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From the 7/23/2021 release of VAERS data:

Found 506,830 cases where Vaccine is COVID19 and Patient Did Not Die



Case Details (Reverse Sorted by Onset Date)

This is page 98 out of 5,069

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VAERS ID: 1428262 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 LA / IM

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

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

Write-up: PATIENT RECEIVED J AND J ( JANSEEN VACCINE) EARLIER FROM DIFFERET LOCATION BUT ON 06/24/2021 PATIENT CAME TO PHARMACY AND RECEIVED PFIZER COVID VACCINE (DOSE NUMBER 1) WIHTOUT INFORMING ABOUT PRIOR VACCINATION RECORD . ALSO PATIENT MARKED NO ON THE CONSENT FORM FILLED AT THE PHARMACY BEFORE RECEIVING VACCINE , WHILE BILLING TO THE INSURANCE ,PHARMACY FOUND OUT THAT PATIENT ALREADY RECEIVED DIFFERETN VACCINE BEFORE AND LATER ON PATIENT CONFIRMED THAT ALSO.


VAERS ID: 1428272 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-06-16
Onset:2021-06-24
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site pruritus, Vaccination site induration, Vaccination site warmth
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Firm, round, hot, itchy area at vaccination site


VAERS ID: 1428432 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 035C21A / 1 LA / IM

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

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

Write-up: Pt reported shellfish allergy on form. Got moderna vaccine and was asked to wait 30 minutes. After waiting period she checked back at counter and said she felt like she has a slight eyelid swelling but it went down and she felt fine and left. She wasn''t given any medication. She called next day 6/25 to cancel second dose and reported couple hours later after she went home, she had some throat swelling similar to a shellfish allergy but didn''t take anything for it and didn''t call doctor, and that also went away a few hours later and completing upon waking up next day.


VAERS ID: 1428680 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-06-23
Onset:2021-06-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Ear pain, Headache, Influenza like illness, Injection site mass, Injection site rash, Pyrexia, Rash erythematous
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Ear pain, head ache, flu like symptoms, red rash and large red lump at injection site, chills, low grade fever. Started almost 24 hours after injection and is still ongoing.


VAERS ID: 1428889 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-06-23
Onset:2021-06-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 1 LA / SYR

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

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

Write-up: Fever, fatigue, chills, and nausea


VAERS ID: 1429315 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Alabama  
Vaccinated:0000-00-00
Onset:2021-06-24
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821288 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Poor quality product administered, Product storage error
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: The patient had no known allergies.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210653835

Write-up: PUNCTURED VIAL STORED MORE THAN A DAY; RECEIVED AN EXPIRED VACCINE DOSE/ POOR QUALITY PRODUCT ADMINISTERED; This spontaneous report received from a pharmacist concerned a 26 year old female. The patient''s height, and weight were not reported. The patient''s pre-existing medical conditions included the patient had no known allergies. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, and batch number: 1821288 expiry: 15-SEP-2021) dose was not reported, administered on 24-JUN-2021 15:00 for prophylactic vaccination. No concomitant medications were reported. On 24-JUN-2021, the subject experienced punctured vial stored more than a day. On 24-JUN-2021, the subject experienced received an expired vaccine dose/ poor quality product administered. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the punctured vial stored more than a day and received an expired vaccine dose/ poor quality product administered was not reported. This report was non-serious.


VAERS ID: 1429331 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 2 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Burning sensation, Dry skin, Insomnia, Rash
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

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

Write-up: Scaly painful rash forming around lips, has grown up both of my cheeks and around my left eye. It has also formed on my neck knuckles and hands. Its bumpy like braille individual bumps with space between the next bump. On my face it burns, and is dryer. I am itchy eveywhere to the point that I cannot sleep. I have taken an allergy pill today to try and get relief but I must admit this isn''t pleasant.


VAERS ID: 1429506 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Headache, Heart rate irregular, Influenza like illness, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Cardiac arrhythmia terms, nonspecific (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Losartan 50mg daily, Zyrtec 10mg daily
Current Illness: Had positive rapid test and negative PCR Covid test on 5/29 WAS SICK FOR A WEEK - tested negative for antibodies on 6/24
Preexisting Conditions: High blood pressure
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Starting at 11pm only 6 hours after shot I began flu like symptoms. From 1am to 2am I had uncontrollable body shivers and pounding headache worst I?ve ever experienced . Had to take hot shower for 40 minutes to regulate body temp and stop shivers. Pulse had been at 114 from 1am- 4am (normally around 85). Took ibprofen for headache.. 20 hours after shot had 104.4 fever and 112 pulse - extreme headache persisting now for 30 hours - high fever coming and going - taking Tylenol and Ibprofen? headache will not go away. Feeling flu like still 30 hours after shot. Pulse is fluctuating between 85 and 115 depending on sleep/rest/medication. This is the worst illness I?ve ever encountered. Headache is unbearable.


VAERS ID: 1429538 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-22
Onset:2021-06-24
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Echocardiogram, Electrocardiogram ST segment abnormal, Laboratory test, Troponin increased
SMQs:, Myocardial infarction (narrow), 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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: daily MVI
Current Illness: none
Preexisting Conditions: none
Allergies: dust
Diagnostic Lab Data: echo, EKG, myocarditis workup
CDC Split Type:

Write-up: chest pain, elevated troponin, ST segment changes on EKG


VAERS ID: 1429571 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-04-01
Onset:2021-06-24
   Days after vaccination:84
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Abortion spontaneous
SMQs:, Termination of pregnancy and risk of abortion (narrow)

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

Write-up: Miscarriage


VAERS ID: 1429583 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache, Myalgia, Pain, Pain in extremity, Pain of skin
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Severe headache, severe muscle pain, skin hurt to touch, severe body aches. My fingers and toes hurt. Could only lay completely still in complete silence and still had massive pain. No relief!


VAERS ID: 1429595 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: New York  
Vaccinated:2021-06-22
Onset:2021-06-24
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Arteriogram coronary normal, Chest pain, Echocardiogram normal, Ejection fraction, Myocarditis
SMQs:, Gastrointestinal nonspecific symptoms and therapeutic procedures (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? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Escitalopram 20mg qDaily, Hydroxyzine 10mg PRN
Current Illness:
Preexisting Conditions: Obesity, Asperger Syndrome
Allergies: NKDA
Diagnostic Lab Data: 6/26/2021 - CT Coronary angiogram negative for CAD. Echo done on the same day showing preserved ejection fraction and no wall motion abnormalities.
CDC Split Type:

Write-up: Chest pain started 1-2 days after vaccine dose, rated a 9/10 in intensity. Clinical diagnosis - Acute myopericarditis Treated with ibuprofen 800mg q8h with resolution of symptoms shortly after 1-2 doses.


VAERS ID: 1429601 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: New York  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chills, Headache, Pain, Pyrexia, Restlessness
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Akathisia (broad), Noninfectious encephalopathy/delirium (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Fever 101, chills, body aches, headache, restlessness. Lasted for about 24 hours and went away on its own


VAERS ID: 1429609 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / UNK LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None.
Current Illness: None.
Preexisting Conditions: None.
Allergies: Red Dye #40
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Arm has rash and hard bump at injection site. This is still persistent after 2 days, it started a few hours after receiving the vaccine and hasn''t gone away yet. I only got a little bump after my first dose immediately after, but this is far worse after my second dose. There is a lot of pain in general and it becomes even worse when my arm touches even fabric.


VAERS ID: 1429632 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Disorientation, Electrocardiogram abnormal, Fall, Hyperhidrosis, Pallor, Seizure
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: Unknown
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: Asthma
Allergies: N/A
Diagnostic Lab Data: EKG at the site.
CDC Split Type:

Write-up: The patient received the vaccine and 4-5 minutes later he fell out of his chair, facedown. He appeared to be convulsing. He was pale, diaphoretic, and disoriented. His blood pressure was 76/36 and his pulse was 84. Radial pulse was 2+. EMT was called. His EKG appeared to have a slight elevation in his inferior leads. He and his guardian deny any significant history. Upon discharge with EMT, the patient was alert and tolerating liquids well. The patient''s guardian states that he has had a similar reaction prior when he was the age of 6. She states that he also felt slightly lightheaded from the first Pfizer vaccination.


VAERS ID: 1429668 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / SYR

Administered by: Public       Purchased by: ?
Symptoms: Abdominal discomfort, Asthenia, Fatigue, Headache, Pain in extremity
SMQs:, Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Journay Ritalin Intuniv Risperidone Clonidine Vit D Methylfolate Melatonin
Current Illness: None
Preexisting Conditions: Autism ADHD
Allergies: NKA
Diagnostic Lab Data: Nine
CDC Split Type:

Write-up: Sore arm, headache, weakness, upset stomach, fatigue


VAERS ID: 1429717 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH PFIZER COVID / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Swollen tongue, Tongue discomfort, Urticaria
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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none known
Current Illness: none known
Preexisting Conditions: none known
Allergies: none known
Diagnostic Lab Data: none.
CDC Split Type:

Write-up: Pt had welts on leg, her tongue started to feel heavier and swell. No shortness of breath.


VAERS ID: 1429753 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-17
Onset:2021-06-24
   Days after vaccination:38
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Cough, 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: DM 2, HLD, tobacco user
Allergies: nka
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Patient received Johnson & Johnson vaccine 5/17/21. Around 3 days ago 5/23 developed fever, chills with cough. Seen at Urgent care. Evaluated by Dr.


VAERS ID: 1429763 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-18
Onset:2021-06-24
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017B21A / UNK LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Injection site rash
SMQs:, Hypersensitivity (narrow)

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

Write-up: Rash at injection site


VAERS ID: 1429802 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-06-23
Onset:2021-06-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Fatigue, Headache, Injection site pain, Nausea, Pain, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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: Amoxicillin penicillin ibuprofen
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever, chills, body aches, headache, nausea, fatigue, sore injection site


VAERS ID: 1429811 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033C214 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Buspirone, fenofibrate, ketoconazole cream, trazodone, Effexor
Current Illness: NONE
Preexisting Conditions: Hyperlipidemia, leukocytosis, low vitamin d
Allergies: NKDA no food allergies
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Allergic Urticaria that started 2 t 3 hours after the injection. She reports fatigue 2 days later with rash resolving with some use of Benadryl. She required additional Steroid injections, pepcid, and Benadryl for outpatient treatment.


VAERS ID: 1429826 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-06-17
Onset:2021-06-24
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Brain natriuretic peptide increased, C-reactive protein increased, Chest pain, Dyspnoea, Electrocardiogram T wave inversion, Pyrexia, Red blood cell sedimentation rate increased, Troponin increased
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Other ischaemic heart disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (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? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: none known
Current Illness: s/p Pfizer #1 on 5/27/2021
Preexisting Conditions: obesity
Allergies: watermelon - dyspnea
Diagnostic Lab Data: troponin 2.93 elevated CRP 35.7 (nl <10), ESR 21, BNP 1961 EKG: inverted T waves V4-V6
CDC Split Type:

Write-up: 6/24/2021 developed tactile fever, substernal chest pain, and shortness of breath 6/25/2021 increased shortness of breath, chest pain


VAERS ID: 1429876 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-23
Onset:2021-06-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009D21A / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood urine present, Feeling abnormal, Nausea, Pyrexia, Sepsis, Vomiting
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sepsis (narrow), 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? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations: moderna covid vaccine first dose on 05/26/2021, age 39, patient reported fever, body ache, chills, headache
Other Medications: phentermine
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient started feeling bad due to fever, nausea, vomiting, and blood in urine. Was transported to emergency room and was diagnosed with sepsis. Was admitted overnight and given iv fluids and antibiotics. Discharged following day and given more antibiotics


VAERS ID: 1429884 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-06-23
Onset:2021-06-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022B21A / 2 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Chills, Fatigue, Injection site pain, Injection site swelling, Myalgia, Nausea, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), 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: Brilinta 90 mg. 2x daily, Metoprolol Tartrate 25 mg. 2x daily, Atorvastatin 40 mg., Aspirin 81 mg., Vitamin D3 125 mcg., Super Vitamin B-Complex, Omega-3 Fish Oil 720 mg.
Current Illness: Heart
Preexisting Conditions: Heart
Allergies: Latex
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Pain, swelling & tenderness at injection site, Fatigue, Muscle Pain, Joint Pain, Chills, Nausea and Fever


VAERS ID: 1429893 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-06-23
Onset:2021-06-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 018B21A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Asthenia, Chills, Delirium, Headache, Injection site pain, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Gabapentin 100mg - 2 AM/2 Noon/3 PM Bupropion ER XL 150mg-daily Tizanindine 4mf- nightly Hydroxychlor sulf 200 mg- 1AM/1PM Lexapro 20mg daily Aspirin 81mg - daily Osteo Bi-Flex - daily Omeprazole 20mg - daily Diphenhydramine HCI 25 mg - da
Current Illness: none
Preexisting Conditions: Lupus Fibromyalgia Osteoarthritis
Allergies: surgical tape
Diagnostic Lab Data:
CDC Split Type:

Write-up: Moderna COVID - 19 vaccine EUA Started with a mild head ache that progressed as the day went on. By 10:00 that evening my head was busting. Sometime during the night I woke up drenched from sweating out my fever. it went as high as 102.5. I was delirious, had chills, and severe body aches. The site of the injection is super sore. The shot was on Wednesday. The symptoms started in less than 12 hours and I did not feel better until today which is Saturday. And honestly, I am still wiped out.


VAERS ID: 1429919 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Tinnitus
SMQs:, Hearing impairment (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: 47 years ago to Flu vaccine, was sick for a week. No vaccines since besides this one.
Other Medications: Soma X 15 years
Current Illness: Interstitial Cystitis
Preexisting Conditions: See Above
Allergies: N/A
Diagnostic Lab Data:
CDC Split Type:

Write-up: Severe worsening of mild tinnitus to high pitch ''screaming'' in both ears. About 30 min after shot. It continues unabated


VAERS ID: 1429964 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

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

Write-up: urticaria


VAERS ID: 1430023 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-06-23
Onset:2021-06-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache
SMQs:

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

Write-up: SEVERE HEADACHE


VAERS ID: 1430024 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Uterine spasm
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: Multivitamin Fish Oil Vitamin D Magnesium
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Uterine cramps


VAERS ID: 1430027 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Chills, Electrocardiogram ST segment elevation, Fibrin D dimer increased, Headache, Myocarditis, Nausea, Palpitations, Troponin, Vomiting
SMQs:, Acute pancreatitis (broad), Haemorrhage laboratory terms (broad), Myocardial infarction (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: Troponin 39 D Dimer 1580 EKG ST elevation
CDC Split Type:

Write-up: Developed chills, nausea, headache, vomiting on 6/24/21-6/25/21, then developed palpitations 6/26/21 prompting evaluation in emergency department and hospitalization for myocarditis


VAERS ID: 1430032 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-22
Onset:2021-06-24
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 AR / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 2 AR / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Echocardiogram normal, Troponin I increased
SMQs:, Myocardial infarction (narrow), 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? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None FIRST DOSE WAS 6/1, SECOND DOSE 6/22 PFIZER VACCINE
Allergies: None
Diagnostic Lab Data: Troponin Results for 6/24/2021 17:40 TROPONIN I: 0.66 (H) 6/25/2021 06:05 TROPONIN I: 14.06 (H) 6/25/2021 16:42 TROPONIN I: 18.87 (H) 6/26/2021 05:59 TROPONIN I: 15.10 (H) 6/26/2021 16:10 TROPONIN I: 18.37 (H) echo with normal function and no effusion
CDC Split Type:

Write-up: First dose 6/1/21, second dose 6/22/21 Chest pain and elevated troponin, treated with ibuprofen, echo with normal function and no effusion


VAERS ID: 1430034 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Idaho  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW / 2 LA / IM

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

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

Write-up: Patient should have received Moderna vaccine for the 2nd vaccine but she received Pfizer


VAERS ID: 1430044 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Mississippi  
Vaccinated:2021-06-23
Onset:2021-06-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain, Chest discomfort, Dizziness, Dyspnoea, Exercise tolerance decreased, Headache, Limb discomfort, Nausea
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (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: Buproprion Solefinacin Claritin Pantoprazole Montelukast Nortryptaline Co-Q-10 Turmeric Condroitin Zinc Magnesium Vitamins D & C Flonase
Current Illness: None
Preexisting Conditions: Overweight
Allergies: Collin drugs Sulfa drugs Lasix
Diagnostic Lab Data: None (yet)
CDC Split Type:

Write-up: Difficulty obtaining deep breath Heaviness in chest, radiating to both arms Reduction in stamina (exercise-induced) Light headache Light, intermittent dizziness Abdominal pain & nausea, but no vomiting


VAERS ID: 1430079 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Mississippi  
Vaccinated:2021-06-23
Onset:2021-06-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site pain, Injection site reaction, Peripheral swelling, Rash erythematous, Skin warm
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (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: Phentermine and Xulane patch
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: AfterI received my 2nd vaccine for covid, I was fine the 1st day. On the 2nd day, my arm became swollen, warm, and painful to touch around the injection site. By the 3rd day, I had developed ?Covid Arm?. I have a large, thick, red rash around the injection site. It is extremely itchy. I did not have this problem when I took the 1st Moderna shot.


VAERS ID: 1430103 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-06-22
Onset:2021-06-24
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011D21A / 2 LA / IM

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

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

Write-up: Site: Bruising at Injection Site-Mild, Site: Pain at Injection Site-Medium, Site: Redness at Injection Site-Medium, Site: Swelling at Injection Site-Medium, Additional Details: Adverse reaction is still ongoing. Pt came to rx today concerned with reaction which started 2 days after vaccination. Arm is warm and red with some bruising. Adviced patient to apply cool compresses and monitor for next few days to see if there is an improvement.


VAERS ID: 1430104 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003C21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anaphylactic reaction, Chills, Flushing, Hyperhidrosis, Hypersensitivity, Injection site bruising, Injection site erythema, Injection site pain, Injection site pruritus, Injection site swelling, Pain, Pruritus, Rash
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anaphylactic/anaphylactoid shock conditions (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Site: Bruising at Injection Site-Severe, Site: Itching at Injection Site-Severe, Site: Pain at Injection Site-Severe, Site: Redness at Injection Site-Severe, Site: Swelling at Injection Site-Severe, Systemic: Allergic: Anaphylaxis-Severe, Systemic: Allergic: Itch Generalized-Severe, Systemic: Allergic: Rash Generalized-Severe, Systemic: Body Aches Generalized-Severe, Systemic: Chills-Severe, Systemic: Flushed / Sweating-Severe, Additional Details: He called saying he had a lot of side effects. I recommended to go to urgent care or ER due to the generalized reaction.


VAERS ID: 1430114 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-06-23
Onset:2021-06-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Blood test, Chest discomfort, Dyspnoea, Electrocardiogram, Palpitations
SMQs:, Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)

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

Write-up: Heart palpitations Shortness of breath Pressure in chest


VAERS ID: 1430124 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-23
Onset:2021-06-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0162 / 2 LA / -

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

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

Write-up: 24 hours after administration got hives at the site. This along with intermittent pain lasted for 4 days


VAERS ID: 1430140 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-06-19
Onset:2021-06-24
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-06-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Rash, Rash erythematous, Rash papular, Rash pruritic
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: Ferrous sulfate 325mg , Ibuprofen 800, multivitamin
Current Illness: None
Preexisting Conditions: Iron Deficiency Anemia
Allergies: Seasonal allergies, Kiwi, some shellfish
Diagnostic Lab Data: None
CDC Split Type:

Write-up: rash on upper torso an extremities of right arm and left arm breast and back Taking on the duplicate form of the hives red itchy patches raised in the middle


VAERS ID: 1430151 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-21
Onset:2021-06-24
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-06-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0153 / 1 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Diarrhoea, Fatigue, Headache, Lymphadenopathy, Musculoskeletal stiffness, Neck pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Arthritis (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Aptiom 600 mg, Keppra 500 mg
Current Illness: none
Preexisting Conditions: Seizures as of December 18, 2020
Allergies: Tamiflu
Diagnostic Lab Data:
CDC Split Type:

Write-up: Headache, Fatique, Diarrhea 4-6 times per day, Neck Stiffness and Pain (swollen lymph nodes), Low Grade Fever


VAERS ID: 1430186 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009D21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Pruritus, Rash, Second trimester pregnancy, Skin warm
SMQs:, Anaphylactic reaction (broad), Normal pregnancy conditions and outcomes (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: Unknown
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: omeprazole
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: 23 week pregnant patient received second dose of Moderna COVID vaccine on 6/24/21 and started developing a rash that night underneath the injection site. Rash was warm to the touch and slightly itchy, but no other adverse effects or signs of anaphylaxis. I recommended the patient use hydrocortisone cream to help with itching and to contact pharmacy and OB if rash worsened or did not resolve in a few days.


VAERS ID: 1430204 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Blood test, Chest X-ray, Coagulation test, Fatigue, Heart rate increased, Paraesthesia, Sensitive skin, Tachycardia, Urine analysis
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None.
Current Illness: None.
Preexisting Conditions: None.
Allergies: None.
Diagnostic Lab Data: Chest X-Ray (6/25/2021) Blood Tests for Infection (6/25/2021) Urine Tests (6/25/2021) Blood Tests for Blood Clots (6/25/2021)
CDC Split Type:

Write-up: Less than 24 hours after the second dose of the Moderna vaccine, I developed tingling and sensitivity all over my body, fatigue, and tachycardia. I reported to the ED of UPMC Shadyside with a bmp of 130. My heart rate remained above 100 bmp throughout the course of the day. The ED team did not find signs of infection, blood clots, or heart inflammation after a multitude of lab tests. After a series of IV fluids and pain medications they were unable to lower my heart rate or find a cause and so I was discharged with instructions to hydrate and rest. The following day my heart rate remained elevated from my typical resting rate. It is not until today (6/27/2021), nearly 72 hours after the injection, that my heart rate has stabilized down to a more typical resting bpm for me.


VAERS ID: 1430224 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / UNK RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain, Back pain, Chills, Decreased appetite, Dizziness postural, Emotional disorder, Flushing, Headache, Hot flush, Hyperhidrosis, Injection site pain, Insomnia, Muscular weakness, Nausea, Pain, Pain in extremity, Skin discolouration, Tinnitus, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hearing impairment (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Period 6/3/2021 (during 1st dose, 2nd Pfizer dose was 6/24/2021)
Preexisting Conditions: None
Allergies: Wasp and bee stings
Diagnostic Lab Data: None
CDC Split Type:

Write-up: 6/24 5pm: arm pain upon injection 6pm: abdomin and lower back pain Late at night time unknown: full body aches, nausea (with throw up), vertigo upon standing, difficulty sleeping, ringing in both ears that lasted a couple minutes, persistent arm pain 6/25 6:30 am nausea with throw up provoked upon smelling food (specifically Kashi raisin no sugar added wheat cereal) did not attempt eating, severe headache, persistent arm pain, hot flash sttong enough to cause hair to drip with sweat, drank small glasses each of water and berry 100% juice 8am-12:30 at work primarily sitting: noticable shivering, color alternated between flushed-deathly pallor-green (reported to self by coworkers 5 RNs/1 LPN/1 MA), severe headache persisted, arm pain persisted, nausea without throwing up, emotional, back pain, no hunger 12:30: napped for 30 min in car backseat with sunshades up and windows cracked. 1pm: reduced headache and nausea, ate .5 peanut butter sandwich and cheezit crackers with water, other sympotoms continued Rest of 6/25: mild headache, moderate arm pain, back pain, slight nausea 6/26: slight headache and sporatic leg weakness throughout the day. No medications/herbal remedies were ever taken.


VAERS ID: 1430255 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 053C21A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: don''t know
Current Illness: NO
Preexisting Conditions: ASTHMA, HIGH CHOLESTEROL
Allergies: NO
Diagnostic Lab Data:
CDC Split Type:

Write-up: The patient came to pharmacy and asked to get the Covid-19 vaccine. He answered the pre-vaccination checklist for covid-19 vaccine form and stated this is his first time getting the vaccine. Pharmacist gave him Moderna Covid-19 vaccine on 06/24/2021. After the patient left, pharmacist entered his immunization record to immunization registry and found that pt already received 2 doses of Pfizer(second dose:02/01/2021) Patient was informed by pharmacist and he admitted that he did not tell pharmacist about his historical covid-19 vaccine because he lost his CDC immunization card. He is planning to travel and decided to revaccinate to get another CDC card Pharmacist apologized to the pt for the mistake of not checking the record before giving him the vaccine. pharmacist followed up with COVID-19 vaccine team for advise about this case on 06/24/21 and was told to call the organization who gave him the vaccine to verify if this is the correct pt However, pharmacist could not contact them ( Facility is pt medical group and the doctor at facility only helped the pt to entered to registry when pt came for visit ; according to the pt he got the vaccine) Pt is doing fine, no side effect as of 06/27/2021 Pharmacist will reach out to COVID team 06/28/21 for further guidance


VAERS ID: 1430274 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-06-14
Onset:2021-06-24
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-06-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 49C21A / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Contusion
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Accidents and injuries (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: 1St Moderna Vaccine - VAERS Report 572158
Other Medications: Vitamin/Mineral supplement. EFA. Algae Superfood supplement. D3 Supplement.
Current Illness: none
Preexisting Conditions: none
Allergies: Allergic to Penicillin.
Diagnostic Lab Data: none
CDC Split Type:

Write-up: More prone to bruising, but instead of healing in 4-5days, healing now takes 2-3 days. Cuts and abrasions also take half the time to heal than normal. Wondering if platelet clotting has been affected.


VAERS ID: 1430298 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-05
Onset:2021-06-24
   Days after vaccination:19
Submitted: 0000-00-00
Entered: 2021-06-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Menstruation delayed
SMQs:, Fertility 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: Missed period that is over 4 days late.


VAERS ID: 1430333 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821288 / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Diplopia, Dizziness, Eye pain, Fatigue, Feeling abnormal, Headache, Hypoaesthesia, Hypoaesthesia oral, Hypoaesthesia teeth, Oscillopsia, Pain, Paraesthesia, Sleep disorder, Vision blurred, Visual impairment
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Dementia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Ocular motility disorders (broad), Arthritis (broad), Hypoglycaemia (broad)

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

Write-up: within an hour after vaccine, both arms and face began tingling and went numb.. mouth/gums front teeth numb...felt dizzy and double vision with a headache the entire day.. by evening the numbness went away but headache and dizzy/double vision continued through the night. Noticed eyeballs hurt when touching eyelids and felt like I was looking through a double lense that kept jumping around, couldn''t focus or see properly. Through the night had strange pains ping on different areas of body, keeping me from sleeping. The 2nd day still had brain fog, double vision, headache and fatigue but numbness went away. Joints (elbow/shoulder/hips) had extreme pain. 3rd day headache better, but still having vision problems and eyeball pain and joint pain. Day 4 (today) still struggling with vision issues and sore eye sockets and major joint pain.


VAERS ID: 1430339 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Ear pain, Pain, Pain in jaw
SMQs:, Osteonecrosis (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: 15, MMR shot required for school. Began feeling ill shortly after the shot (cold or flu-like symptoms) but recovered in a 1-2 da
Other Medications: Wellbutrin, Losartan, HCTZ, Vitamin D 50,000, Claritin D and Benadryl
Current Illness:
Preexisting Conditions: Low vitamin d, chronic sinusitis, hypertension
Allergies: Latex, tomatoes, cheese, strawberries, red dye, cats, dogs, mites, most weeds, grasses and some trees
Diagnostic Lab Data:
CDC Split Type:

Write-up: Shortly after receiving the shot I could feel the vaccine moving from my left arm toward my back and up the left side of my neck. My left jaw began to have a stinging feeling and I experienced pain. The next day my left jaw remained a tolerable pain, and late that evening I felt a pain behind my left ear. Currently, the pain comes and goes and my health insurance company recommended I go to an urgent care facility.


VAERS ID: 1430398 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: South Dakota  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808986 / 1 LA / IM
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. T032003 / 1 LA / IM

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

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

Write-up: Redness, swelling, warmth. Using ibuprofen, tylenol, and cold compress. monitoring growth


VAERS ID: 1430400 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: New Mexico  
Vaccinated:2021-06-23
Onset:2021-06-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017CZ11A / UNK - / -

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

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

Write-up: Patient reported being hospitalized day after vaccination: symptoms included severe vomiting, chills, fever, fatigue. Could not keep food down during stay. Given IV medications for vomiting.


VAERS ID: 1430430 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2021-06-23
Onset:2021-06-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 UN / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Echocardiogram normal, Pleuritic pain, Troponin I increased
SMQs:, Myocardial infarction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Infective pneumonia (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, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Troponin I elevated and peaked at 7, now down trending. Echo wnl.
CDC Split Type:

Write-up: Patient presented with chest pain and pleuritic pain the day after receiving her 2nd COVID vaccine. Treated with ASA x1 and scheduled Ibuprofen. Pain improving


VAERS ID: 1430449 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

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

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

Write-up: limb pain starting in injection area on left upper forearm to right fore arm. limb pain occasionally flairs up and has remained persistant for a few days.


VAERS ID: 1430496 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: New Hampshire  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 2 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Fatigue, Injection site discomfort, Injection site reaction, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Moderate Pressure and Tightness in Injection Site muscle (same discomfort as second dose of Pfizer Vaccine, but stronger). Laste
Other Medications: None
Current Illness: Mild flulike symptoms (rare coughing and sneezing), but no diagnosis.
Preexisting Conditions: Anxiety and Depression
Allergies: None Known
Diagnostic Lab Data:
CDC Split Type:

Write-up: - Mild localized pressure and tightness in injection site muscle (not as strong as with first dose of Pfizer Vaccine). Lasted about 24 hours. - Mild fever and moderate fatigue (just treated with rest). Lasted about 48 hours.


VAERS ID: 1430501 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: Aortic prolapse
Allergies: none
Diagnostic Lab Data: 143/82, P: 82, O2 100%
CDC Split Type:

Write-up: Patient left after 15 minute wait period. Shortly after, patient returned, complaining of itching to extremities with signs of mild rashes along extremities. While under care, rashes subsided with no evidence of difficulty breathing or itching.


VAERS ID: 1430503 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-06-19
Onset:2021-06-24
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypoaesthesia, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad)

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

Write-up: Systemic: Numbness (specify: facial area, extremities)-Medium, Additional Details: Patient''s wife called the pharmacy on 06/27/21 to say that the patient has been complaining of tingling in both arms that started 4 days after the second dose of pfizer covid 19 vaccine. She also said will contact his phisician tomorrow, we gave her the vaers toll-free n umber and also the phone number for pfizer safety reporting.


VAERS ID: 1430568 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (UNKNOWN)) / UNKNOWN MANUFACTURER 207A21A / N/A LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Dysphagia, Dysphonia, Eructation, Eye swelling, Headache, Nausea, Paraesthesia, Paraesthesia oral, Sinus congestion, Swelling face
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Headache, face and eyes swelling, sinus congestion , difficulty swallowing, voice change, nausea and belching. Benadryl 25mg chewable taken, benadryl 25mg tablet and tylenol 1000 mg taken. Monitored then approx 1 hour later face and lip tingling, increase in headache left side of head tingling, face and eyes remained swollen. Horse voice ,difficulty swallowing 50mg of benadryl taken.


VAERS ID: 1430577 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Feeling abnormal, Hypoaesthesia
SMQs:, Peripheral neuropathy (broad), Dementia (broad), Guillain-Barre syndrome (broad)

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

Write-up: Numbness; History of anxiety, depression, asthma presents today for symptoms onset within half an hour after receiving her second Madera COVID-19 vaccine dose at 10 AM today. She complains of numbness/"funny feeling" on left face, tongue, arm and leg. She denies headache, change in vision/speech/hearing/mentation/gait, focal weakness, lightheadedness or disequilibrium. She had a similar reaction following her first vaccination a month ago, but that cleared within 30 minutes.


VAERS ID: 1430579 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Rhode Island  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A221A / UNK RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Abdominal discomfort, Arthralgia, Decreased appetite, Dysarthria, Muscular weakness, Pyrexia, Somnolence, Thirst decreased, Vision blurred
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Aching joints, upset stomach, sleepiness, slurred speech, drowsiness, blurred vision, weak muscles, lack of thirst and appetite, fever


VAERS ID: 1430588 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 2 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Expired product administered, No adverse event, Product storage error
SMQs:, Medication errors (narrow)

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

Write-up: Patient received dose #1 of Pfizer vaccine on 6/6/2021 @ Vaccination site and was notified by email that vial was left in freezer past recommended time frame. Medication expired beyond its freezer allowable date. Email recommended patient get re-vaccinated with dose again. Re-administered dose on 6/24/2021 as recommended. No adverse reactions identified on site.


VAERS ID: 1430595 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-06-23
Onset:2021-06-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 AR / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Echocardiogram normal, Myocarditis, Troponin increased
SMQs:, Myocardial infarction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: 6/26/2021: Troponin elevation (peak at our institution 2.57 ng/ml, normal by discharge)
CDC Split Type:

Write-up: chest pain 24 hours after vaccination with evidence of myocarditis by elevated troponins. Admitted for observation. echocardiogram was within normal limits. Tropinin downtrended over 24 hours and she was discharged home with outpatient cardiology follow-up to include a cardiac MRI and outpatient cardiology visit.


VAERS ID: 1430599 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-06-22
Onset:2021-06-24
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Hyperhidrosis, Nausea, Vertigo
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (narrow), Hypoglycaemia (broad)

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

Write-up: Severe vertigo or dizziness and nausea that lasted around 4 hours. After the 1st two hours, I took a couple of aspirins which had me sweating initially and seemed to help a little. I was finally able to leave work around 10 am, at which time I went to bed for several hours. When I got up, the severeness was gone but mildly lingering. As of today, there is a small hint of dizziness in the background, but I feel much better.


VAERS ID: 1430613 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-06-19
Onset:2021-06-24
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 2 UN / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain, Condition aggravated, Lipase increased, Pancreatitis acute, SARS-CoV-2 test negative
SMQs:, Acute pancreatitis (narrow), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Seroquel 25mg, Accutane 40mg, Multivitamin, Vitamin C, Vitamin D, Vitamin E
Current Illness: None
Preexisting Conditions: Genetic predisposition to pancreatitis
Allergies: None
Diagnostic Lab Data: 6/24 Lipase $g6000 6/24 SARS CoV-2 PCR NEGATIVE 6/26 Lipase 753
CDC Split Type:

Write-up: The patient has a known genetic predisposition to pancreatitis. He received his first Pfizer Covid vaccine on 5/23. On 6/13 he had mild pain consistent with his history of pancreatitis. He was able to treat this at home with oral pain medications so did not have to seek other care. He received his 2nd Pfizer Covid vaccine 6/19. On 6/24 he had onset of more severe abdominal pain so went to the ER. There his lipase was found to be $g6000. He was admitted for acute pancreatitis. He was given IV fluids, pain control until his symptoms resolved.


VAERS ID: 1430634 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 2 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Immunisation, No adverse event, Product storage error
SMQs:, Medication errors (narrow)

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

Write-up: Patient received dose #1 of Pfizer vaccine on 6/6/2021 and was notified by email that vial was left in freezer past recommended time frame. Medication expired beyond its freezer allowable date. Email recommended patient get re-vaccinated with dose again. Affiliated Physicians re-administered dose on 6/24/2021 as recommended. No adverse reactions identified on site.


VAERS ID: 1430646 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EY0579 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal discomfort, Arthralgia, Chills, Fatigue, Feeling abnormal, Lymph node pain, Lymphadenopathy, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Perindopril erbumine 4mg Magnesium oxide 400mg D3K2 vitamin supplement B12
Current Illness: None
Preexisting Conditions: Just blood pressure but under control
Allergies: Penicillin
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Pain in muscles and joints Fatigue Foggy thinking Fever Chills Upset stomache Swollen lymph nodes under left arm and very painful


VAERS ID: 1430923 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-02-08
Onset:2021-06-24
   Days after vaccination:136
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6021 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN3247 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Adverse event, Blood lactate dehydrogenase increased, C-reactive protein increased, COVID-19, Confusional state, Cough, Dyspnoea, Endotracheal intubation, Fibrin D dimer, Hypoxia, Lethargy, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Bronchitis
Preexisting Conditions: CHF (diastolic), DM type 2, HTN, HLD, Atrial fibrillation
Allergies: Iodine, morphine
Diagnostic Lab Data: SARS-CoV-2 antigen test: Positive (unknown time/date) SARS-CoV-2 PCR (Roche): Positive - 6/26/21 C-reactive protein (6/25/21) 26.36 mg/dL LDH (6/25/21) 246 u/L D-dimer (6/24/21) 1.12 feu/mL
CDC Split Type:

Write-up: Developed symptoms of SARS-CoV-2 infection including shortness of breath, cough and was tested due to persistence of symptoms despite antibiotic treatment. Antigen testing was positive. Approximately 1 week after symptom onset patient was noted to be lethargic and confused by family who contacted EMS. Patient was hypoxic in ER and required 8 L of O2. Was admitted with COVID-19. Subsequently did decompensate on the floor and required intubation. Currently intubated receiving remdesivir, dexamethasone, and antibiotics.


VAERS ID: 1430928 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821286 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Axillary mass, Chills, Headache, Pain, Pain in extremity, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Gabepentin 300mg at night Vartalon Compositum 1500-1200 mg morning
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Headache, arm and shoulder pain- 06/24/21 4pm Fever, chills, body aches- 06/24/21 11pm Lumps under right underarm- 06/26/21 8am Lumps under left underarm - 06/28/21 8am


VAERS ID: 1430976 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-06-22
Onset:2021-06-24
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 054C21A / 1 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Joint swelling, Rash, Rash erythematous, Rash pruritic, Scab, Skin warm
SMQs:, Anaphylactic reaction (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Patient presented with red rash and some swelling around elbow area of left arm (which is the same arm as vaccination). Patient reports the rash started approx. 2 pm on 6/24. He reports it is very itchy and warm to the touch. Upper and lower arm not affected rash and swelling was localized to the elbow area. Pt had a few scabs on the area which he reported were due to him scratching the affected area. Patient reports no other symptoms occurred and is already scheduled to see PCP on Thursday to be evaluated. Advised patient on OTC measures he could take at this time (benadyl and topical hydrocortisone) and if condition worsens to seek medical attention sooner.


VAERS ID: 1430994 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: New York  
Vaccinated:2021-05-13
Onset:2021-06-24
   Days after vaccination:42
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Computerised tomogram, Dyspnoea, Electrocardiogram, Hyperhidrosis, Ultrasound scan, X-ray
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: no
Current Illness: no
Preexisting Conditions: no
Allergies: no
Diagnostic Lab Data: xrays, ultrasound, ekg, cat scan,
CDC Split Type:

Write-up: hard time breathing, profuse sweating.


VAERS ID: 1431007 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026D21A / 1 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. T000892 / 1 LA / SC

Administered by: Pharmacy       Purchased by: ?
Symptoms: Inappropriate schedule of product administration, Wrong dose
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: NO PRESCRIPTIONS OR OTC MEDICINES. PT GOT BOTH MMR VACCINE AND MODERNA VACCINE AT THE SAME TIME. INITIALLY, PT WAS REQUESTING FOR MMR AND NOT MODERNA.PT ALREADY HAD GOT JOHNSON AND JOHNSON VACCINE IN APRIL 2021.COVID VACCINE GOT DUPLICATED.
Current Illness: NO PRESCRIPTIONS OR OTC MEDICINES. PT GOT BOTH MMR VACCINE AND MODERNA VACCINE AT THE SAME TIME. INITIALLY, PT WAS REQUESTING FOR MMR AND NOT MODERNA.PT ALREADY HAD GOT JOHNSON AND JOHNSON VACCINE IN APRIL 2021.COVID VACCINE GOT DUPLICATED.
Preexisting Conditions: NONE
Allergies: NONE
Diagnostic Lab Data: NO LAB TESTS DONE
CDC Split Type:

Write-up: NO PRESCRIPTIONS OR OTC MEDICINES. PT GOT BOTH MMR VACCINE AND MODERNA VACCINE AT THE SAME TIME. INITIALLY, PT WAS REQUESTING FOR MMR AND NOT MODERNA.PT ALREADY HAD GOT JOHNSON AND JOHNSON VACCINE IN APRIL 2021.COVID VACCINE GOT DUPLICATED.


VAERS ID: 1431134 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-06-23
Onset:2021-06-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH PFIZER / 2 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Echocardiogram, Electrocardiogram, Magnetic resonance imaging abnormal, Troponin increased
SMQs:, Myocardial infarction (narrow), 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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Troponins trended, EKG''s trended, Cardiac MRI, Echo
CDC Split Type:

Write-up: Chest pain, elevated Troponin


VAERS ID: 1431197 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026D21A / 1 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. T000892 / 1 LA / SC

Administered by: Pharmacy       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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NO PRESCRIPTIONS OR OTC MEDICINES. PT GOT BOTH MMR VACCINE AND MODERNA VACCINE AT THE SAME TIME. INITIALLY, PT WAS REQUESTING FOR MMR AND NOT MODERNA.PT ALREADY HAD GOT JOHNSON AND JOHNSON VACCINE IN APRIL 2021.COVID VACCINE GOT DUPLICATED.
Current Illness: NO ILLNESS
Preexisting Conditions: NO CHRONIC OR LONG STANDING CONDITIONS.
Allergies: NO ALLERGIES
Diagnostic Lab Data: NO MEDICAL OR LAB TESTS DONE
CDC Split Type:

Write-up: PT GOT BOTH MMR VACCINE AND MODERNA VACCINE AT THE SAME TIME. INITIALLY, PT WAS REQUESTING FOR MMR AND NOT MODERNA.PT ALREADY HAD GOT JOHNSON AND JOHNSON VACCINE IN APRIL 2021.COVID VACCINE GOT DUPLICATED.


VAERS ID: 1431214 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017B21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Dyspnoea, Hypoaesthesia, Muscle spasms, Nausea, Paraesthesia, Vertigo, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Dystonia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular 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? No
Previous Vaccinations: Moderna lot# 037k20A given 12/23/2020, age 42, reaction SOB (went to ER)
Other Medications: HCTZ MVI Omega-3
Current Illness: N/A
Preexisting Conditions: HTN
Allergies: NKDA
Diagnostic Lab Data: CBC, CMP, D-Dimer, UA and pregnancy test All seem to be WNL with some values low
CDC Split Type:

Write-up: This is my 3rd time filing this form because their is an error. Hopefully it takes this time Severe SOB, numbness and tingling of hands, legs, and feet. Cramping of thumbs where they are claw like and cannot move. This lasted for 4hours Severe dizziness/vertigo with intractable nausea and vomiting Took 2 meclizine and zofran at home ER gave 1L NS, zofran, toradol, and valium


VAERS ID: 1431246 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-23
Onset:2021-06-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0169 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Abdominal pain, Abdominal pain upper, Asthenia, Diarrhoea, Muscle spasms, Nausea, Pain
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Wellbutrin, Pepcid AC Ibuprofen 800mg
Current Illness: none,
Preexisting Conditions: Sciatica, Torn hip labrum, depression,
Allergies: Mobic, Morphine
Diagnostic Lab Data:
CDC Split Type:

Write-up: Severe epigastric pain, nausea, diarrhea, abdominal pain, body aches, muscle spasms, weakness,


VAERS ID: 1431266 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-26
Onset:2021-06-24
   Days after vaccination:29
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / N/A - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Fibrin D dimer, Pulmonary embolism, Pulmonary imaging procedure abnormal
SMQs:, Embolic and thrombotic events, venous (narrow), Infective pneumonia (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, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: metoprolol, losartan, atorvastatin, albuterol, insulin, allopurinol, pramipexole, duloxetine, mometasone, amlodipine, pantoprazole, fluticasone, mirtazipine
Current Illness:
Preexisting Conditions: diabetes, chronic obstructive asthma, arthritis, OSA, hypertension, GERD, gout, aortic atherosclerosis
Allergies: enalapril, lisinopril, levofloxacin, losartan, lovastatin, simvastatin, trazodone
Diagnostic Lab Data: chest imaging, D-dimer
CDC Split Type:

Write-up: pulmonary embolus


VAERS ID: 1431314 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: New York  
Vaccinated:2021-05-26
Onset:2021-06-24
   Days after vaccination:29
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       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: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: a month after the 2nd shot I developed shingles


VAERS ID: 1431319 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: New York  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050C21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Headache, Impaired work ability, Nausea
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)

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

Write-up: About 15 minutes after receiving the vaccine patient stated that she was dizzy and that her head hurt. Patient was advised to sit for 15 minutes and was monitored by pharmacist. After about 10 minutes patient complained of nausea and was advised to sit for 15 more minutes and was monitored by the pharmacist. After about 45 minutes following initial complaint patient stated that nausea subsided but she was dizzy and her head still hurt. Patient was given a note to call out of work upon request and took a cab home. Pharmacist contacted patient evening of 6/24/21 and patient stated that symptoms were gone after resting for the day.


VAERS ID: 1431342 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Paraesthesia, Restlessness
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Dementia (broad), Akathisia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Hypoglycaemia (broad)

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

Write-up: Patient reports tingling in knees and restlessness that started on day of vaccination and has continued since. Patient has been asked to continue following up/reporting with status of the adverse event to healthcare provider.


VAERS ID: 1431354 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8727 / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Neck pain, Pain, Pain in extremity
SMQs:, Arthritis (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Shortly after vaccination client felt intense pain in the right side of her neck radiating down her arm. Client was at the vaccination site in the observation lot at this time, and the Nurse called the ambulance to come assess the client. The client was transported to the ER with the consent of the mother.


VAERS ID: 1431370 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Cardiac telemetry normal, Chest pain, Echocardiogram abnormal, Ejection fraction decreased, Electrocardiogram abnormal, Fatigue, Headache, Magnetic resonance imaging heart, Myocarditis, Pain, Sinus tachycardia, Troponin I increased
SMQs:, Cardiac failure (narrow), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None known
Preexisting Conditions: None
Allergies: None known
Diagnostic Lab Data: Presenting ECG on 6/27/21 showed sinus tachycardia at 112 BPM and was otherwise normal (no evidence by ECG for pericarditis) Troponin-I was 4.20 on 6/27/21 at 8:38 am. The troponin-I peaked at 6.30 on 6/27/21 at 2:00pm before trending down. Echocardiogram on 6/28/21 was normal including normal estimated left ventricular ejection fraction of 55%. Cardiac MRI was ordered and pending at this time.
CDC Split Type:

Write-up: Chest pain developed later on the same day as his 2nd Moderna COVID-19 vaccine dose. He presented to the emergency department on 6/27/21. Other symptoms, including body aches, headaches, and fatigue resolved prior to presentation. The chest pain resolved completely by 6/28/21, the day after presentation. He was given ibuprofen for pain management. He was monitored on telemetry without significant events as of the time of this report. He was being treated for a presumed diagnosis of myocarditis secondary to the Moderna COVID-19 vaccine.


VAERS ID: 1431404 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-04-01
Onset:2021-06-24
   Days after vaccination:84
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH N/A / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: amLODIPine 2.5 mg aspirin 81 mg atorvastatin 10 mg Cozaar 50 mg Eliquis 5 mg ezetimibe 10 mg Lasix 20 mg Lidocaine Pain Relief 4 % topical patch metoprolol succinate ER 25 mg
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: carvedilol Ceclor cefaclor Crestor hydralazine iodine losartan melatonin rosuvastatin simvastatin St. John''s wort
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: new onset localized eruption both upper arms.


VAERS ID: 1431429 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051C21A / 1 LA / IM

Administered by: Pharmacy       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? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none that I am aware of
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: pt had already completed course of Pfizer in February , his MD had done a blood assay to test for the antigen it came back as negative and his MD recommended he get the moderna vaccine now - no reaction yet but unsure due to different vaccine


VAERS ID: 1431511 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-06-23
Onset:2021-06-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest X-ray normal, Chest pain, Cytomegalovirus test negative, Echocardiogram normal, Electrocardiogram ST segment abnormal, Epstein-Barr virus test negative, Full blood count normal, Myocarditis, Respiratory viral panel, SARS-CoV-2 test negative, Sinus arrhythmia, Troponin increased, Viral test
SMQs:, Myocardial infarction (narrow), Disorders of sinus node function (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: ADHD
Allergies: none
Diagnostic Lab Data: Troponin: 3.1 (6/26 @ 1830) -$g 0.06 (6/26 @ 2230) -$g 5.03 (6/27 @ 0545) -$g 3.53 (6/27 @ 1030) -$g 3.14 (6/27 @ 1600) -$g 2.8 (6/27 @ 2200) -$g 1.33 (6/28 @ 0400) -$g 0.87 (6/28 @ 1100) CBC unremarkable COVID negative (6/26), Respiratory viral panel negative (6/27), EBV PCR negative (6/27), CMV PCR negative (6/27), remainder of myocarditis panel pending CXR Normal (6.26) ECG 6/26:Normal sinus rhythm with sinus arrhythmia, Nonspecific ST abnormality Echo 6/26: Normal
CDC Split Type:

Write-up: 14 yo male presented with a 3 day history of chest pain after COVID-19 vaccine, found to have elevated Troponin level. Dx most likely myocarditis in the setting of recent COVID-19 vaccine. Patient was started on Ibuprofen 600 mg q6 hr scheduled. Troponin trended q6 hours with subsequent downtrending of Troponins. (Highest troponin 5.03; most recent troponin 0.87 prior to discharge)


VAERS ID: 1431742 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypoaesthesia, Injection site pain
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad)

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

Write-up: patient experience pain at site of reaction but also experience numbness at lower left jaw/upper left neck which started a little after an hour after administration. After patient got a good night''s sleep, all symptoms disappeared after about 24 hours.


VAERS ID: 1431984 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 2 LA / IM

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

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

Write-up: The patient returned for her 2nd Pfizer vaccine after 2 weeks (14 days) instead of 3 weeks. This wasn''t noticed until after the shot had been administered and her vaccination record card was being filled out. Patient was monitored for 15 minutes after and no adverse event were observed


VAERS ID: 1431993 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-06-23
Onset:2021-06-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Malaise, Somnolence
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Buspirone escital latuda mirtazapine vitamin d prenatal vitamin strattera hydroxyzine ibuprofen
Current Illness: None
Preexisting Conditions: None
Allergies: Narcotics
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Sleeping dizzy feeling sick not eating much


VAERS ID: 1432811 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Florida  
Vaccinated:0000-00-00
Onset:2021-06-24
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: The patient had no known drug allergies.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210654015

Write-up: LEFT ARM SWELLING; This spontaneous report received from a consumer concerned a 38 year old female. The patient''s height, and weight were not reported. The patient''s pre-existing medical conditions included the patient had no known drug allergies. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 043A21A, and expiry: UNKNOWN) dose was not reported, administered on 23-JUN-2021 for prophylactic vaccination. No concomitant medications were reported. On 24-JUN-2021, the subject experienced left arm swelling. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from left arm swelling. This report was non-serious.


VAERS ID: 1432812 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: California  
Vaccinated:0000-00-00
Onset:2021-06-24
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Poor quality product administered, Product storage error
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: USJNJFOC20210654091

Write-up: TEMPERATURE EXCURSION ON PRODUCT; INCORRECT PRODUCT STORAGE; This spontaneous report received from a patient concerned a patient of unspecified age and sex. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 203A21A, expiry: 07-AUG-2021) dose was not reported, administered on 24-JUN-2021 for prophylactic vaccination. No concomitant medications were reported. On 24-JUN-2021, the subject experienced temperature excursion on product. On 24-JUN-2021, the subject experienced incorrect product storage. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from temperature excursion on product, and incorrect product storage on 24-JUN-2021. This report was non-serious. This report was associated with product quality complaint: 90000184025


VAERS ID: 1432823 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Paraesthesia, Shoulder injury related to vaccine administration
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Arthritis (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: Error: Shoulder Joint Injury (prolonged pain, tingling, etc.)-


VAERS ID: 1432837 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Georgia  
Vaccinated:0000-00-00
Onset:2021-06-24
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / UNK - / -

Administered by: Military       Purchased by: ?
Symptoms: Dyspepsia, Flatulence
SMQs:, Gastrointestinal nonspecific dysfunction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: GLATOPA
Current Illness: Gas; Multiple sclerosis
Preexisting Conditions: Comments: No known allergies
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210655821

Write-up: GAS; INDIGESTION; This spontaneous report received from a patient concerned a 59 year old male. The patient''s height, and weight were not reported. The patient''s concurrent conditions included gas/indigestion issues, and multiple sclerosis exposure, and other pre-existing medical conditions included no known allergies. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 043a21a, and expiry: 05-AUG-2021) dose was not reported, administered on 24-JUN-2021 for prophylactic vaccination. Concomitant medications included glatiramer acetate for multiple sclerosis exposure. On 24-JUN-2021, the subject experienced gas. On 24-JUN-2021, the subject experienced indigestion. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from gas, and indigestion on 25-JUN-2021. This report was non-serious.


VAERS ID: 1433146 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-07
Onset:2021-06-24
   Days after vaccination:48
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6208 / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Pericarditis
SMQs:, Systemic lupus erythematosus (broad), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: I30.9 - Acute pericarditis, unspecified


VAERS ID: 1433205 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-06-17
Onset:2021-06-24
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004C21A / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Discomfort, Joint swelling, Non-pitting oedema, Oedema peripheral, Weight increased
SMQs:, Cardiac failure (broad), Angioedema (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Ibuprofen- PRN
Current Illness: None
Preexisting Conditions: None
Allergies: Amoxicillin causes anaphylaxis.
Diagnostic Lab Data: none to date.
CDC Split Type:

Write-up: Started on 24Jun2021 with left knee swelling. Progressively the swelling has become more systemic. From 25-28Jun2021, I gained 12 pounds in what seems to be ''water weight''. I have pitting edema in my lower legs and non-pitting edema in my abdomen, thighs, and upper legs. I feel ''heavy''. I''ve made an appointment with my primary care doctor for 01Jul2021 and will go to an urgent care-type appointment later today.


VAERS ID: 1433212 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-06-23
Onset:2021-06-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Chills, Electrocardiogram normal, Hypotension, Laboratory test, Lethargy, Pain, Palpitations, Pyrexia, Tachycardia, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: b12/folate, probiotic, vitamin c, vitamin d, zinc, fish oil
Current Illness: none
Preexisting Conditions: none
Allergies: allergic to egg and dairy, sulfa, propofol
Diagnostic Lab Data: cardiac labs and EKG were normal
CDC Split Type:

Write-up: Had vaccine at 4 pm on 6/23/21 1 am woke to racing heart and palpitation lasted two hours and resolved 6 am woke fever chills and achey 10 am racing heart, palpitations then resolved 1pm severe chest pain, severe tachycardia and low BP Went to ER continued to be tachycardic and low BP, chest pain less, had episode of HR shooting up to 180 and then violently throwing up cardiac labs and EKG were normal left with tachycardia on standing and suggested we follow up with cardiologist asap- appt is 7/6/21 received one bag of IV fluids fever, erratic heart rate and lethargy resolved on 6/27/21


VAERS ID: 1433266 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-06-23
Onset:2021-06-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Chills, Headache, Heavy menstrual bleeding, Pain, Pyrexia
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), 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:

Write-up: Prolonged menses. Patient stated that she was on the last day of her menses, was having scanty flow. The next day her period was very heavy saturating 3 pads per day from then to now (6days later). Started with headaches, and achy, felt feverish inside and then also had chills. Took Tylenol for other symptoms, but still has heavy menses. Referred her to her GYN physician.


VAERS ID: 1433276 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039C21A / 1 LA / IM

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

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

Write-up: Unknown - Unable to reach patient''s guardian or patient himself to inquire. Unable to confirm whether or not patient has experienced an adverse event at this time. Patient or his guardian have not been in contact to report an adverse event.


VAERS ID: 1433352 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-04-12
Onset:2021-06-24
   Days after vaccination:73
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute myocardial infarction, Anticoagulant therapy, Arthralgia, Atrial fibrillation, Blood sodium increased, Brain natriuretic peptide increased, Cardioversion, Chest pain, Electrocardiogram abnormal, Myocardial infarction, Troponin increased
SMQs:, Cardiac failure (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Embolic and thrombotic events, arterial (narrow), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Arthritis (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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: NKA
Diagnostic Lab Data: Date of 6/24/21= Troponin= 0.322, BNP= 148, Na+= 146. EKG= A-Fib with HR of 154 prior to IV Cardiovert.
CDC Split Type:

Write-up: Patient had a Non-STEMI MI on 6/24/21 with new onset A-Fib also. Pt arrived to ER from clinic with c/o chest and Left shoulder pain for 2weeks. Arrived to ER with HR in 150s that converted with IV Diltiazem. Pt showed s/s of MI with elevated Troponin. IV Heparin drip and IV Heparin bolus was given. Pt was transported by helicopter to hospital for further treatment and studies.


VAERS ID: 1433365 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-23
Onset:2021-06-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808982 / UNK LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Fatigue, Feeling cold, Malaise, Pain
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Amlodopine, Atorvastatin, Vitamin D, Baby Aspirin
Current Illness:
Preexisting Conditions: lower back pain
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Feverish symptoms (feeling cold), body ache, and fatigue


VAERS ID: 1433427 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-06-23
Onset:2021-06-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Peripheral swelling, Skin discolouration
SMQs:, Cardiac failure (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypotonic-hyporesponsive episode (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: na
Preexisting Conditions: na
Allergies: nkda
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received his second dose of the Pfizer COVID vaccine around 10 am in his left arm and noticed that later than evening his right forearm changed colors (purple/red). The next day the color had returned to normal but his right hand and middle finger were swollen and purple/red in color. He said he had applied a cream but does not remember what it was. Reports no itching or pain. Followed up with the patient a few days (6 days from administration of vaccine) later. Patient reports they are feeling better and the swelling is gone and color is back to normal. He only used ice and did not take any other medications.


VAERS ID: 1433470 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-06-17
Onset:2021-06-24
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Back pain, Pain in extremity, Sensory disturbance
SMQs:, Peripheral neuropathy (narrow), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (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: Mirolax-1x daily Psyllium Fiber 2x daily Fluocinolone - Ears Albuterol Sulfate HFA inhalation aerosol ? as needed Baby Aspirin 1x daily Furosemide 20 mg - 2 x daily Tums ? 1x wk. Melatonin ? 1x wk Azelastine 0.1% as needed (once a week at t
Current Illness: High Blood Pressure only when laying down (low normal during the day when out of bed), Irritable Bowel Syndrome, Cataracts, Periodic Asthma, Sleep Apnea, High Cholesterol , Arthritis, Osteoporosis
Preexisting Conditions: IBS, Periodic Asthma, Sleep Apnea, High Cholesterol, Arthritis, Osteoporosis
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Pain for a few days in upper left leg in back and then in front, now it stopped Pain in upper left back, below shoulder, for at least 5 days. Pulsations in left side of back - almost on my side, at night and during the day.


VAERS ID: 1433539 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6206 / 2 LA / IM

Administered by: Public       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: none
Current Illness: none
Preexisting Conditions: none
Allergies: NKDA
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Second Pfizer Co Vid vaccine given too soon (given at 14 days out instead of 21 days). No harm to patient


VAERS ID: 1433639 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Oklahoma  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6206 / 2 LA / IM

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

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

Write-up: Second Pfizer Co Vid vaccine given to soon, given at day 14 instead of day 21 d/t scheduling error and not realizing date


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