-specific vasculitis. Management was continued. On the 2nd up to current hospital day, patient subjectively feels better. Edema is resolving along with rashes. Abdominal pain is less and patient has better appetite. 09.30.21 HEMATOLOGY Hemoglobin 162 hematocrit 46 WBC 5 -10 x 10^9 / L 8.0 Neutrophils 72 lymphocytes 28 Platelets 150 09.30.21 SERUM CHEMISTRY Sodium 135 Potassium 3.7 Mg 0.64 Ionized Calcium 1.25 Albumin Mass 41 SGOT 41.55 (1.0003x) SGPT 140.23 (3.5x) TP 68.53 A 41 G 27.53 Lipase 6.42 Fibrinogen 2.4 09.30.2021 CHEST XRAY: CLEAR ECG: NORMAL SINUS RHYTHM 2D ECHO: 77% EF Normal left ventricular dimensions with adequate contractility and systolic function Normal atria Normal valves Normal left ventricular diastolic function Normal pulmonary artery systolic pressure WHOLE ABDOMINAL CT SCAN WITH IV CONTRAST Impression: 1. Gastric and bowel wall edema, irregular mucosal thickening and undue enhancement with fat stranding and adjacent prominent sub centimeter lymph nodes, as detailed above. In this patient with a history of bipedal edema and purpuric rashes in both lower extremities, findings may be secondary to a non-specific vasculitis. The possibility of gastric and bowel wall infarct or inflammatory changes cannot be entirely excluded. Direct endoscopic visualization is suggested. 2. Cholecystolithiases with no evidence of cholecystitis during the time of examination. 3. Small undescended left testicle.


VAERS ID: 1768033 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-09-01
Onset:2021-09-26
   Days after vaccination:25
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048F21A / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cardiac arrest, Fatigue, Hyperhidrosis, Implantable defibrillator insertion, Pyrexia, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? Yes
Died? No
Permanent Disability? Yes
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: No over the counter meds
Current Illness: I was diagnosed with cardio myopathy in December due to have had Covid back in March of 2020
Preexisting Conditions: Asthma High blood pressure
Allergies: White fish
Diagnostic Lab Data: I was rushed to hospital. Many tests were done and an icd was put in me.
CDC Split Type:

Write-up: That night I was ok- I woke up a little wet so I thought I must have had a fever but I was ok. Then around 1:15 I started getting tired and then I started vomiting and then I went into cardiac arrest. The 2nd dose kept me in bed for 2 days with flu like symptoms so I was expecting that. But this time my heart stopped


VAERS ID: 1768409 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-04-08
Onset:2021-09-26
   Days after vaccination:171
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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

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

Write-up: Breakthrough COVID+ case after completing full vaccination series.


VAERS ID: 1768442 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-26
Onset:2021-09-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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: Was advised by health department that patient had received 3rd shot at a pharmacy before returning to our pharmacy for her 3rd. After looking at our system and the patient''s vaccination card we determined that patient had only received 2 shots and was due to receive her third. She did not disclose that she had already received a 3rd shot.


VAERS ID: 1769022 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-25
Onset:2021-09-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037F21A / 1 LA / IM

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

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

Write-up: Patient reported severe muscle soreness throughout body that has lasted since vaccine (about 2 weeks).


VAERS ID: 1769272 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-09
Onset:2021-09-26
   Days after vaccination:17
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / IM

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

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

Write-up: Patient developed shingles within 3 weeks of vaccine.


VAERS ID: 1770477 (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: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 - / OT

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: receiving a Moderna COVID19 vaccine dose after 2 doses of Pfizer''s COVID19 vaccine; This spontaneous case was reported by a pharmacist and describes the occurrence of INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (receiving a Moderna COVID19 vaccine dose after 2 doses of Pfizer''s COVID19 vaccine) in a 76-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. Previously administered products included for an unreported indication: PFIZER BIONTECH COVID-19 VACCINE (patient had received 2 doses of the Pfizer''s COVID19 vaccine). On 26-Sep-2021, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 26-Sep-2021, the patient experienced INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (receiving a Moderna COVID19 vaccine dose after 2 doses of Pfizer''s COVID19 vaccine). On 26-Sep-2021, INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (receiving a Moderna COVID19 vaccine dose after 2 doses of Pfizer''s COVID19 vaccine) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No concomitant medications were provided by the reporter. Treatment information was not provided.


VAERS ID: 1770587 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-26
Onset:2021-09-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blindness, Seizure
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Glaucoma (broad), Optic nerve disorders (broad), Retinal disorders (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: USPFIZER INC202101266662

Write-up: Almost immediately lost vision; Had a seizure for about 5 seconds; This is a spontaneous report from a contactable consumer (patient). A 22-years-old male patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, Solution for injection), dose 1 via an unspecified route of administration, administered in the left arm on 26Sep2021 at 10:45 (Batch/Lot Number: FF2589) as dose 1, single (at the age of 22 years-old) for Covid-19 immunisation. Medical history was not reported. There were no concomitant medications. No other medications in four weeks. Pharmacy did not monitor after the vaccine was administered. The patient came out to the car and almost immediately lost vision and had a seizure for about 5 seconds on 26Sep2021 at 11:15 AM. The patient had no Covid prior to the vaccination and Covid was not tested post vaccination. No treatment was administered for the events. The outcome of the events was unknown. The events resulted in: Doctor or other healthcare professional office/clinic visit. No follow-up attempts are possible. No further information is expected.


VAERS ID: 1771203 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Rhode Island  
Vaccinated:2021-09-26
Onset:2021-09-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204B21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cardiac flutter, Constipation, Dizziness, Dyspepsia, Feeling hot, Gastrointestinal disorder, Headache
SMQs:, Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Gastrointestinal nonspecific dysfunction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Tachyarrhythmia terms, nonspecific (narrow), Vestibular disorders (broad)

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

Write-up: Headache almost every day since the vaccine Heartburn almost every day since the vaccine Bowel issues including constipation Fluttering in chest periodically Periods of overheating and lightheadedness None of these symptoms are normal for me


VAERS ID: 1771730 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: New York  
Vaccinated:2021-09-26
Onset:2021-09-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 212A21A / 1 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Blood test, Chills, Deafness unilateral, Dizziness, Dyspnoea, Electrocardiogram, Eye haemorrhage, Headache, Hypotension, Palpitations, Tinnitus
SMQs:, Anaphylactic reaction (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Retinal disorders (broad), Hearing impairment (narrow), Vestibular disorders (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Not applicable
Current Illness: Not applicable
Preexisting Conditions: Not applicable
Allergies: Amoxicillin
Diagnostic Lab Data: Ekg, blood tests were done on 9/27/21
CDC Split Type:

Write-up: After receiving the johnson johnson vaccine I began to feel a bit of chest palpitation on my drive back home. Early the next morning I felt extremely winded I checked my vitals. My B/P was significantly lower than normal and my heart was racing averaging 119 to 128. I felt dizziness and as if I''d faint if I bent down. Massive craking headache and chills ensued. I decided to go the urgent care where they did and ekg and found abnormal reading that doesn''t correlate with my normal ekg when I go to my provider. They insisted that I betaken to the ER via ambulance. The ER also reproduced the same abnormal readings. I was advised to see my primary. And my primary advised for me to see a cardiologist. Soon after my hearing in my left ear became diminished with ringing and a blood shot developed in my right eye.


VAERS ID: 1771817 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-09-25
Onset:2021-09-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal discomfort, Chest pain, Condition aggravated, Feeling abnormal, Gastritis, Headache, Impaired work ability, Memory impairment, Oesophageal pain, Pain, Pyrexia, Sensation of foreign body, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific inflammation (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Depression (excl suicide and self injury) (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Tetanus shot - have sore arm after (it usually lasts a day) (can''t remember the last time I had one though)
Other Medications: No
Current Illness: No
Preexisting Conditions: Gastritis - started several years ago (it comes and goes); Migraines
Allergies: Lactose; Codeine; Aleve
Diagnostic Lab Data: No labs or medical test - just a physical exam.
CDC Split Type: vsafe

Write-up: I started having (on Sunday - after midnight, actually) started vomiting all the rest of the morning long. Husband administered Phenergan to me - I have it on hand for Migraines. The rest of the day, I had achiness, headache, fever (got to 101 for awhile then to 9.6). I had those symptoms until Tuesday. I couldn''t go to work on Monday. I don''t remember if I took migraine medicine or not during that time. I have had brain fog - there are things I can''t remember. I was prescribed Omeprazole - the Saturday following the week I got the shot. Because I started getting a burning sensation up esophagus and a sharp pain up in the center underneath my breast bone - felt like someone was stabbing me with a knife) - I went to the Walk-in Clinic (same doctor''s office that I go to - Family Medicine) on that Saturday after I had the symptoms. The doctor thought my gastritis had a flare up again. I have had this sensation since I''ve had the shot. Omeprazole - haven''t been having the sharp pains that I was having but I still feel a lump in my throat. She told me to watch the foods I eat - it''s eating a lot a bland food which is hard to do when I am working outside the home. Still have the stomach issues.


VAERS ID: 1772076 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-09-10
Onset:2021-09-26
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041B21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Chills, Fatigue, Headache, Hot flush, Malaise, Myalgia, Neck pain, Oropharyngeal pain, Pain, Ventricular extrasystoles
SMQs:, Rhabdomyolysis/myopathy (broad), Ventricular tachyarrhythmias (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: toprol , paxil, lipitor, motrin,
Current Illness: seasonal allergies
Preexisting Conditions: LVNC, heart valve prolapses, cardiomyopathies, ect.
Allergies: sulpha, cardizem, latex.
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: As soon as I woke up in the morning I felt sick, my throat hurt my glands head and neck hurt, I had a severe headache body aches, chills, heat flashes more PVC then I normally have, weak and tired, super strong muscle pains, I took, motrin, xanax, flexxeril and alka selter sinus and chloraseptic for my throat pain , prn, I am due to have my 2nd booster shot today and I still have all the same symptoms but much milder now, but is seems to change constantly. I sure hope this next one causes no more side effects and I will have immunity to this virus.


VAERS ID: 1772991 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-24
Onset:2021-09-26
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Asthenia, Chest discomfort, Chest pain
SMQs:, Anaphylactic reaction (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (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: Levoxil - 25 mcg
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Left shoulder pain and weakness - 2 weeks Chest tightness and pain - randomly for 2 weeks


VAERS ID: 1773150 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-09-26
Onset:2021-09-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 1 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Burning sensation, Neck mass
SMQs:, Peripheral neuropathy (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: Asthma
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Burning sensation in hands, chronic on and off. Lump in neck/clavicle area.


VAERS ID: 1773441 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Florida  
Vaccinated:2020-12-30
Onset:2021-09-26
   Days after vaccination:270
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011L20A / 3 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, Body temperature, Decreased appetite, Feeling abnormal, Headache, Myalgia, Pyrexia, Vaccination site pain, Vaccination site pruritus
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Name: BODY TEMPERATURE; Result Unstructured Data: fever of 99.2.
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: has a sore arm with some itching as of today 29Sep2021only her arm is still affected; The following day everything hurt but her hair, she could stay up a half hour then; fever of 99.2; joint pain; bad headache; Her 3rd injection was on 26Sep2021 at 11:30AM that day she had a sore arm; she started feeling bad; she hardly ate or drank all day; This spontaneous case was reported by a consumer and describes the occurrence of FEELING ABNORMAL (she started feeling bad), DECREASED APPETITE (she hardly ate or drank all day), VACCINATION SITE PRURITUS (has a sore arm with some itching as of today 29Sep2021only her arm is still affected), MYALGIA (The following day everything hurt but her hair, she could stay up a half hour then) and PYREXIA (fever of 99.2) in a 65-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 011L20A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. On 30-Dec-2020, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 26-Jan-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 26-Sep-2021 at 11:30 AM, received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 26-Sep-2021, the patient experienced FEELING ABNORMAL (she started feeling bad), DECREASED APPETITE (she hardly ate or drank all day), MYALGIA (The following day everything hurt but her hair, she could stay up a half hour then), PYREXIA (fever of 99.2), ARTHRALGIA (joint pain), HEADACHE (bad headache) and VACCINATION SITE PAIN (Her 3rd injection was on 26Sep2021 at 11:30AM that day she had a sore arm). On 29-Sep-2021, the patient experienced VACCINATION SITE PRURITUS (has a sore arm with some itching as of today 29Sep2021only her arm is still affected). On 28-Sep-2021, FEELING ABNORMAL (she started feeling bad), DECREASED APPETITE (she hardly ate or drank all day), MYALGIA (The following day everything hurt but her hair, she could stay up a half hour then), PYREXIA (fever of 99.2), ARTHRALGIA (joint pain), HEADACHE (bad headache) and VACCINATION SITE PAIN (Her 3rd injection was on 26Sep2021 at 11:30AM that day she had a sore arm) had resolved. At the time of the report, VACCINATION SITE PRURITUS (has a sore arm with some itching as of today 29Sep2021only her arm is still affected) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On an unknown date, Body temperature: 99.2 (High) fever of 99.2.. No concomitant medication reported. No treatment information was provided. This case was linked to MOD-2021-335962, MOD-2021-335979, MOD-2021-335962 (Patient Link).


VAERS ID: 1773626 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-09-25
Onset:2021-09-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 1 RA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Lethargy, Oropharyngeal pain, Pain in extremity, Pharyngitis streptococcal, Pyrexia, SARS-CoV-2 test
SMQs:, Agranulocytosis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal infections (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: LAMOTRIGINE; VYVANSE; QUETIAPINE; PRISTIQ
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Bipolar disorder; Chronic anxiety; Chronic depression; Cyclothymia; Epilepsy; Obesity
Allergies:
Diagnostic Lab Data: Test Date: 202109; Test Name: COVID test name: ID NOW; Test Result: Negative ; Comments: Post vaccination: Test type: Blood test Test name: ID Now
CDC Split Type: USPFIZER INC202101277936

Write-up: then sore throat. It was reported that it almost felt like strep; Sore throat; sore arm; Fever; Lethargy; This is a spontaneous report from a non-contactable consumer (patient). A 28-year-old non-pregnant female patient received bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE, solution for injection), dose 1 via an unspecified route of administration, administered in Arm Right on 25Sep2021 12:30 (Batch/Lot Number: FF2587) (at the age of 28 years, as reported) as DOSE 1, SINGLE for covid-19 immunisation. Medical history included epilepsy, cyclothymic disorder, bipolar disorder, depression, anxiety, obesity, all from an unknown date and unknown if ongoing. The patient did not receive any other vaccines within 4 weeks prior to the COVID vaccine. Concomitant medications included lamotrigine; lisdexamfetamine mesilate (VYVANSE); quetiapine; desvenlafaxine succinate monohydrate (PRISTIQ); all taken for an unspecified indication, start and stop date were not reported. The patient previously took remeron and experienced drug hypersensitivity. It was reported that on 26Sep2021 10:30, the patient experienced sore throat, no coughing or runny nose, the normal sore arm, fever, lethargy, and then sore throat. It was reported that it almost felt like strep. The patient was negative for Covid. The events occurred almost 22 hours after the first dose vaccine. No treatment was received for the events. The outcome of events was not recovered. Prior to vaccination, the patient was not diagnosed with COVID-19. Since the vaccination, the patient been tested for COVID-19. Results of tests and procedures for investigation of the patient: COVID Test type post vaccination: Blood test, COVID Test name post vaccination: ID Now, Result: Negative. No follow-up attempts are possible. No further information is expected.


VAERS ID: 1774911 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-09-23
Onset:2021-09-26
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Computerised tomogram head normal, Endotracheal intubation, Enterovirus test positive, Facial bones fracture, Fall, Human rhinovirus test positive, Injury, Mechanical ventilation, Seizure, Unresponsive to stimuli, Walking aid user
SMQs:, Angioedema (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Hostility/aggression (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Respiratory failure (broad), Hypoglycaemia (broad), Opportunistic infections (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 14 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: gabapentin (NEURONTIN) 400 mg capsule Take 800 mg by mouth 3 times a day dilTIAZem (CARTIA XT) 180 mg extended release capsule Take 180 mg by mouth 1 time per day metFORMIN (GLUCOPHAGE XR) 500 mg extended release tablet Take 1,000 mg by m
Current Illness: Admitted to hospital after weakness and fall at home post vaccine with nasal fracture. Rhino/enterovirus infection detected on 9/26. Discharged to swing bed. Readmitted October 8 with new onset seizure activity, intubated on invasive vent support now.
Preexisting Conditions: DM, HTN, HFrEF, CKD.
Allergies: morphine, lasix, allopurinol.
Diagnostic Lab Data: CT head negative for acute findings. Awaiting neurology consult and EEG.
CDC Split Type:

Write-up: He reported weakness ever since the vaccine. He now reportedly required a walker to get around. He became weaker to the point of suffer a fall 9/26, 3 days after vaccine and was hospitalized with trauma and nasal fracture. Also found to have tested + for rhino/enterovirus. Subsequently discharged to swing bed and readmitted on October 8 with new onset SEIZURES, now unresponsive and intubated on vent support.


VAERS ID: 1775104 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-09-24
Onset:2021-09-26
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Angiogram pulmonary abnormal, Fibrin D dimer, Laboratory test, Pulmonary venous thrombosis
SMQs:, Embolic and thrombotic events, venous (narrow), Pulmonary hypertension (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: smoker
Allergies: none
Diagnostic Lab Data: CTA angio chest in hospital, D dimer, labs
CDC Split Type:

Write-up: pulmonary vein thrombosis


VAERS ID: 1775426 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-08-26
Onset:2021-09-26
   Days after vaccination:31
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anaemia, Blood test
SMQs:, Haematopoietic erythropenia (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: Ability Tegratol Effexor Trazadone Hydroxyzine
Current Illness:
Preexisting Conditions: Mood disorder
Allergies: Lamictal
Diagnostic Lab Data: Blood work 9/26/2021 Bloodwork 10/06/21
CDC Split Type:

Write-up: Anemia


VAERS ID: 1775659 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-01-26
Onset:2021-09-26
   Days after vaccination:243
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1686 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Atypical pneumonia, Body temperature increased, COVID-19, COVID-19 pneumonia, Cardiac failure congestive, Chest X-ray abnormal, Condition aggravated, Dizziness, Fall, Hepatic mass, Lung infiltration, Lung opacity, Pulmonary oedema, SARS-CoV-2 test positive
SMQs:, Cardiac failure (narrow), Liver related investigations, signs and symptoms (narrow), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Accidents and injuries (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 36 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Amiodarone, lovastatin, allopurinol, fish oil, lisinopril/hydrochlorothiazide, magnesium, metoprolol succinate, omeprazole, spironolactone, trihexyphenidyl, ventolin inhaler PRN, warfarin
Current Illness:
Preexisting Conditions: ? GERD (gastroesophageal reflux disease) ? Injury of kidney ? Orthostatic hypotension ? Atherosclerotic heart disease ? Acute on chronic combined systolic and diastolic heart failure ? Presyncope ? Dyslipidemia ? Ventricular fibrillation arrest 05/2014 s/p ICD ? Pernicious anemia ? Hypothyroidism ? Thrombocytopenia ? Pre-diabetes ? Hyperuricemia ? Parkinson disease ? Stroke ? Internal derangement of knee ? S/P ICD (internal cardiac defibrillator) 2014 ? Ventricular tachycardia( NSVT) Abnormal T wave alternans s/p AICD 2007 ? Nonalcoholic steatohepatitis (NASH) ? Chronic kidney disease, stage III (moderate) ? Hernia of abdominal cavity ? Pancytopenia ? Ventricular flutter ? Chronic atrial fibrillation ? Benign nodular prostatic hyperplasia ? Chronic total occlusion of coronary artery RCA ? Anticoagulated on Coumadin ? Ischemic cardiomyopathy(Moderate-Severe LV dysfunction) LVEF 30-35% 2019 ? Chorea ? Falls frequently ? Community acquired pneumonia ? MDS (myelodysplastic syndrome) ? Fall ? Liver mass, left lobe ? Coagulopathy ? Sepsis due to Klebsiella
Allergies: Levofloxacin
Diagnostic Lab Data: 9/6/21 COVID19: positive 9/5/21 chest xray: Slightly worsening opacities within the left upper lobe and right mid lung primary differential consideration includes developing pneumonia multifocal pneumonia or possibly asymmetric edema. 9/6/21 chest xray: Interval worsening in pulmonary parenchymal opacification pattern. Findings suspicious for atypical pneumonia with underlying pulmonary edema not excluded.
CDC Split Type:

Write-up: On 8/29/21, patient was watching TV when he starting to feel very dizzy and had a fall but denies any loss of consciousness. Patient denies any chest pain or shortness of breath or palpitations. Patient denies any abdominal pain or nausea or vomiting or constipation or diarrhea. No fever no chills. Patient was found to have a hepatic mass and CHF. Patient was admitted and COVID was negative on 8/29. On 9/6/21 patient got another COVID19 test done due to spike in temperature and chest xray showed infiltrate. and it came back positive. He also developed COVID 19 infection with pneumonia and was treated with steroids, ceftriaxone and doxy and Remdesivir, off oxygen and off isolation. He was discharged to a nursing home on 10/5/21 for rehab. He will complete antibiotic course with Augmentin 875-125 mg bid for 7 days and Fluconazole 200 mg daily for 7 days.


VAERS ID: 1776060 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-09-25
Onset:2021-09-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 049C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypoaesthesia, Pain in extremity, Paraesthesia, Tinnitus
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Hearing impairment (narrow), Tendinopathies and ligament disorders (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:
CDC Split Type:

Write-up: Systemic: Numbness (specify: facial area, extremities)-Mild, Systemic: Tinnitus-Medium, Additional Details: Aches along the edge of his ulna bone on his left arm. Patient also describes tingling in the heel of his left had. Tinnitus worse in left ear than right.


VAERS ID: 1776362 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-09-25
Onset:2021-09-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH B01358A / 3 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Losartan, Hydrochlorothiazide, Metformin, Levothyroxine, Atorvastatin, Vit B-12, Vit D-3, Multivitamin, Fish Oil, Glucosamine-Chondroitin, Alpha-Lipoic Acid
Current Illness: None
Preexisting Conditions: Controlled high blood pressure, prediabetes
Allergies: Penicillin, Percodan
Diagnostic Lab Data:
CDC Split Type:

Write-up: About 26 hours after shot my hands began to itch and 27 hours after shot my tongue swelled. Hands had stopped itching. All Urgent Cares closed on Sunday evening. Talked to a pharmacist and was advised to take Benadryl. Took 2 pills every 4 hours for a total of 6 pills. Tongue returned to normal size within 4 hours of first 2 pills. Contacted my internist the next morning (Monday). Since reaction had reversed, I did not visit doctor office.


VAERS ID: 1776384 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-03-01
Onset:2021-09-26
   Days after vaccination:209
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Dyspnoea, Productive cough, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: KIDNEY & PANCREAS TRANSPLANT 2020, CAD S/P STENT PLACEMENT X 2, OSA, HTN
Allergies:
Diagnostic Lab Data: NASOPHARYNGEAL COVID-19 PCR 10/10/21 - POSITIVE
CDC Split Type:

Write-up: SYMPTOMATIC COVID-19 - SPO2 64% ON RA, PROGRESSIVE SOB; PRODUCTIVE, PURULENT COUGH


VAERS ID: 1776523 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-09-24
Onset:2021-09-26
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Deafness bilateral, Ear pain, Hypoacusis, Tinnitus
SMQs:, Hearing impairment (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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: I LOST HEARING IN BOTH EARS. I AM EXPERIENCING TINNITIS IN ONE EAR WHICH IS ABOUT HALF VOLUME W MUFFLED SOUND AND SHARP PAIN AND EVEN LESS HEARING WITH EVEN MORE MUFFLED IN LEFT EAR.


VAERS ID: 1776704 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-10
Onset:2021-09-26
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Activated partial thromboplastin time, Angiogram cerebral, Antithrombin III, Arteriogram carotid, Blood glucose, Blood homocysteine, Blood immunoglobulin G, Blood immunoglobulin M, Blood magnesium, Blood phosphorus, C-reactive protein, Cardiolipin antibody, Cerebrovascular accident, Chest X-ray, Coagulation factor VIII level, Computerised tomogram head, Differential white blood cell count, Echocardiogram, Electrocardiogram, Full blood count, Gene mutation identification test, Glomerular filtration rate, Glycosylated haemoglobin, Hypoaesthesia, Laboratory test, Lipids, Magnetic resonance imaging head, Metabolic function test, Muscular weakness, Perfusion brain scan, Prothrombin level, Prothrombin time, Red blood cell sedimentation rate, SARS-CoV-2 antibody test, SARS-CoV-2 test, Scan with contrast, Troponin I, Ultrasound Doppler, Urine analysis, Venogram
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), COVID-19 (broad), Sexual dysfunction (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: CT HEAD W/O CONTRAST Sep 28, 2021 TEE COMPLETE Sep 28, 2021 HOMOCYSTEINE Sep 28, 2021 ECHO COMPLETE Sep 27, 2021 US CAROTID DUPLEX Sep 27, 2021 US LOWER EXTREMITY VENOUS BILAT Sep 27, 2021 CT HEAD W/O CONTRAST Sep 27, 2021 CBC WITHOUT DIFFERENTIAL Sep 27, 2021 BASIC METABOLIC PANEL Sep 27, 2021 MAGNESIUM Sep 27, 2021 PHOSPHORUS Sep 27, 2021 PROTHROMBIN TIME Sep 27, 2021 ACTIVATED PARTIAL THROMBOPLA? Sep 27, 2021 MISC LAB - TYPE IN, BLOOD Sep 27, 2021 FACTOR II MUTATION BY PCR Sep 27, 2021 FACTOR V LEIDEN BY PCR Sep 27, 2021 CARDIOLIPIN ANTIBODIES, IGG & IGM Sep 27, 2021 ANTITHROMBIN III Sep 27, 2021 FACTOR VIII ASSAY Sep 27, 2021 ESTIMATED GLOMERULAR FILTRATI? Sep 27, 2021 LIPID PANEL Sep 27, 2021 COMPREHENSIVE METABOLIC PANEL Sep 27, 2021 COMPLETE BLOOD COUNT Sep 27, 2021 DIFFERENTIAL Sep 27, 2021 ESTIMATED GLOMERULAR FILTRATI? Sep 27, 2021 MRI BRAIN W/ AND W/O CONTRAST Sep 26, 2021 MRV BRAIN W/O CONTRAST Sep 26, 2021 POC URINALYSIS DIPSTICK Sep 26, 2021 XR CHEST 1 VIEW Sep 26, 2021 HEMOGLOBIN A1C Sep 26, 2021 C-REACTIVE PROTEIN, (CRP HS, CAR? Sep 26, 2021 HOMOCYSTEINE Sep 26, 2021 SEDIMENTATION RATE, WESTERGREN Sep 26, 2021 CT BRAIN PERFUSION Sep 26, 2021 CTA HEAD & NECK Sep 26, 2021 SARS-COV-2 MOLECULAR(RAPID-AB? Sep 26, 2021 CT HEAD W/O CONTRAST Sep 26, 2021 COMPLETE BLOOD COUNT Sep 26, 2021 ACTIVATED PARTIAL THROMBOPLA? Sep 26, 2021 PROTHROMBIN TIME Sep 26, 2021 TROPONIN I, HIGH-SENSITIVITY Sep 26, 2021 COMPREHENSIVE METABOLIC PANEL Sep 26, 2021 DIFFERENTIAL Sep 26, 2021 ESTIMATED GLOMERULAR FILTRATI? Sep 26, 2021 ECG ROUTINE 12 + LEADS Sep 26, 2021 POC GLUCOSE Unknown Provider Sep 26, 2021
CDC Split Type:

Write-up: Stroke; at 1:30 pm Sept.26 left arm became non-responsive; called 911; in ER left side of face began to feel numb and left leg was becoming weaker; doctors administered stroke medicine at 5pm after which left arm started responding, but fingers were still numb;


VAERS ID: 1776788 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: West Virginia  
Vaccinated:2021-09-09
Onset:2021-09-26
   Days after vaccination:17
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050E21A / UNK UN / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Blepharospasm, Cerebral infarction, Dyskinesia, Dysstasia, Epilepsy, Facial paralysis, Loss of consciousness, Posture abnormal, Slow response to stimuli, Wheelchair user
SMQs:, Torsade de pointes/QT prolongation (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), Ischaemic central nervous system vascular conditions (narrow), Convulsions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Dyskinesia (narrow), Dystonia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hearing impairment (broad), Periorbital and eyelid disorders (narrow), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Gatifloxacin, Cipro, Levaquin, Penicillins, Quinolones, Latex
Current Illness:
Preexisting Conditions: UNSPECIFIED SEQUELAE OF CEREBRAL INFARCTION 5/12/2021 noted in the medical record CHRONIC OBSTRUCTIVE PULMONARY DISEASE, UNSPECIFIED 3/24/2021 ATHEROSCLEROTIC HEART DISEASE OF NATIVE CORONARY ARTERY WITHOUT ANGINA PECTORIS 3/24/221 GASTRO-ESOPHAGEAL REFLUX DISEASE WITHOUT ESOPHAGITIS hyperlipidemia CONTACT WITH AND (SUSPECTED) EXPOSURE TO COVID-19 3/24/2021 CEREBRAL INFARCTION, UNSPECIFIED 3/24/2021
Allergies: Gatifloxacin, Cipro, Levaquin, Penicillins, Quinolones, Latex
Diagnostic Lab Data:
CDC Split Type:

Write-up: the resident was noted to be leaning to the right side from w/c almost falling to the floor before cna caught her and assisted her upright. loss of consciousness noted, jerking to the left side, left eye twitching approximately 1 minute. assisted to bed to assess, unable to follow direction, unable to stand, mouth drawn to the left side. she began to arouse in and out with verbal stimuli but was not able to follow directions. . Sent to ER for medical evaluation Diagnosis updated: 9/29/2021 - EPILEPSY, UNSP, NOT INTRACTABLE, WITHOUT STATUS EPILEPTICUS, I69.398: OTHER SEQUELAE OF CEREBRAL INFARCTION The patient started on Keppra


VAERS ID: 1776869 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-26
Onset:2021-09-26
   Days after vaccination:184
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014M20A / 2 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009B323A / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Cough, Headache, Nausea, Oropharyngeal pain, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

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

Write-up: sore throat, headache, cough, nausea and vomiting


VAERS ID: 1776915 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-08-25
Onset:2021-09-26
   Days after vaccination:32
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033B21A / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Anosmia, Cough, Decreased appetite, Dyspnoea, Fatigue, Pyrexia, Rhinorrhoea
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: fever, runny nose, fatigue, cough, shortness of breath, no appetite, loss of smell


VAERS ID: 1776947 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-03
Onset:2021-09-26
   Days after vaccination:23
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025B21A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046B21A / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Cough, Fatigue, Headache, Nasal congestion, Oropharyngeal pain, Pain, Rhinorrhoea
SMQs:, Anaphylactic reaction (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (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: runny nose, sore throat, headache, fatigue, cough, achy; and nasal congestion


VAERS ID: 1777002 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-02
Onset:2021-09-26
   Days after vaccination:116
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       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: None stated.


VAERS ID: 1777006 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-26
Onset:2021-09-26
   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 FF2587 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood test, Chest pain, Computerised tomogram head, Electrocardiogram, Gait disturbance, Hypoaesthesia, Hypoaesthesia oral, Pharyngeal hypoaesthesia
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypoglycaemia (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: vit D3 5000 iu, Amlodipine 5mg daily. multi vit daily, occasional omeprazole -last dose 6 months ago
Current Illness: sinusitis and ear effusion - treated with Amoxil about one month prior- resolved
Preexisting Conditions: hypertension and occasional GERD
Allergies: Aleve and lisinopril
Diagnostic Lab Data: Ekg, CT head, blood work, given hydration , solumedrol, lexpro, prednisone and benadryl
CDC Split Type:

Write-up: Symptoms started within 0ne minute s/p vaccine- started numbness tongue/throat/ mouth, the palms, feet, lower legs and developed intense severe burning in center of chest. no improvement after 45- left . Call PMD from home told to take Benadryl. -told to get medical attention if not improvement. Went to urgent care a couple hours later because no improvement.- told to go back to hospital. Went to hospital waited 7 hours to be seen. They did ECG and blood work and neuro checks- discharged told to follow up with PMD. Burning and numb kept intensifying and had right groin pain (last a couple hours), tourniquet feeling in spine and head, difficulty walking. saw PMD next day given Lexpro- no improvement. Symptoms continued to intensify and she went Hospital 9/30/21 - Provider said he seen this reaction from the vaccine and gave her Normal saline, Solumedrol, CT head, ECG and blood work. Discharge home with prednisone. symptoms decreased by a good amount. Better but still having numbness in feet, lower leg , spine, ,back of head, biceps and hands since vaccine.


VAERS ID: 1778975 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-01-06
Onset:2021-09-26
   Days after vaccination:263
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1685 / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Chills, Cough, Headache, Myalgia, Nasal congestion, Rhinorrhoea, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: Complaint of cough, chills, headache, runny nose/congestion, and myalgia


VAERS ID: 1779267 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-24
Onset:2021-09-26
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 2 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Atrial fibrillation, Cardiac monitoring, Chest pain, Dyspnoea, Electrocardiogram, Palpitations, Tachycardia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: EKG''s. Pediatric cardiologist currently has her on 30 day monitor
CDC Split Type:

Write-up: My daughters heart races (tachycardia) and goes into afib. She gets short of breath and also has chest pains.


VAERS ID: 1779565 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: D.C.  
Vaccinated:2021-04-06
Onset:2021-09-26
   Days after vaccination:173
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025B21A / 2 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Computerised tomogram abnormal, Dyspnoea, Fatigue, Fibrin D dimer increased, Full blood count abnormal, Liver function test abnormal, Myalgia, Ultrasound scan abnormal, White blood cell count abnormal
SMQs:, Rhabdomyolysis/myopathy (broad), Liver related investigations, signs and symptoms (narrow), Anaphylactic reaction (broad), Haematopoietic leukopenia (broad), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Malignancy related therapeutic and diagnostic procedures (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Albuterol; multivitamin
Current Illness: No
Preexisting Conditions: Asthma
Allergies: Amoxicillin; iodine; seafood
Diagnostic Lab Data: Labs WBC, CBC panel, D-dimer results were positive, but they have not determined why. Chemistry panel, liver function panel, thyroid test, CT, ultrasound. All results turned out positive.
CDC Split Type: vsafe

Write-up: On 09/26/2021 I have shortness of breath, fatigue and muscle soreness and it still continues. The doctor originally thought it might be a blood clot, but that was ruled out.


VAERS ID: 1779638 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-04-08
Onset:2021-09-26
   Days after vaccination:171
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 RA / IM

Administered by: Other       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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Synthroid (generic)
Current Illness: none
Preexisting Conditions: none
Allergies: non
Diagnostic Lab Data: 9/28/2021: PCR Covid test
CDC Split Type:

Write-up: Positive Covid diagnosis


VAERS ID: 1782406 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-03-10
Onset:2021-09-26
   Days after vaccination:200
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6198 / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6208 / 2 - / -

Administered by: Public       Purchased by: ?
Symptoms: Chest pain, Dyspnoea, Pulmonary embolism
SMQs:, Anaphylactic reaction (broad), Embolic and thrombotic events, venous (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: multivitamins, vitamin B 3, fish oil, probiotics, vitamin c, Allegra, Flonase, Pepcid, Eliquis, lisinopril
Current Illness:
Preexisting Conditions: high blood pressure. Had another blood clot in 2012 in her leg.
Allergies: Erythromycin
Diagnostic Lab Data: Hospital has all records.
CDC Split Type:

Write-up: began having shortness of breath and chest pain in September 2021. Went to ER and had both lungs with Pulmonary Emboli. Client had covid virus October 2020.


VAERS ID: 1782442 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-01
Onset:2021-09-26
   Days after vaccination:209
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012A21A / UNK 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: COVID 19


VAERS ID: 1782503 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-09-24
Onset:2021-09-26
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047CZ1A / 3 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Oropharyngeal discomfort, Rash
SMQs:, Anaphylactic reaction (broad), 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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Nurtec 75mg PO every other day, mirtazipine 30mg PO QHS, cyclobenzaprine 5mg PO QD PRN
Current Illness: N/A
Preexisting Conditions: SVT, gastritis, insomnia
Allergies: NKA
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Started as mild rash on left hip on Sunday (2 days after injection) Spread for several days until it was intolerable on Monday 10/4/21. It had become very large on my left hip/flank area, spread to both arms, my chest, and lower back. Spoke to infection control nurse at work on Monday 10/4. She recommended I be seen. Went to ER physician. He said it was a systemic reaction to vaccine. My throat felt odd that night and worsened the next morning. Started Prednisone and antihistamine Tuesday 10/5 AM.


VAERS ID: 1782873 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-09-23
Onset:2021-09-26
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808986 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Blood test, Joint swelling, Urine analysis
SMQs:, Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: citalopram 20 mg at bedtime
Current Illness: Urinary tract infection
Preexisting Conditions: None
Allergies: Penicillin, sulfa, bactrim
Diagnostic Lab Data: Laboratory blood work and urine collected on 10/8/21
CDC Split Type:

Write-up: Pain and swelling of joints related to knuckles of both hands and right anterior ankle; no injury to either of these sites.


VAERS ID: 1782962 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-03-02
Onset:2021-09-26
   Days after vaccination:208
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Cough, Fatigue, Myalgia, Nausea, Pyrexia, SARS-CoV-2 test, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), 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? Yes
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: Type 1 diabetes and cerebrovascular disease
Allergies:
Diagnostic Lab Data: SARS-CoV-2 Antigen specimen collected 10/5/21 and 2019 Coronavirus RNA specimen collected 10/7/21
CDC Split Type:

Write-up: Hospitalized for covid; symptoms include subjective fever, cough, nausea/vomiting, fatigue, and myalgia


VAERS ID: 1783051 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-09-26
Onset:2021-09-26
   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 - / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Incorrect route of product administration, Injection site erythema, Injection site pain, Injection site pruritus, Injection site rash, Injection site swelling
SMQs:, Drug abuse and dependence (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Medication errors (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: Daily Multivitamin, Calcium supplement, valtrex PRN. Daily Collagen supplement
Current Illness: None
Preexisting Conditions: None
Allergies: Ceclor
Diagnostic Lab Data:
CDC Split Type:

Write-up: Arm with baseball sized, raised, painful, itchy, red welt. Not sure if it was due to the vaccine or the fact that the shot was not given in the appropriate spot. It was given lower in my arm and not in the delt


VAERS ID: 1783140 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-03-31
Onset:2021-09-26
   Days after vaccination:179
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Blister, Interchange of vaccine products, Lip blister, Oral herpes, Oral mucosal blistering
SMQs:, Severe cutaneous adverse reactions (broad), Oropharyngeal infections (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (broad), Medication errors (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Diabetic, Copd. Arthritis..
Preexisting Conditions: Diabetic, Copd. Arthritis.
Allergies: codeine I was told today by my doctor that the Pfizer booster shot i got on 09/21/2021 After the booster shot on 09/21/2021. about a week later I started having severe cold sore in my mouth my hand and my face on some of my feet. Please contact me for the info I don''t want to have this happen to others who mixed up vaccines..
Diagnostic Lab Data: None
CDC Split Type:

Write-up: my body severe blister in my mouth . Lips face hand, face, Arm, and foot spreading.


VAERS ID: 1783784 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-24
Onset:2021-09-26
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / UNK - / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Chest pain, Dyspnoea, Gait disturbance, Pain in extremity
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Spironolactone
Current Illness: COPD LBB
Preexisting Conditions: COPD LBB
Allergies: IVP Dye, Iodine, Shellfish
Diagnostic Lab Data: Doctor prescribed 40 mg of Prednisone daily for 7 days.
CDC Split Type:

Write-up: Much more than usual, extreme shortness of breath. Unable to walk from one room to another. Having oxygen constant. Chest pain. Shoulder and arm pain.


VAERS ID: 1785474 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-08-26
Onset:2021-09-26
   Days after vaccination:31
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036C21A / 3 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Ear swelling, Herpes zoster, Nasopharyngitis, Pain in jaw, SARS-CoV-2 test negative, SARS-CoV-2 test positive, Swelling face
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Osteonecrosis (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Prednisone; methotrexate; Enbrel
Current Illness: No
Preexisting Conditions: RA
Allergies: Sulfa drugs
Diagnostic Lab Data: 12Sep2021 & 1Oct2021 clinic covid test was negative
CDC Split Type: vsafe

Write-up: I was having cold symptoms and was having small bubbles temple on my face on the right and it spread to the entire top side of face. Lots of swelling on the ear and jaw and pain. I had two at home test that was positive but clinic test was negative. Clinic for covid testing on 12Sep2021 & 1Oct2021. Urgent care on 29Sep2021 diagnosed as shingles and went to eye doctor the next am. Shingles was on eyelid.


VAERS ID: 1785526 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-01-08
Onset:2021-09-26
   Days after vaccination:261
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 EK9231 / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Chills, Cough, Headache, Malaise, Nasal congestion, Nausea, Pyrexia, Rhinorrhoea, SARS-CoV-2 test positive, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), 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 cough, chills, elevated temperature, headache, runny nose/congestion, malaise and nausea/vomiting.


VAERS ID: 1785965 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-25
Onset:2021-09-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Injection site swelling, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Patient described fever and fatigue 24 hours after vaccination. Upon going to get her flu shot about 2 weeks after she noticed a goose egg type ball near the site of the injection. From my memory when vaccinating the goose egg was already present on the arm before vaccination but worth noting. The patient did not report any redness or noticeable swelling post vaccination and it wasnt until the next vaccine that it was noticed.


VAERS ID: 1786569 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-03-18
Onset:2021-09-26
   Days after vaccination:192
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP6955 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Arteriosclerosis coronary artery, Bipolar I disorder, COVID-19, Cerebrovascular accident, Chest X-ray abnormal, Chronic kidney disease, Computerised tomogram head normal, Condition aggravated, Confusional state, Delirium, Essential hypertension, Gait disturbance, Leukocytosis, Lung opacity, Mental status changes, Metabolic encephalopathy, Neurological symptom, Pneumonia, Polyneuropathy, Pyrexia, SARS-CoV-2 test positive, Urinary tract infection, Vascular dementia
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (narrow), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Dementia (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Parkinson-like events (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Hostility/aggression (broad), Hypertension (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Other ischaemic heart disease (narrow), Chronic kidney disease (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Hypoglycaemia (broad), Infective pneumonia (narrow), Dehydration (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 18 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen (TYLENOL) 500 mg tablet ascorbic acid, vitamin C, (VITAMIN C) 500 mg tablet aspirin 81 mg chewable tablet bisacodyL (DULCOLAX) 5 mg EC tablet divalproex (DEPAKOTE) 500 mg 24 hr tablet donepeziL (ARICEPT) 10 mg tablet mag
Current Illness:
Preexisting Conditions: Non-Hospital Hyperlipidemia History of malignant neoplasm of prostate Postoperative urethral stricture Prediabetes Spinal stenosis in cervical region Metabolic encephalopathy Normal pressure hydrocephalus Falls
Allergies: Metoclopramide HclHives / Urticaria Escitalopram OxalateOther (document details in comments) LamotrigineOther (document details in comments) Ziprasidone HclOther (document details in comments)
Diagnostic Lab Data: 10/07/2021 1830 COVID-19 (SARS CoV-2,RNA Molecular Amplification) Collected: 10/07/21 1830 | Final result | Specimen: Swab from Nasopharynx COVID-19 SARS-CoV-2 Overall Result Detected Critical 10/07/2021 1830 COVID-19 PCR - Communal Living / SNF Placement (Asymptomatic) Collected: 10/07/21 1830 | Final result | Specimen: Swab from Nasopharynx Procedure Component Value Ref Range Date/Time X-ray chest 1 view, Portable [3307066337] Resulted: 10/11/21 1451 Order Status: Completed Updated: 10/11/21 1451 Narrative: XR CHEST 1 VW PORT IMPRESSION: Slight increased opacity to both lungs may represent mild pneumonia on a poor inspiration chest END OF IMPRESSION: INDICATION: fever. TECHNIQUE: Portable COMPARISON: CXR 9/26/2021 FINDINGS: Mild opacity seen in both lungs. The heart and vascularity mediastinum are normal. Poor inspiration is obtained. VP shunt is seen over the right thorax. Postsurgical changes are seen spine and sternum. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient. CT head stroke without contrast [3305293441] Resulted: 09/26/21 2013 Order Status: Completed Updated: 09/26/21 2013 Narrative: CT HEAD STROKE WO CONTRAST IMPRESSION: 1. There is no CT evidence of acute intracranial abnormality. 2. Ventriculoperitoneal shunt catheter in good position, and the appearance of the cerebral ventricles is unchanged when compared to the prior study. The ventricle size is stable. Note: I personally communicated the results of this examination directly by telephone to doctor in the emergency room at approximately 8:10 PM this evening. END OF IMPRESSION: INDICATION: stroke. Increasing confusion over the past 2 hours. Male, 78 years TECHNIQUE: Head CT was performed without intravenous contrast. Up-to-date CT equipment and radiation dose reduction techniques were employed. CTDIvol: 31.0 mGy. DLP: 625 mGy-cm. COMPARISON: May 22, 2021 FINDINGS: The ventricles and sulci are normal in size and symmetric, with some symmetric prominence of the lateral ventricles unchanged compared to the prior study earlier this year. There is also a ventriculoperitoneal shunt catheter noted within the right lateral ventricle, unchanged in position. There is no evidence of midline shift, mass effect or altered cerebral ventricles. The ventricular size is unchanged from prior study. There is no evidence of acute intracranial hemorrhage. There is no CT evidence of acute territorial infarction. Limited visualization of the orbits and paranasal sinuses is unremarkable. There is no evidence of skull fracture. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient. X-ray chest 1 view [3305293442] Resulted: 09/26/21 1925 Order Status: Completed Updated: 09/26/21 1925 Narrative: XR CHEST 1 VW PORT IMPRESSION: No acute process. END OF IMPRESSION: INDICATION: Stroke symptoms. Male; 78 years TECHNIQUE: Portable AP upright chest 7:07 PM COMPARISON: May 22, 2021 FINDINGS: Ventriculoperitoneal shunt catheter overlies the right chest. There are sternotomy wire sutures from previous CABG. Spinal surgical changes are noted involving the lower cervical and upper thoracic spine. The lungs are clear with no evidence of any active cardiopulmonary, mediastinal, or pleural process. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.
CDC Split Type:

Write-up: ED to Hosp-Admission Current 9/26/2021 - present (18 days) COVID-19 Principal problem Hospital Problems POA * (Principal) Toxic metabolic encephalopathy Yes Coronary arteriosclerosis Yes Multi-infarct dementia with delirium Yes Bipolar affective disorder, depressed, in full remission Yes Stage 3a chronic kidney disease Yes Essential hypertension Yes Polyneuropathy associated with underlying disease Yes VP (ventriculoperitoneal) shunt status Not Applicable Ambulatory dysfunction Yes Medical Problems Plan: Admit patient to MedSurg under observation status. PT evaluation to gauge patient''s mobility as the wife is able to take care of him as long as he is able to walk with a walker Toxic metabolic encephalopathy has resolved, patient is at baseline, wife is at bedside to confirm. Continue home medications Avoid benzodiazepines and opiates to prevent delirium, frequent reorientation, maintain sleep-wake circadian rhythm. Consult infectious diseases the patient has a history of VRE in the urine looks infected however it is difficult to gauge if the patient is actually symptomatic. He does have mild leukocytosis. Addendum: spiked fever overnight, will switch abx to linezolid. Culture reviewed, only sensitive to linezolid. ID consult is pending. VTE prophylaxis: Heparin Full Code History of Present Illness Chief Complaint Patient presents with ? Altered Mental Status Patient is an 78 y.o. male. Past medical history of VP shunt, dementia, ambulatory dysfunction dependent on a walker, BPH status post proctectomy complicated by urinary incontinence. Patient is accompanied by his wife who is at the provider of history. She states that he was in his usual state of health and he was sitting in his recliner in the garage which he normally does. She went out to go check on him and asked him to come inside so she can change his diaper at that point the patient would not get out of the chair and look like no one was home. She denies seeing any tonic-clonic like activity. She called over a neighbor to help get patient out of the chair and when they were not able to, they called EMS. Patient is pleasantly demented and is symptom free. He is seen eating a sandwich and appears to be very comfortable. Wife is at bedside who states that he is back to his baseline mental status. She does straight cath him every other day. In the ER labs are notable for mild leukocytosis with urine that appears to be infected. He was given ceftriaxone in the ER. Labs and imaging reviewed.


VAERS ID: 1735802 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-09-21
Onset:2021-09-26
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

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

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

Write-up: Allergic skin reaction 5 days after the vaccine.15 cm, red skin, warm and itching. .


VAERS ID: 1740224 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-09-22
Onset:2021-09-26
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Contusion, Skin discolouration
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Accidents and injuries (narrow), Hypotonic-hyporesponsive episode (broad)

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

Write-up: Large bruise to lower right shin. Size approximately size of adult male palm. No injury occured prior to this, no bumps or bruises before etc. Appears as discolouration, yellow to purple. No pain in area.


VAERS ID: 1740927 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-09-25
Onset:2021-09-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK0112 / UNK LA / SYR

Administered by: School       Purchased by: ?
Symptoms: Headache
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: No
Current Illness: No
Preexisting Conditions: No
Allergies: No
Diagnostic Lab Data:
CDC Split Type:

Write-up: Headache on top


VAERS ID: 1760861 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-09-26
Onset:2021-09-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal pain upper, Cold sweat, Eye pain, Flatulence, Palpitations, Photophobia, Tremor
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Cardiomyopathy (broad), Corneal disorders (broad), Retinal disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: GBMODERNATX, INC.MOD20213

Write-up: Heart pounding; Light sensitivity to eye; Pain behind eyes; Stomach pain; Gas; Cold sweat; Shaking; This case was received via the regulatory authority (Reference number: GB-MHRA-ADR 25998665) on 27-Sep-2021 and was forwarded to Moderna on 27-Sep-2021. This regulatory authority case was reported by a consumer and describes the occurrence of PALPITATIONS (Heart pounding), PHOTOPHOBIA (Light sensitivity to eye), EYE PAIN (Pain behind eyes), ABDOMINAL PAIN UPPER (Stomach pain), FLATULENCE (Gas), COLD SWEAT (Cold sweat) and TREMOR (Shaking) in a 28-year-old female patient who received mRNA-1273 (Moderna CoviD-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On 26-Sep-2021, the patient received second dose of mRNA-1273 (Moderna CoviD-19 Vaccine) (unknown route) 1 dosage form. On 26-Sep-2021, the patient experienced PALPITATIONS (Heart pounding) (seriousness criterion medically significant), PHOTOPHOBIA (Light sensitivity to eye) (seriousness criterion medically significant), EYE PAIN (Pain behind eyes) (seriousness criterion medically significant), ABDOMINAL PAIN UPPER (Stomach pain) (seriousness criterion medically significant), FLATULENCE (Gas) (seriousness criterion medically significant), COLD SWEAT (Cold sweat) (seriousness criterion medically significant) and TREMOR (Shaking) (seriousness criterion medically significant). At the time of the report, PALPITATIONS (Heart pounding), PHOTOPHOBIA (Light sensitivity to eye), EYE PAIN (Pain behind eyes), ABDOMINAL PAIN UPPER (Stomach pain), FLATULENCE (Gas), COLD SWEAT (Cold sweat) and TREMOR (Shaking) had not resolved. The action taken with mRNA-1273 (Moderna CoviD-19 Vaccine) (Unknown) was unknown. No concomitant medications reported by reporter. No treatment medications provided by the reporter. RA: Symptoms started about 12 hours after vaccination. Company Comment: This case concerns a 28 year old female patient with no relevant medical history ,who experienced the serious unexpected events of Palpitations, Photophobia, Eye pain, Abdominal pain upper, Flatulence, Cold sweat and Tremor.The events occurred one day after second dose of Spikevax. The rechallenge was unknown since no information about the first dose was disclosed.The benefit-risk relationship of Spikevax is not affected by this report. Events seriousness assessed as per Regulatory Authority reporting.; Sender''s Comments: This case concerns a 28 year old female patient with no relevant medical history ,who experienced the serious unexpected events of Palpitations, Photophobia, Eye pain, Abdominal pain upper, Flatulence, Cold sweat and Tremor.The events occurred one day after second dose of Spikevax. The rechallenge was unknown since no information about the first dose was disclosed.The benefit-risk relationship of Spikevax is not affected by this report. Events seriousness assessed as per Regulatory Authority reporting.


VAERS ID: 1763059 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-09-26
Onset:2021-09-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 3004668 / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Dizziness, 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? 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: GBMODERNATX, INC.MOD20213

Write-up: syncope; Dizziness; This case was received via the regulatory authority (Reference number: GB-MHRA-ADR 25997809) on 27-Sep-2021 and was forwarded to Moderna on 27-Sep-2021. This regulatory authority case was reported by an other health care professional and describes the occurrence of SYNCOPE (syncope) in a 25-year-old female patient who received mRNA-1273 (Moderna CoviD-19 Vaccine) (batch no. 3004668) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. On 26-Sep-2021, the patient received second dose of mRNA-1273 (Moderna CoviD-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On an unknown date, the patient received first dose of mRNA-1273 (Moderna CoviD-19 Vaccine) (unknown route) 1 dosage form. On 26-Sep-2021, the patient experienced DIZZINESS (Dizziness). On an unknown date, the patient experienced SYNCOPE (syncope) (seriousness criterion medically significant). At the time of the report, SYNCOPE (syncope) outcome was unknown and DIZZINESS (Dizziness) had resolved. The action taken with mRNA-1273 (Moderna CoviD-19 Vaccine) (Unknown) was unknown. For mRNA-1273 (Moderna CoviD-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. Patient has not had symptoms associated with COVID-19 Not had a COVID-19 test. At 10.16 patient felt dizzy and hot and moved to couch pre syncope At.10.17 water offered to patient. BP measured 118/79 P69 At 10.30 BP was103/73 P70 seen and assessed by B6 shift lead and fit enough to leave the building Patient has not tested positive for COVID-19 since having the vaccine Patient was not enrolled in clinical trial. No concomitant medication details was provided. No treatment medication details was provided. This case concerns a 25-year-old, female patient with no relevant medical history, who experienced the unexpected events of Syncope ,Dizziness, and Feeling hot. The events occurred within a few minutes after the second dose of the MODERNA COVID-19 VACCINE. Rechallenge is not applicable as no additional dosing is expected to be given. The benefit-risk relationship of MODERNA COVID-19 VACCINE is not affected by this report. Event Syncope was automatically upgraded as serious as per ADR list; however, based on information available (no intervention/treatment/hospitalization required) and ,as per medical judgement, was assessed as non-serious. Also, outcome of event Syncope is captured per ADR from Regulatory Authority reporting (Unknown) and differ from what is described in the case narrative(Recovered/Resolved).; Sender''s Comments: This case concerns a 25-year-old, female patient with no relevant medical history, who experienced the unexpected events of Syncope ,Dizziness, and Feeling hot. The events occurred within a few minutes after the second dose of the MODERNA COVID-19 VACCINE. Rechallenge is not applicable as no additional dosing is expected to be given. The benefit-risk relationship of MODERNA COVID-19 VACCINE is not affected by this report. Event Syncope was automatically upgraded as serious as per ADR list; however, based on information available (no intervention/treatment/hospitalization required) and ,as per medical judgement, was assessed as non-serious. Also, outcome of event Syncope is captured per ADR from Regulatory Authority reporting (Unknown) and differ from what is described in the case narrative(Recovered/Resolved).


VAERS ID: 1769768 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-09-26
Onset:2021-09-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Other       Purchased by: ?
Symptoms: SARS-CoV-2 test, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Faint; Felt faint; Injury
Allergies:
Diagnostic Lab Data: Test Date: 20210925; Test Name: COVID-19 virus test; Test Result: Negative ; Comments: No - Negative COVID-19 test
CDC Split Type: GBPFIZER INC202101274421

Write-up: Fainting; This is a spontaneous report from a contactable other hcp. This is a report received from the regulatory authority. The regulatory authority report number is GB-MHRA-WEBCOVID-202109261258338410-0OLNS, Sender''s (Case) Safety Report Unique Identifier GB-MHRA-ADR 25997852. A 17-year-old female patient received first dose of bnt162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE), via an unspecified route of administration on 26Sep2021 (at the age of 17-years-old) as dose 1, single for COVID-19 immunisation. Medical history included injury, felt faint and faint. Felt faint in the past post vaccination and fainted before following injury. Advised to always lay down with vaccination etc, in the future. Patient has not had symptoms associated with COVID-19. Patient was not pregnant, and she was not currently breastfeeding. The patient''s concomitant medications were not reported. The patient experienced fainting on 26Sep2021. Patient fainted on reaching her chair post vaccination, banged her head on the floor. Was assisted by staff and another patient who was sat nearby. Recovered sufficiently to be wheeled to the recovery pod. Drink given, next of kin attended and laid back. Head injury advice form given. Patient has not tested positive for COVID-19 since having the vaccine. Patient was not enrolled in clinical trial. The report was not related to possible blood clots or low platelet counts. The patient underwent lab tests and procedures which included COVID-19 virus test: negative on 25Sep2021 (No - Negative COVID-19 test). The outcome of event was recovering. No follow-up attempts are possible; information about lot/batch number cannot be obtained. No further information is expected.


VAERS ID: 1776014 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-09-26
Onset:2021-09-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 3005701 / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Depressed level of consciousness, Presyncope
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: JPMODERNATX, INC.MOD20213

Write-up: Decreased consciousness; Vasovagal reflex; This case was received via regulatory authority (Reference number: JP-TAKEDA-2021TJP100708) on 02-Oct-2021 and was forwarded to Moderna on 08-Oct-2021. This case was reported by a physician via a medical representative of regulatory authority. Decreased consciousness was assessed as serious by the MAH. On an unknown date, body temperature before vaccination: 36.3 degrees Celsius. On 26-Sep-2021, the patient received the 1st dose of this vaccine. Vasovagal reflex developed after the vaccination. The patients face became pale, and the patient complained to a nurse that almost loss of consciousness developed. Cold sweat was also observed, and the patient was transported to the first-aid room. At 11:01, BP 120/60 mmHg, HR 41/min, and SpO2 98% at room air. Awake and alert, no difficulty of breathing, breath sounds were clear, and air entered well, there was no cardiac murmur, and heart sounds were regular. The symptoms disappeared after rest and leg elevation. Heart rate increased to 52 minutes. The patient was followed up for about 30 minutes, and the recovery was confirmed. The patient went home. The outcome of vasovagal reflex and decreased consciousness was reported as recovered. Follow-up investigation will be made. Company Comment: The events developed after the administration of COVID-19 vaccine mRNA (mRNA 1273) and there is temporal relationship.; Reporter''s Comments: The events developed after the administration of COVID-19 vaccine mRNA (mRNA 1273) and there is temporal relationship.; Sender''s Comments: This case concerns a 18-year-old, male patient with no relevant medical history, who experienced, serious unlisted event of Consciousness decreased. The event occurred same day after first dose of of Moderna COVID-19 Vaccine. The rechallenge was unknown as the date just for first dose was provided. The benefit-risk relationship of Moderna COVID-19 Vaccine is not affected by this report.


VAERS ID: 1778081 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-09-26
Onset:2021-09-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ5782 / 2 - / -

Administered by: Other       Purchased by: ?
Symptoms: Chills, Condition aggravated, Cough, Headache, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Asthmatic
Allergies:
Diagnostic Lab Data:
CDC Split Type: GBPFIZER INC202101280539

Write-up: being severe; Chills; Headache; Fever; Coughing; This is a spontaneous report from a contactable consumer received from the regulatory authority.The regulatory authority report number is GB-MHRA-WEBCOVID-202109272047274350-C4RZJ.Safety Report Unique Identifier GB-MHRA-ADR 26002687. An 18-year-old adult male patient received a second dose of BNT162B2 (PFIZER-BioNTech COVID-19 VACCINE, solution for injection, lot number: FJ5782), via an unspecified route of administration on 26Sep2021 (age at vaccination 18 years) as dose 2, single for COVID-19 immunization. Medical history included asthma. The patient concomitant medications were not reported. Unsure if patient has had symptoms associated with COVID-19. Not had a COVID-19 test. The patient has not tested positive for COVID-19 since having the vaccine. The patient was not enrolled in the clinical trial. The patient previously received a first dose of BNT162B2 (PFIZER-BioNTech COVID-19 VACCINE, solution for injection), via an unspecified route of administration on an unspecified date as dose 1, single for COVID-19 immunization. On 26Sep2021, the patient experienced chills, headache, fever and coughing and on 27Sep2021, patient condition got severe. It was reported that all began in the early stage circa 3 hours after the vaccine really started being severe on 27Sep2021. The case was assessed as serious (medically significant). The outcome of event condition aggravated was unknown and patient had not yet recovered from other events. No follow-up attempts are needed. No further information is expected.


VAERS ID: 1778532 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-09-26
Onset:2021-09-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FG0978 / 1 - / -

Administered by: Other       Purchased by: ?
Symptoms: Blood pressure measurement, Body temperature, Bradycardia, Feeling cold, Heart rate, Hypotension, Nausea, Presyncope
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: List of non-encoded Patient Relevant History: Patient Other Relevant History 1: none
Allergies:
Diagnostic Lab Data: Test Date: 20210926; Test Name: blood pressure; Result Unstructured Data: Test Result:80s / 40s; Test Date: 20210926; Test Name: Body temperature; Result Unstructured Data: Test Result:36.5 Centigrade; Comments: before vaccination; Test Date: 20210926; Test Name: heart rate; Result Unstructured Data: Test Result:50s
CDC Split Type: JPPFIZER INC202101268747

Write-up: Vagal reflex/Vasovagal reflex; Bradycardia; blood pressure was 80s / 40s/Hypotension; Chilliness; mild Feeling queasy; This is a spontaneous report from a contactable physician received from the regulatory authority. Regulatory authority report number is v21128864. A 16-year-old male patient received bnt162b2 (COMIRNATY, Solution for injection, Lot Number: FG0978; Expiration Date: 30Nov2021) via an unspecified route of administration on 26Sep2021 15:30 (at 16-year-old) as DOSE 1, SINGLE for covid-19 immunisation. Medical history was none and concomitant medications were not reported. 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). Body temperature before vaccination was 36.5 degrees Centigrade. On 26Sep2021 at 15:40 (10 minutes after the vaccination), the patient experienced Vasovagal reflex. On 26Sep2021 (the day of vaccination), the outcome of the event was recovered. The course of the event was as follows: About 10 minutes after vaccination, the patient complained of Chilliness during observation, blood pressure was 80s / 40s, and heart rate was 50s. The patient experienced mild Feeling queasy, no Pharynx strange sensation of or Itchy skin, diagnosed as Vagal reflex. When the patient lay down and observed, the symptoms improved in about 30 minutes, and the patient went home on his own. The reporting physician classified the event as non-serious and assessed that the event was related to bnt162b2. There was no other possible cause of the event such as any other diseases. The reporting physician commented as follows: Vagal reflex with Hypotension and Bradycardia after injection. It was suspected to be related to the vaccine.


VAERS ID: 1780611 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:2021-09-26
Onset:2021-09-26
   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 - / 2 - / -

Administered by: Other       Purchased by: ?
Symptoms: Inappropriate schedule of product administration, Influenza, Maternal exposure during pregnancy
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Medication errors (narrow), Infective pneumonia (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: FOLIC ACID
Current Illness: Pregnancy (Estimated due date: 03Dec2021)
Preexisting Conditions: Medical History/Concurrent Conditions: Folic acid supplementation
Allergies:
Diagnostic Lab Data:
CDC Split Type: GBPFIZER INC202101280614

Write-up: Maternal exposure during pregnancy; Flu; Inappropriate schedule of vaccine administered; This is a solicited report from the regulatory authority program from a contactable consumer received from the regulatory authority. Regulatory authority report number is GB-MHRA-YCVM-202109271039100930-F1AW6, Safety Report Unique Identifier is GB-MHRA-ADR 25999576. This consumer reported information for both mother and fetus/baby. This is a maternal report. A 28-year-old female patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE), on 26Sep2021 as dose 2, single for COVID-19 immunization. Medical history included ongoing pregnancy (Estimated due date: 03Dec2021) and folic acid supplementation. Patient had not had symptoms associated with COVID-19, not had a COVID-19 test. Patient was not currently breastfeeding. Patient was pregnant at the time of vaccination. The mother reported she became pregnant while taking BNT162B2. Patient was not enrolled in clinical trial. Concomitant medication included folic acid taken for vitamin supplementation, start and stop date were not reported. Historical vaccine included bnt162b2 on 17Jul2021 as dose 1, single for COVID-19 immunization. The patient experienced maternal exposure during pregnancy on an unspecified date with outcome of unknown, and flu on 27Sep2021 with outcome of recovering, and inappropriate schedule of vaccine administered on 26Sep2021. The events maternal exposure during pregnancy and flu were assessed as serious, medically significant by the health authority. The reporter''s assessment of the causal relationship of the events with the suspect product was not provided at the time of this report. Since no determination has been received, the case is managed based on the company causality assessment. No follow-up attempts are possible; information about lot/batch number cannot be obtained. No further information is expected.; Sender''s Comments: Based on the current available information and the plausible drug-event temporal association, a possible contributory role of the suspect product BNT162B2 to the development of event maternal exposure during pregnancy, flu ) cannot be excluded. The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to regulatory authorities, Ethics Committees, and Investigators, as appropriate. Based on known drug safety profile, there is reasonable possibility of causal association between the inappropriate schedule of vaccine administered] and the suspect drug.


VAERS ID: 1783736 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:2021-09-26
Onset:2021-09-26
   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 FF2153 / 2 - / -

Administered by: Other       Purchased by: ?
Symptoms: Inappropriate schedule of product administration, Maternal exposure timing unspecified, Pain in jaw, SARS-CoV-2 test, Swelling face, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Osteonecrosis (broad), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Hypersensitivity (narrow), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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 INC202101300812

Write-up: Hives; Jaw pain; Maternal Drug Exposure; Swelling of face; patient received BNT162B2, dose 1 on 31Jul2021 and dose 2 on 26Sep2021; This is a spontaneous report from a contactable consumer. This is a report received from a regulatory authority. The regulatory authority report number is GB-MHRA-WEBCOVID-202109292256212150-TJWWW. Safety Report Unique Identifier GB-MHRA-ADR 26014685. This consumer reported information for both mother and fetus. This is the maternal report. A pregnant female patient of an unspecified age received BNT162B2 (COVID-19 MRNA VACCINE BIONTECH), via an unspecified route of administration on 26Sep2021 (Batch/Lot Number: FF2153) as dose 2, single for COVID-19 immunisation. The patient medical history was not reported. Patient has not had symptoms associated with COVID-19. Patient was not enrolled in clinical trial. The patient received the first dose of BNT162B2 on 31Jul2021 for COVID-19 immunisation. The patient''s concomitant medications were not reported. The patient received BNT162B2, dose 1 on 31Jul2021 and dose 2 on 26Sep2021. The patient experienced maternal drug exposure, hives and jaw pain on an unspecified date and swelling of face on 27Sep2021. The events were reported as serious (medically significant). The patient underwent lab tests and procedures which included COVID-19 virus test: no - negative covid-19 test on an unknown date. The outcome hives, swelling of face and jaw pain was not recovered while unknown for the other events. No follow-up attempts are needed. No further information is expected.


VAERS ID: 1784225 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-09-26
Onset:2021-09-26
   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 FF2018 / 1 - / -

Administered by: Other       Purchased by: ?
Symptoms: Cold sweat, Contusion, Fall, Loss of consciousness, Presyncope
SMQs:, Torsade de pointes/QT prolongation (broad), Haemorrhage terms (excl laboratory terms) (narrow), 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), Accidents and injuries (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? 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: JPPFIZER INC202101278217

Write-up: lost consciousness; Fall; bruised head; suspected of having a vagal reflex; Cold sweat; This is a spontaneous report from a contactable physician (vaccinator) received from the regulatory authority. Regulatory authority report number is v21127761. A 16-year-old female patient received BNT162B2 (COMIRNATY, Solution for injection, Lot number: FF2018 expiration date: 31Dec2021), via an unspecified route of administration on 26Sep2021 as dose 1, single (at the age of 16 years old) for COVID-19 immunisation. The patient''s medical history and concomitant medications were not reported. On 26Sep2021 (after the vaccination), the patient experienced events. The course of the event was as follows: After vaccination during waiting for 15 minutes, the patient fell forward (fall), bruised head and lost consciousness, suspected of having a vagal reflex. No dyspnoea or blood pressure decreased. Patient experienced cold sweat. The outcome of the events was unknown. The reporting physician (vaccinator) classified the event as serious (risk of disability) and assessed that the event was unrelated to bnt162b2. There was no other possible cause of the event such as any other diseases.; Sender''s Comments: Based on the information currently available and currently known drug safety profile, the reported events of loss of consciousness, fall, contusion, presyncope and cold sweat are assessed as not related to BNT162B2. The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to regulatory authorities, Ethics Committees, and Investigators, as appropriate.


VAERS ID: 1784237 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-09-26
Onset:2021-09-26
   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 FF9944 / 1 LA / OT

Administered by: Other       Purchased by: ?
Symptoms: Body temperature, Grip strength decreased, Muscular weakness
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? 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: 20210926; Test Name: body temperature; Result Unstructured Data: Test Result:35.7 Centigrade; Comments: before vaccination
CDC Split Type: JPPFIZER INC202101281974

Write-up: weakness appeared on the left lower limb and expanded to limbs; had tactile but no grip strength; This is a spontaneous report from a contactable physician received from the regulatory authority. Regulatory authority report number is v21127891. A 13-year-old male patient received bnt162b2 (COMIRNATY), dose 1 intramuscular, administered in Arm Left on 26Sep2021 15:10 (Lot Number: FF9944; Expiration Date: 30Nov2021) (at age of 13-year-old) as DOSE 1, SINGLE for covid-19 immunisation. Body temperature before vaccination was 35.7 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). Medical history was none. The patient''s concomitant medications were not reported. The patient experienced weakness appeared on the left lower limb and expanded to limbs (hospitalization) on 26Sep2021 15:20 with outcome of recovered on 27Sep2021, had tactile but no grip strength (hospitalization) on 26Sep2021 with outcome of recovered on 27Sep2021. The course of the event was as follows: On 26Sep2021, 10 minutes after the intramuscular in arm left, weakness appeared on the left lower limb and expanded to limbs. Follow-up observation for about 50 minutes was taken, but no recovering, so the patient was emergency transported to the hospital. When arrived the hospital, the patient had tactile but no grip strength. IV drip was given and the patient was admitted to hospital for further follow up observation. 2 hours after hospitalization, it was recovering. On 27Sep2021 in the morning (1 day after vaccination), normal life was possible for the patient. There was no consciousness disturbed during the follow up. The reporting physician classified the event as non-serious and assessed that the event was related to bnt162b2. There was no other possible cause of the event such as any other diseases. The reporting physician commented as follows: The events occurred at 10 minutes after vaccination, so it was considered that the event was related to bnt162b2. But mental factors could not be denied.; Reporter''s Comments: The events occurred at 10 minutes after vaccination, so it was considered that the event was related to bnt162b2. But mental factors could not be denied.


VAERS ID: 1784238 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-09-26
Onset:2021-09-26
   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 FF5790 / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
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: 20210926; Test Name: body temperature; Result Unstructured Data: Test Result:36.7 Centigrade; Comments: before vaccination; Test Date: 20210926; Test Name: spo2; Result Unstructured Data: Test Result:96-97 %
CDC Split Type: JPPFIZER INC202101281976

Write-up: Urticaria/wheals appeared on the left lower leg and expanded to the chest abdomen and the upper forearm.; itching; This is a spontaneous report from a contactable physician received from the regulatory authority. Regulatory authority report number is v21127729. A 14-year-old male patient received bnt162b2 (COMIRNATY; Solution for injection), dose 1 at vaccination age of 14-year-old via an unspecified route of administration on 26Sep2021 at 15:00 (Lot Number: FF5790; Expiration Date: 31Dec2021) as first single dose (dose 1, single) for covid-19 immunisation. The patient''s medical history was none. Body temperature before vaccination was 36.7 degrees Centigrade. 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). The patient''s concomitant medications were not reported. On 26Sep2021 at 19:00 (4 hours after vaccination), the patient experienced Urticaria. On 27Sep2021 (1 day after vaccination), the outcome of the event was recovered. The course of the event was as follows: On 26Sep2021 from around 19:00 (the day of vaccination), wheals appeared on the left lower leg and expanded to the chest abdomen and the upper forearm. At 19:15, the patient took Fexofenadine 60mg orally, wheals decreased at around 24:00, and disappeared in the next morning (27Sep2021). There was Itching but disappeared later. There were no respiratory symptoms. Spo2 96-97%. The reporting physician classified the event as non-serious and assessed that the event was related to bnt162b2. There was no other possible cause of the event such as any other diseases. The reporting physician commented as follows: The events occurred 4 hours after vaccination, it was possible that there were other factors.


VAERS ID: 1787262 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Foreign  
Vaccinated:0000-00-00
Onset:2021-09-26
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Chest pain, Chills, Pain, Pyrexia, Somnolence
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: ROJNJFOC20211024553

Write-up: Sleepiness; Chest pain; Fever; GENERALISED BODY PAIN; Chills; This spontaneous report received from a consumer via Regulatory Authority (RO-NMA-2021-SPCOV12751) on 12-OCT-2021 and concerned a 20 year old female of unspecified race and ethnic origin. The patient''s weight was 50 kilograms, and height was 165 centimeters. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: XE389 expiry: UNKNOWN) 1 dosage forms, 1 total administered on 26-SEP-2021 for active immunisation. No concomitant medications were reported. On 26-SEP-2021, the patient experienced sleepiness, chest pain, fever, generalised body pain, chills and was hospitalized (date unspecified). The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient was recovering from sleepiness, chest pain, fever, generalised body pain, and chills. This report was serious (Hospitalization Caused / Prolonged).


VAERS ID: 1734455 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-23
Onset:2021-09-25
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Nikki (birth control)
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None. Literature online says it should reduce in 7-10 days
CDC Split Type:

Write-up: Left sided supraclavicular swollen lymph node


VAERS ID: 1734456 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-09-23
Onset:2021-09-25
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

Administered by: Pharmacy       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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Arthritis
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Upper lip swelling over 24 hrs after shot.


VAERS ID: 1734478 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-09-23
Onset:2021-09-25
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Diarrhoea, Headache
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Diarrhea, Headache


VAERS ID: 1734527 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-24
Onset:2021-09-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037F21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Headache, Immediate post-injection reaction, Injection site erythema, Injection site pain, Injection site swelling, Injection site warmth, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Shot one was nearly as bad, but not quite.
Other Medications: None
Current Illness:
Preexisting Conditions: Obese
Allergies: Sulfa
Diagnostic Lab Data:
CDC Split Type:

Write-up: Immediate dizziness at the time of injection that lasted about 20 minutes. Extremely painful injection site with swelling (a lump), redness, and heat. Intermittent muscle pain rotating from thigh to calf, to arms, and so on. Slight headache could be muscle in neck. We are applying ice to the injection site.


VAERS ID: 1734531 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-24
Onset:2021-09-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 3 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Immunodeficiency, 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: Administration error mixed series mRNA vaccine Pfizer and Moderna.


VAERS ID: 1734544 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-24
Onset:2021-09-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 3 RA / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Multiple vitamin
Current Illness: None
Preexisting Conditions: Arthritis; post mastectomy pain syndrome
Allergies: Amoxicillin; gadolinium
Diagnostic Lab Data:
CDC Split Type:

Write-up: Body aches headache tired dizzy


VAERS ID: 1734579 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: New York  
Vaccinated:2021-08-31
Onset:2021-09-25
   Days after vaccination:25
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 LA / IM

Administered by: Pharmacy       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: Pt got hospitalized yesterday


VAERS ID: 1734597 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: New York  
Vaccinated:2021-09-25
Onset:2021-09-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0162 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Eye pain
SMQs:, Glaucoma (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Levothyroxine, Pantoprazole, Vitamin D, fishoil
Current Illness: none
Preexisting Conditions: removed thyroid, GERD
Allergies: none known
Diagnostic Lab Data: Eye exam by dr.
CDC Split Type:

Write-up: Pain behind and including Left Eye. Tx: Prednisone (acetate) eye drops. return to normal, but see 2nd shot ( have not returned to normal)!


VAERS ID: 1734608 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-24
Onset:2021-09-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal pain upper, Arthralgia, Chills, Dizziness, Fatigue, Migraine, Myalgia, Nausea
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Migraine since 2 hours after 2nd vaccine, nausea, stomach pain, fatigue, chills, muscle & joint pain, dizziness.


VAERS ID: 1734626 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-09-25
Onset:2021-09-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 2 LA / IM

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

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

Write-up: Patient fainted when sitting in waiting room after getting the vaccine. She had been sitting in tripod stance looking at her phone and thinks she fainted and rolled to the ground from the chair. She was sitting on the floor when my assistant walked by after hearing her phone drop. We helped her to the exam table where she lay with head elevated, talking normally and oriented x4. Drank water and ate a granola bar since she said she had not eaten yet today. About 30 min after receiving the shot she felt like she could leave and felt normal. No head injury noted and no bleeding noted. She did say she may feel a little tender on upper right forehead and hairline.


VAERS ID: 1734632 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-24
Onset:2021-09-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 035C21A / 1 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Smallpox immunization
Other Medications: Centrum one a day vitamin 150mg buproprion XL 30mg duloxetine
Current Illness: Common cold concluded 10days prior to vaccine. Non Covid (tested during course of illness)
Preexisting Conditions: N/A
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Swollen left deltoid above and below injection site. 1.5? by 6? in surface area and approximately 1/2? (a half inch) in elevation.


VAERS ID: 1734646 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-25
Onset:2021-09-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / UNK - / -

Administered by: Other       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: Acetaminophen Amlodipine Besylate Aranesp (Billable) Aranesp (Billable) Calcitriol Calcium Acetate Clonidine HCl Clonidine HCl Covid-19 Pfizer-BioNTech Addl dose Gentamicin 320mcg/ml in 4% Citrate Gentamicin 320mcg/ml in 4% Citrate Heparin
Current Illness:
Preexisting Conditions: ESRD
Allergies: None known
Diagnostic Lab Data:
CDC Split Type:

Write-up: Administration error mixed series mRNA vaccine Pfizer and Moderna.


VAERS ID: 1734648 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-25
Onset:2021-09-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 3 LA / IM

Administered by: Other       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: Acetaminophen Aranesp (Billable) Aspirin Calcitriol Calcitriol; Covid-19 Pfizer-BioNTech Addl dose Diltiazem HCl ER Heparin bolus Heparin hourly Hydralazine HCL Insulin Lispro (Human) Lovastatin Nepro/Carb Steady Normal Saline
Current Illness:
Preexisting Conditions: ESRD Diabetes, currently on insulin
Allergies: None known
Diagnostic Lab Data:
CDC Split Type:

Write-up: Administration error mixed series mRNA vaccine Pfizer and Moderna.


VAERS ID: 1734649 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-25
Onset:2021-09-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 3 RA / IM

Administered by: Other       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: Acetaminophen Aranesp (Billable) Calcitriol Covid-19 Pfizer-BioNTech Addl dose Divalproex Sodium Docu Soft Engerix-B (Hepatitis B Vaccine) Furosemide Gentamicin 320mcg/ml in 4% Citrate Gentamicin 320mcg/ml in 4% Citrate Heparin bolus Hepar
Current Illness:
Preexisting Conditions: ESRD Diabetes, currently on insulin History of hypertension
Allergies: None known
Diagnostic Lab Data:
CDC Split Type:

Write-up: Administration error mixed series mRNA vaccine Pfizer and Moderna.


VAERS ID: 1734655 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-09-25
Onset:2021-09-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / UNK - / -

Administered by: Public       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: patient came in stating for first dose of COVID-19 vaccine. reflected 1st dose. Provider gave pfizer dose. When support staff looked up pt. eligibility for incentive program in record showed pt. had J&J 3/28/21. Pt. admitted to doing this because he heard pfizer was a better vaccine. incentive was not given.


VAERS ID: 1734656 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-25
Onset:2021-09-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 3 RA / IM

Administered by: Other       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: Acetaminophen Aranesp (Billable) Calcitriol, Covid-19 Pfizer-BioNTech Addl dose Divalproex Sodium Docu Soft Engerix-B (Hepatitis B Vaccine) Furosemide Gentamicin 320mcg/ml in 4% Citrate Gentamicin 320mcg/ml in 4% Citrate Heparin bolus Hepar
Current Illness:
Preexisting Conditions: ESRD Diabetes, currently on insulin History of hypertension
Allergies: None known
Diagnostic Lab Data:
CDC Split Type:

Write-up: Administration error mixed series mRNA vaccine Pfizer and Moderna.


VAERS ID: 1734657 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-25
Onset:2021-09-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 3 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Extra dose administered, Interchange of vaccine products
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: Acetaminophen Aranesp (Billable) Calcitriol
Current Illness:
Preexisting Conditions: ESRD Diabetes, currently on insulin History of hypertension
Allergies: None known
Diagnostic Lab Data:
CDC Split Type:

Write-up: Administration error mixed series mRNA vaccine Pfizer and Moderna.


VAERS ID: 1734663 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-25
Onset:2021-09-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 3 RA / IM

Administered by: Other       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: Acetaminophen Amlodipine Besylate Aranesp (Billable) Aspirin; Calcitriol Carvedilol Clonidine HCl Covid-19 Pfizer-BioNTech Addl dose Glipizide Heparin bolus Hydralazine HCL Normal Saline Oxygen Tums
Current Illness:
Preexisting Conditions: ESRD
Allergies: Metformin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Administration error mixed series mRNA vaccine Pfizer and Moderna.


VAERS ID: 1734664 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-25
Onset:2021-09-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 3 RA / IM

Administered by: Other       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: Acetaminophen Aranesp (Billable) Calcitriol Divalproex Sodium Docu Soft Engerix-B (Hepatitis B Vaccine) Furosemide Gentamicin 320mcg/ml in 4% Citrate Gentamicin 320mcg/ml in 4% Citrate Heparin bolus Heparin hourly Losartan Potassium Mirtaza
Current Illness:
Preexisting Conditions: ESRD Diabetes, currently on insulin History of hypertension
Allergies: None known
Diagnostic Lab Data:
CDC Split Type:

Write-up: Administration error mixed series mRNA vaccine Pfizer and Moderna.


VAERS ID: 1734666 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-25
Onset:2021-09-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 3 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Extra dose administered, Interchange of vaccine products
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: Acetaminophen Amlodipine Besylate Aranesp
Current Illness:
Preexisting Conditions: ESRD
Allergies: None known
Diagnostic Lab Data:
CDC Split Type:

Write-up: Administration error mixed series mRNA vaccine Pfizer and Moderna.


VAERS ID: 1734681 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-09-04
Onset:2021-09-25
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004F21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abortion spontaneous, Exposure during pregnancy
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Termination of pregnancy and risk of abortion (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient miscarried in the 11 days following vaccine administration. Patient does have a history of miscarriage.


VAERS ID: 1734682 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-25
Onset:2021-09-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 2 RA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 309614 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Loss of consciousness, Seizure
SMQs:, Torsade de pointes/QT prolongation (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), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: not known
Current Illness: none reported
Preexisting Conditions: none reported
Allergies: none known to patient
Diagnostic Lab Data: Fire Department and ambulance arrived and was helping patient.
CDC Split Type:

Write-up: After 5 to 10 minutes of receiving vaccines, she lost consciousness, woke up and went into seizures for duration less than a minute. Emergency Medical Services was contacted; however, patient refused to go to the hospital.


VAERS ID: 1734685 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-23
Onset:2021-09-25
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Vaginal haemorrhage
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow)

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

Write-up: Vaginal Bleeding 2 days after the shot


VAERS ID: 1734709 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-24
Onset:2021-09-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / IM

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

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

Write-up: The lymph node in my collar bone area is very swollen and tender to touch. My neck hurts, and my arm hurts .


VAERS ID: 1734714 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-25
Onset:2021-09-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047C21A / 2 LA / IM

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

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

Write-up: dizziness


VAERS ID: 1734716 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-25
Onset:2021-09-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 3 RA / IM

Administered by: Other       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: Acetaminophen Acetaminophen Albuterol Amlodipine
Current Illness:
Preexisting Conditions: ESRD Amputation Congestive heart failure Diabetes History of hypertension
Allergies: Codeine almonds
Diagnostic Lab Data:
CDC Split Type:

Write-up: Administration error mixed series mRNA vaccine Pfizer and Moderna.


VAERS ID: 1734718 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-25
Onset:2021-09-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 3 RA / IM

Administered by: Other       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: Aranesp (Billable) Aranesp (Billable) Aspirin Auryxia; Calcitriol Cetirizine HCl Covid-19 Pfizer-BioNTech Addl dose Degludec insulin (Tresiba) Dialyvite 800 Famotidine Furosemide Gabapentin Gentamicin 320mcg/ml in 4% Citrate Gentamicin 320
Current Illness:
Preexisting Conditions: ESRD Congestive heart failure Diabetes, currently on insulin History of hypertension
Allergies: Amoxapine
Diagnostic Lab Data:
CDC Split Type:

Write-up: Administration error mixed series mRNA vaccine Pfizer and Moderna.


VAERS ID: 1734719 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-23
Onset:2021-09-25
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Injection site pain, Injection site swelling, Lymphoedema
SMQs:, Retroperitoneal fibrosis (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: enalapril ,norvasc, metformin, januvia,
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: L arm pain, swelling-- lymphedema L arm


VAERS ID: 1734721 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-25
Onset:2021-09-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 3 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Extra dose administered, Interchange of vaccine products
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: Acetaminophen Aranesp (Billable) Aranesp (Billable) Aspir-81, B-Complex Calcitriol Covid-19 Pfizer-BioNTech Addl dose Dialyvite 800 Effexor EMLA, Heparin bolus, Normal Saline, Oxygen, Sevelamer Carbonate EMLA Heparin bolus Normal Saline Oxy
Current Illness:
Preexisting Conditions: ESRD
Allergies: Codeine Penicillin Sulfa
Diagnostic Lab Data:
CDC Split Type:

Write-up: Administration error mixed series mRNA vaccine Pfizer and Moderna.


VAERS ID: 1734726 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-09-24
Onset:2021-09-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Condition aggravated, Injection site pain, Vaccine positive rechallenge
SMQs:, Extravasation events (injections, infusions and implants) (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: injection site soreness, generalized arthragias after doses 1 and 2 of Pfizer Covid-19 vaccine.
Other Medications: levothyroxine, atorvastatin, finasteride
Current Illness: none
Preexisting Conditions: hypertension, hypothyroidism
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: injection site soreness, generalized arthralgias (bilateral wrists, elbows, shoulders, and knees)


VAERS ID: 1734740 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-25
Onset:2021-09-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 211A21A / 1 LA / IM

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

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

Write-up: On Saturday, September 25, 2021 client came to vaccination POD for a Covid-19 Janssen dose. Client stated to ancillary staff during check-in process that he was vaccinated with Covid-19 vaccine 7 months ago in February, without proof of vaccination. At this time Covid-19 vaccine is not a vaccine approved. Elevated to Medical team & Vaccine Operations Lead and approved client to get the Janssen vaccine as it has been more than 28 days since receiving the one dose of non-FDA-authorized Covid-19 vaccine. Client has no history of allergies or previous adverse reactions to other vaccines. Client was to be a 15 minute wait in the Observation Area. Client received his Covid-19 Janssen (LOT #: 211A21A) at approximately 10:32 AM in his left arm. Client experienced no adverse reaction while waiting in Observation Area and left vaccination site with a steady gait at approximately 10:50 AM.


VAERS ID: 1734769 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-09-23
Onset:2021-09-25
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

Administered by: Pharmacy       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: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: Sulfa antibiotics
Diagnostic Lab Data:
CDC Split Type:

Write-up: Bells Palsy to left side of face


VAERS ID: 1734780 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-09-25
Onset:2021-09-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Disorientation, Dizziness, Fall, Hyperhidrosis, Loss of consciousness, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad), Dehydration (broad)

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

Write-up: Patient became disoriented, light headed, briefly lost consciousness, and fell out of the chair. He then got up and began sweating profusely and began vomiting. 911 was called and patient was taken to the hospital by EMS.


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