chrisvoncsefalvay/vaers-narrative-generation huggingface dataset:
Age: 36.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Electrocardiogram abnormal, Fibrin D dimer normal, Full blood count normal, International normalised ratio normal, Metabolic function test normal
Clinical narrative: Patient went to the emergency department 6/17/2021 due to dizziness, palpitations, intermittent chest pressure.  Non-concerning labs and EKG.  Diagnosed with possible anxiety.  Patient reports that he never experienced pain or panic attacks prior to receiving vaccine.  He continues to have random panic attacks and chest pain.  He currently is awaiting echocardiogram and Holter monitor.  He will start buspirone in case this is all anxiety.
Age: 36.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Palpitations, Panic attack, Prothrombin time normal, Sinus tachycardia
Clinical narrative: Patient went to the emergency department 6/17/2021 due to dizziness, palpitations, intermittent chest pressure.  Non-concerning labs and EKG.  Diagnosed with possible anxiety.  Patient reports that he never experienced pain or panic attacks prior to receiving vaccine.  He continues to have random panic attacks and chest pain.  He currently is awaiting echocardiogram and Holter monitor.  He will start buspirone in case this is all anxiety.
Age: 36.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Dizziness, Heart rate increased, Hypoaesthesia, Palpitations, Panic attack
Clinical narrative: Patient went to the emergency department 6/17/2021 due to dizziness, palpitations, intermittent chest pressure.  Non-concerning labs and EKG.  Diagnosed with possible anxiety.  Patient reports that he never experienced pain or panic attacks prior to receiving vaccine.  He continues to have random panic attacks and chest pain.  He currently is awaiting echocardiogram and Holter monitor.  He will start buspirone in case this is all anxiety.
Age: 15.0
Sex: F
Vaccine: COVID19
Symptoms: Herpes zoster
Clinical narrative: PATIENT DEVELOPED SHINGLES IN RIGHT C4-5 DISTRIBUTION
Age: 51.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Death, Hypotension, Jaundice, Loss of consciousness
Clinical narrative: Patient received their vaccine on 6/17 and had no complaints of adverse effects. The patient was found unconscious at some point between 6/17-6/18. They appeared jaundice and had low BP. They were airlifted to the hospital and died on 6/18/21.
Age: 51.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Dyspnoea, Pulse abnormal, Resuscitation
Clinical narrative: Patient received their vaccine on 6/17 and had no complaints of adverse effects. The patient was found unconscious at some point between 6/17-6/18. They appeared jaundice and had low BP. They were airlifted to the hospital and died on 6/18/21.
Age: 33.0
Sex: F
Vaccine: COVID19
Symptoms: Blood test normal, Foetal heart rate abnormal, Uterine dilation and curettage
Clinical narrative: I received the first shot of my Covid vaccine after having two "normal" ultrasounds, with my pregnancy progressing just fine.  I found out the baby no longer had a heartbeat on 4/23 at a routine ultrasound appointment, which was about 2 weeks after my first shot (which was on 4/8). I was told the baby was measuring 9.5 weeks, and I should have been measuring 10.5 weeks; so it's heart stopped beating about a week after the first shot. I had a d&c at 10.5 weeks.  We did bloodwork and genetic testing and all test results came back "normal".
Age: 55.0
Sex: M
Vaccine: COVID19
Symptoms: Unevaluable event
Clinical narrative: Unknown
Age: 28.0
Sex: M
Vaccine: COVID19
Symptoms: Dizziness, Immediate post-injection reaction, Loss of consciousness
Clinical narrative: Patient felt dizzy immediately after administration of vaccine.  I had him stay in the chair and after about 1 minute he blacked out for 5 to 10 seconds then awoke.  He said he felt like he had been dreaming for an hour, he was no longer dizzy.  I had him sit for another 20 minutes.  He indicated he felt fine and he left.  A follow up call 3 days later he said he was ok and had no further issues.
Age: 78.0
Sex: F
Vaccine: COVID19
Symptoms: Haemorrhage, Inflammation, Peripheral swelling, X-ray
Clinical narrative: Arm swelled and became inflamed and had some bleeding.  6 weeks of therapy
Age: 50.0
Sex: F
Vaccine: VARZOS
Symptoms: Herpes zoster, Pain, Rash, Skin weeping
Clinical narrative: Developed severe all over body pain around 14 hours after the shot. Could not sleep. Took two Aleve which had no impact. For the next 24 hours of all over body pain between a 4 and 7. No fever. Then it improved for 48 hours before pain increased under left breast and left back for three to four days before noticing an oozing rash under the left breast on June 25. Went to doctor who diagnosed it as Shingles based on presentation.
Age: 55.0
Sex: F
Vaccine: COVID19
Symptoms: Guillain-Barre syndrome, Magnetic resonance imaging, Pain
Clinical narrative: Hospitalized with pain,then diagnosed with GBS
Age: 16.0
Sex: M
Vaccine: COVID19
Symptoms: Product administered to patient of inappropriate age
Clinical narrative: 16 year old received Moderna as 1st dose. 2nd dose Moderna was administered according to CDC guidelines - off label use unauthorized age.  Medical Director signed off on Moderna administration.
Age: 59.0
Sex: M
Vaccine: COVID19
Symptoms: Syncope
Clinical narrative: Convulsive syncope approximately 5 minutes after receiving injection.  No treatment given and patient came out of it on his own after approximately 30-60 seconds.
Age: 35.0
Sex: F
Vaccine: COVID19
Symptoms: Blood test normal, Dyspnoea, Fatigue, Inflammation, Oropharyngeal pain
Clinical narrative: Fatigue, short of breath, Sore throat, inflammation
Age: 35.0
Sex: F
Vaccine: COVID19
Symptoms: SARS-CoV-2 test negative, Streptococcus test negative
Clinical narrative: Fatigue, short of breath, Sore throat, inflammation
Age: 12.0
Sex: M
Vaccine: COVID19
Symptoms: Mouth ulceration
Clinical narrative: 2 mouth ulcers on inner lower lip
Age: 44.0
Sex: F
Vaccine: COVID19
Symptoms: Cough, Dyspnoea, Fatigue, Feeling abnormal, Pain
Clinical narrative: It all started with extreme fatigue, fever, body aches, coughs, chest pain, shortness of breath and brain fog. The fever, body aches has stop but everything else has continue.
Age: 44.0
Sex: F
Vaccine: COVID19
Symptoms: Pyrexia
Clinical narrative: It all started with extreme fatigue, fever, body aches, coughs, chest pain, shortness of breath and brain fog. The fever, body aches has stop but everything else has continue.
Age: 65.0
Sex: F
Vaccine: COVID19
Symptoms: Aphasia, Computerised tomogram, Dizziness, Head discomfort, Headache
Clinical narrative: No immediate reaction to the vaccine. Two weeks later, developed head pain and pressure daily in varying intensity. April 19, developed severe head pain, accompanied by dizziness and vomiting   April 30, 2021. Seen by PCP. May 5, 2021, consulted neurologist for issues while having follow-up for apnea. She ordered an MRI. Headaches and pressure continue almost daily.
Age: 65.0
Sex: F
Vaccine: COVID19
Symptoms: Magnetic resonance imaging, Migraine, Vomiting
Clinical narrative: No immediate reaction to the vaccine. Two weeks later, developed head pain and pressure daily in varying intensity. April 19, developed severe head pain, accompanied by dizziness and vomiting   April 30, 2021. Seen by PCP. May 5, 2021, consulted neurologist for issues while having follow-up for apnea. She ordered an MRI. Headaches and pressure continue almost daily.
Age: 17.0
Sex: M
Vaccine: COVID19
Symptoms: Blood glucose normal, Electrocardiogram normal, Syncope
Clinical narrative: Pfizer vaccine given. Patient was waiting 15 minutes after vaccine before departing. Patient was accompanied by father and two siblings. Patient fainted while sitting.
Age: 36.0
Sex: F
Vaccine: COVID19
Symptoms: Back pain, Chest pain, Headache, Neck mass, Neck pain
Clinical narrative: A lot of pain in the neck and arm appearance of balls in the neck chest pain tingling in the left arm. The pain is also in the back on the left side, headache.
Age: 36.0
Sex: F
Vaccine: COVID19
Symptoms: Pain in extremity, Paraesthesia
Clinical narrative: A lot of pain in the neck and arm appearance of balls in the neck chest pain tingling in the left arm. The pain is also in the back on the left side, headache.
Age: 22.0
Sex: M
Vaccine: COVID19
Symptoms: Hyperhidrosis, Hypopnoea, Loss of consciousness, Mydriasis, Unresponsive to stimuli
Clinical narrative: Patient blacked out, eyes dilated, started sweating, was unresponsive for about 2 minutes, with shallow breathing. He had a pulse the whole time. EMS was called. He started to be responsive, blood pressure was ok and he felt better so he refused to go to hospital.
Age: 21.0
Sex: M
Vaccine: COVID19
Symptoms: Alanine aminotransferase increased, Blood glucose increased, Blood test, Chest X-ray normal, Chest pain
Clinical narrative: Chest pains (tension and pressure), nausea, loss of appetite, fatigue, shart left arm pain non muscular lasting for weeks.
Age: 21.0
Sex: M
Vaccine: COVID19
Symptoms: Decreased appetite, Electrocardiogram, Fatigue, Monocyte count increased, Nausea
Clinical narrative: Chest pains (tension and pressure), nausea, loss of appetite, fatigue, shart left arm pain non muscular lasting for weeks.
Age: 21.0
Sex: M
Vaccine: COVID19
Symptoms: Pain in extremity, Red blood cell sedimentation rate increased
Clinical narrative: Chest pains (tension and pressure), nausea, loss of appetite, fatigue, shart left arm pain non muscular lasting for weeks.
Age: 51.0
Sex: F
Vaccine: COVID19
Symptoms: Asthenia, Blood calcium, Blood test, Blood thyroid stimulating hormone, Cardiac stress test
Clinical narrative: Daily Headaches, Felt like tight knot in epigastric area, weakness, high blood pressure, heart palpitations, high heart rate, overcome by feeling like was going to die(only in the first 3 weeks), lost 8 pounds in 2 weeks,  feeling of heavy arms and legs,  sensitive to caffeine and sugar  First month was the worst and slowly started feeling some better.  Still have headaches, blood pressure problems, palpitations, uncomfortable feeling in epigastric region and sometimes feels tight there like its being squeezed, dont have much stamina, cant exercise (was a runner)
Age: 51.0
Sex: F
Vaccine: COVID19
Symptoms: Computerised tomogram abdomen, Electrocardiogram, Electrocardiogram ambulatory, Epigastric discomfort, Fibrin D dimer
Clinical narrative: Daily Headaches, Felt like tight knot in epigastric area, weakness, high blood pressure, heart palpitations, high heart rate, overcome by feeling like was going to die(only in the first 3 weeks), lost 8 pounds in 2 weeks,  feeling of heavy arms and legs,  sensitive to caffeine and sugar  First month was the worst and slowly started feeling some better.  Still have headaches, blood pressure problems, palpitations, uncomfortable feeling in epigastric region and sometimes feels tight there like its being squeezed, dont have much stamina, cant exercise (was a runner)
Age: 51.0
Sex: F
Vaccine: COVID19
Symptoms: Full blood count, Headache, Heart rate increased, Hypertension, Limb discomfort
Clinical narrative: Daily Headaches, Felt like tight knot in epigastric area, weakness, high blood pressure, heart palpitations, high heart rate, overcome by feeling like was going to die(only in the first 3 weeks), lost 8 pounds in 2 weeks,  feeling of heavy arms and legs,  sensitive to caffeine and sugar  First month was the worst and slowly started feeling some better.  Still have headaches, blood pressure problems, palpitations, uncomfortable feeling in epigastric region and sometimes feels tight there like its being squeezed, dont have much stamina, cant exercise (was a runner)
Age: 51.0
Sex: F
Vaccine: COVID19
Symptoms: Lipase, Loss of personal independence in daily activities, Metabolic function test, Palpitations, Urine analysis
Clinical narrative: Daily Headaches, Felt like tight knot in epigastric area, weakness, high blood pressure, heart palpitations, high heart rate, overcome by feeling like was going to die(only in the first 3 weeks), lost 8 pounds in 2 weeks,  feeling of heavy arms and legs,  sensitive to caffeine and sugar  First month was the worst and slowly started feeling some better.  Still have headaches, blood pressure problems, palpitations, uncomfortable feeling in epigastric region and sometimes feels tight there like its being squeezed, dont have much stamina, cant exercise (was a runner)
Age: 51.0
Sex: F
Vaccine: COVID19
Symptoms: Weight decreased, X-ray
Clinical narrative: Daily Headaches, Felt like tight knot in epigastric area, weakness, high blood pressure, heart palpitations, high heart rate, overcome by feeling like was going to die(only in the first 3 weeks), lost 8 pounds in 2 weeks,  feeling of heavy arms and legs,  sensitive to caffeine and sugar  First month was the worst and slowly started feeling some better.  Still have headaches, blood pressure problems, palpitations, uncomfortable feeling in epigastric region and sometimes feels tight there like its being squeezed, dont have much stamina, cant exercise (was a runner)
Age: 15.0
Sex: M
Vaccine: COVID19
Symptoms: Cardiac imaging procedure abnormal, Chest pain, Echocardiogram, Echocardiogram normal, Electrocardiogram ST segment elevation
Clinical narrative: He received his 2nd dose of COVID vaccine (Pfizer) on 6/19. He developed a fever on 6/20 which lasted for a day. He then felt better on 6/21.  Then, on 6/22 at 1am, he woke from sleep due to chest pain. It was sharp and did not radiate anywhere, and not reproducible. He took 400 mg ibuprofen which improved his pain somewhat.  Denies any other fever, rhinorrhea, cough, SOB, difficulty breathing, n/v/d, dysuria or difficulty with urination.    Admitted 6/22 due to elevated troponin and abnormal EKG.  Troponin leak and MRI with findings consistent with myocarditis.  Had NSVT x 4 beats on 6/22.  He was treated with 5 days of Motrin 600 mg ATC.
Age: 15.0
Sex: M
Vaccine: COVID19
Symptoms: Myocarditis, Pyrexia, Scan with contrast abnormal, Sleep disorder, Troponin increased
Clinical narrative: He received his 2nd dose of COVID vaccine (Pfizer) on 6/19. He developed a fever on 6/20 which lasted for a day. He then felt better on 6/21.  Then, on 6/22 at 1am, he woke from sleep due to chest pain. It was sharp and did not radiate anywhere, and not reproducible. He took 400 mg ibuprofen which improved his pain somewhat.  Denies any other fever, rhinorrhea, cough, SOB, difficulty breathing, n/v/d, dysuria or difficulty with urination.    Admitted 6/22 due to elevated troponin and abnormal EKG.  Troponin leak and MRI with findings consistent with myocarditis.  Had NSVT x 4 beats on 6/22.  He was treated with 5 days of Motrin 600 mg ATC.
Age: 15.0
Sex: M
Vaccine: COVID19
Symptoms: Ventricular tachycardia
Clinical narrative: He received his 2nd dose of COVID vaccine (Pfizer) on 6/19. He developed a fever on 6/20 which lasted for a day. He then felt better on 6/21.  Then, on 6/22 at 1am, he woke from sleep due to chest pain. It was sharp and did not radiate anywhere, and not reproducible. He took 400 mg ibuprofen which improved his pain somewhat.  Denies any other fever, rhinorrhea, cough, SOB, difficulty breathing, n/v/d, dysuria or difficulty with urination.    Admitted 6/22 due to elevated troponin and abnormal EKG.  Troponin leak and MRI with findings consistent with myocarditis.  Had NSVT x 4 beats on 6/22.  He was treated with 5 days of Motrin 600 mg ATC.
Age: 54.0
Sex: M
Vaccine: COVID19
Symptoms: Anticoagulant therapy, Headache, Magnetic resonance imaging head abnormal, Transverse sinus thrombosis
Clinical narrative: severe headache started after few days of the second moderna shot  ended up in the hospital after few days of headache  MRI brain shows transverse sinus thrombosis  started on anticoagulation discharge home in 2 days on oral anticoagulation
Age: 78.0
Sex: M
Vaccine: COVID19
Symptoms: Abnormal dreams, Parosmia
Clinical narrative: Very irritating unidentified smell always present,also very vivid dreams every night since about 2 days after 2nd vaccination.
Age: 48.0
Sex: F
Vaccine: COVID19
Symptoms: Vaccination complication
Clinical narrative: COVID arm
Age: 22.0
Sex: M
Vaccine: COVID19
Symptoms: Chills, Pyrexia
Clinical narrative: Fever and chills alternating for about 1.5 days after vaccination
Age: 17.0
Sex: F
Vaccine: COVID19
Symptoms: Off label use, Product administered to patient of inappropriate age
Clinical narrative: 17 year old received 1st dose Moderna. 2nd dose Moderna administered according the CDC guidelines for off label use  -unauthorized age.  Medical Director signed off on Moderna administration
Age: 13.0
Sex: F
Vaccine: COVID19
Symptoms: Amylase, C-reactive protein, Full blood count, Parotitis
Clinical narrative: Parotitis
Age: 50.0
Sex: F
Vaccine: COVID19
Symptoms: Gait disturbance, Hypoaesthesia, Pain in extremity, Ultrasound scan
Clinical narrative: Calf pain for weeks, like a strain.   Walking with limp.  Numbness in foot and leg.
Age: 47.0
Sex: F
Vaccine: COVID19
Symptoms: Rash, Rash erythematous, Rash pruritic, Urticaria
Clinical narrative: Pt has had multiple red bumbs or hives on numerous parts of body beginning the day off vaccination. The red areas itch and are painful to the pt.  Areas include her arms, face, legs, hips, head, face, feet (various spots from head to toe).  Some of the red areas come and go. some of the red areas (such as on arms) have been persistent.   Treatment: dephenhydramine, zyrtec, medrol tablets
Age: 32.0
Sex: F
Vaccine: COVID19, COVID19
Symptoms: Death
Clinical narrative: N/A -- patient was perfectly fine during wait time
Age: 63.0
Sex: F
Vaccine: COVID19
Symptoms: Back pain, Chills, Drainage, Dysgeusia, Fatigue
Clinical narrative: Starting on the day of the vaccine, within a couple of hours, I felt mildly tired. About 13 hours later, my arm felt tender. On 3/24/2021, I had drainage and runny nose, quick chill and noticed a metallic taste in my mouth. I called the doctor and was advised to take acetaminophen to get rid of metallic taste. I had symptoms on and off of feeling tired, fatigue, running nose, drainage, low grade fever, mild back achiness and by day 16, the symptoms went away.
Age: 63.0
Sex: F
Vaccine: COVID19
Symptoms: Pyrexia, Rhinorrhoea, Tenderness
Clinical narrative: Starting on the day of the vaccine, within a couple of hours, I felt mildly tired. About 13 hours later, my arm felt tender. On 3/24/2021, I had drainage and runny nose, quick chill and noticed a metallic taste in my mouth. I called the doctor and was advised to take acetaminophen to get rid of metallic taste. I had symptoms on and off of feeling tired, fatigue, running nose, drainage, low grade fever, mild back achiness and by day 16, the symptoms went away.
Age: 76.0
Sex: F
Vaccine: COVID19
Symptoms: Autoimmune thyroiditis, Condition aggravated
Clinical narrative: The Moderna triggered a severe and debilitating  flareup of my Hashimotos.  There really is no medication to treat this condition other than a gluten- free diet and supplements.  I am reporting this because the vaccine triggered an existing autoimmune condition.
Age: 33.0
Sex: F
Vaccine: COVID19
Symptoms: Food aversion
Clinical narrative: Food aversions
Age: 49.0
Sex: M
Vaccine: COVID19
Symptoms: Arthralgia, Cardiac discomfort, Chest discomfort, Fatigue, Feeling abnormal
Clinical narrative: Fever 102 for 2 days, 101 for 3rd day , 100 for the fourth day.  Severe headache for 3 days, arm pain for 4 days, joint pain for 3 days, kidney pain for 2 days, chest pressure, fatigue for weeks - still don?t feel normal. heart discomfort occurred a few days after injection, still having the discomfort and  fatigue. Saw doctor today and was referred to cardiologist for evaluation.
Age: 49.0
Sex: M
Vaccine: COVID19
Symptoms: Headache, Pain in extremity, Pyrexia, Renal pain
Clinical narrative: Fever 102 for 2 days, 101 for 3rd day , 100 for the fourth day.  Severe headache for 3 days, arm pain for 4 days, joint pain for 3 days, kidney pain for 2 days, chest pressure, fatigue for weeks - still don?t feel normal. heart discomfort occurred a few days after injection, still having the discomfort and  fatigue. Saw doctor today and was referred to cardiologist for evaluation.
Age: 59.0
Sex: M
Vaccine: COVID19
Symptoms: Asthma, Back pain, Chest discomfort, Condition aggravated, Dizziness
Clinical narrative: patient experienced lower back pain, nausea, dizziness, tightness in chest, asthma symptoms  patient went to see the primary doctor and was evaluated
Age: 59.0
Sex: M
Vaccine: COVID19
Symptoms: Nausea
Clinical narrative: patient experienced lower back pain, nausea, dizziness, tightness in chest, asthma symptoms  patient went to see the primary doctor and was evaluated
Age: 70.0
Sex: F
Vaccine: COVID19
Symptoms: Burning sensation, Diarrhoea, Pyrexia, Vomiting
Clinical narrative: rush went through body, throw up - diarrehea, fever, inside of body felt like chemical burn / ok in 4 days
Age: 44.0
Sex: F
Vaccine: COVID19
Symptoms: Cardiac flutter, Chest discomfort, Electrocardiogram, Palpitations
Clinical narrative: palpitations, fluttering, tightness in chest
Age: 42.0
Sex: F
Vaccine: COVID19
Symptoms: Underdose
Clinical narrative: Pt did not experience adverse event.  A week after receiving  the vaccine, the pt told her provider that after receiving vaccine, some of the vaccine leaked out of her arm and that she did not receive the full dose.  Per CDC guidance for deviations, if dose amount actually given is indeterminant, then dose can be repeated.  Pt wanted to get repeat dose, and is scheduled for one.
Age: 39.0
Sex: F
Vaccine: COVID19
Symptoms: Abdominal pain lower, Abdominal pain upper, Appendicitis, Computerised tomogram, Ultrasound abdomen
Clinical narrative: I had stomach pain on Sunday evening on April 4th. In the morning, I experienced a lot of uncomfortable pain - located in my lower right side. I went to the doctor on the 5th. Then that same day, I went to the ER and I was diagnosed with appendicitis. I spent 2 nights in the ER. My appendix was enlarged. I was given antibiotics. I was discharged on April 7th. I took the antibiotic medication for ten days.
Age: 52.0
Sex: M
Vaccine: COVID19
Symptoms: Faeces discoloured
Clinical narrative: green stool with no other symptoms
Age: 65.0
Sex: M
Vaccine: COVID19
Symptoms: Extra dose administered
Clinical narrative: Patient received 3 doses of Moderna. 2/13/21, 4/10/21, 5/8/21. Patient indicated that he was late in receiving the 2nd dose and on advise of his  physician he was instructed to have a 3rd does due to the late administration of the 2nd dose.
Age: 70.0
Sex: F
Vaccine: COVID19
Symptoms: Platelet count decreased, Thrombocytopenia
Clinical narrative: severe thrombocytopenia requiring hospitalization
Age: 17.0
Sex: F
Vaccine: COVID19
Symptoms: No adverse event, Product administered to patient of inappropriate age
Clinical narrative: Client was inadvertently given Moderna vaccine dose prior to turning 18 years old. Parents received vaccine at the same time as client. No adverse reaction reported. Error was discovered when client returned to clinic without parents for 2nd dose. Did not administer 2nd dose. Instructed to return after Moderna is approved by FDA for teenagers.
Age: 46.0
Sex: M
Vaccine: COVID19
Symptoms: Multiple injuries, Syncope
Clinical narrative: Syncope while riding bicycle (multiple serious injuries incurred) exactly 2 weeks after second dose suspected to be related to vaccine. At the time I considered myself exceptionally fit, healthy with no recent history or forewarning of passing out.
Age: 15.0
Sex: M
Vaccine: COVID19
Symptoms: Chest pain, Echocardiogram abnormal, Electrocardiogram abnormal, Myocardial fibrosis, Palpitations
Clinical narrative: PT IS A 15 Y/O MALE WHO WAS NORMAL UNTIL 4 DAYS AFTER SECOND PFIZER COVID VACCINE. WOKE UP AT 6:00AM WITH SHARP CHEST PAIN.  PATIENT THEN MADE AN APPOINTMENT WITH THEIR PEDIATRICIAN FOR PALPITATIONS AND CHEST PAIN. THE PEDIATRICIAN REFERRED PATIENT OVER ON 06/14/2021 AND WAS SEEN BY OUR CARDIOLOGIST ON 06/15/2021. WHERE AN EKG AND ECHO-CARDIOGRAM WAS  PERFORMED AND CONFIRMED ABNORMAL EKG AND mild septal flatttening ( on m-mode) in the proximal muscular septum. A MRI WAS ORDERED AND WAS PERFORMED ON 06/23/2021 WHICH CONFIRMED MYOCARDIAL SCARRING.
Age: 22.0
Sex: M
Vaccine: COVID19
Symptoms: Dizziness, Dyspnoea, Nausea, Pyrexia, Seizure
Clinical narrative: On the morning of 04-16-2021 I had a syncope in my restroom at my home. When I awoke I had convulsions. On Friday night, I developed fever, shakiness of my legs. On Sunday I had blurred vision, had nausea and had trouble breathing. These symptoms lasted one month. I had vertigo, nausea and had trouble breathing. As of today, I still have difficulty breathing, the nausea and dizziness are not present today. I will not get my second vaccine due to my symptoms to my first vaccine.
Age: 22.0
Sex: M
Vaccine: COVID19
Symptoms: Syncope, Tremor, Vertigo, Vision blurred
Clinical narrative: On the morning of 04-16-2021 I had a syncope in my restroom at my home. When I awoke I had convulsions. On Friday night, I developed fever, shakiness of my legs. On Sunday I had blurred vision, had nausea and had trouble breathing. These symptoms lasted one month. I had vertigo, nausea and had trouble breathing. As of today, I still have difficulty breathing, the nausea and dizziness are not present today. I will not get my second vaccine due to my symptoms to my first vaccine.
Age: 42.0
Sex: F
Vaccine: COVID19
Symptoms: Chills, Discomfort, Feeling of body temperature change, Mobility decreased, Pain
Clinical narrative: Arm swelling, started to swell up early evening despite constantly moving it and massaging the shot site area. Fever came shortly thereafter, 99.9 then progressed higher throughout the night at 101.5. Body aches are immensely painful, hard to maneuver limbs. Also chills as my body has been constantly cold then hot. Extremely uncomfortable.
Age: 42.0
Sex: F
Vaccine: COVID19
Symptoms: Peripheral swelling, Pyrexia
Clinical narrative: Arm swelling, started to swell up early evening despite constantly moving it and massaging the shot site area. Fever came shortly thereafter, 99.9 then progressed higher throughout the night at 101.5. Body aches are immensely painful, hard to maneuver limbs. Also chills as my body has been constantly cold then hot. Extremely uncomfortable.
Age: 50.0
Sex: F
Vaccine: COVID19
Symptoms: Angina pectoris, Dyspnoea, Electrocardiogram normal
Clinical narrative: I have had serious PAIN in my heart, unable to catch breath and heart pain doesnt end., I Went to E.R. and they told me I was fine because EKG came back ok. I Have NEVER had pain let alone such pain in my heart in my life? I Feel terrible and am terrified to get second shot? I Hope someone can help me
Age: 34.0
Sex: M
Vaccine: COVID19
Symptoms: Anxiety, Dizziness, Hyperhidrosis
Clinical narrative: 5-10 mins after the vaccine, while patient was sitting for 15 mins in the pharmacy waiting area, he felt dizzy, sweaty and anxious. He walked back the vaccination room. We offered him water, then we checked his vitals at 11:24am (BP 111/62, HR 52 bpm). He took his mask off, took few deep breaths, took more water. Then rechecked his vitals again at 11:31 am (BP 115/79, HR 65 bpm). He said that he started feeling better and less sweaty. Per patient, he had a bagel, a Redbull and smoked marijuana few hours before the vaccine. He was nervous about getting the second dose and the possible side effects that he heard about. Patient left the pharmacy around 11:35am with his wife and son. His wife mentioned that she will be driving him home. Patient was counseled to seek medical help if he experience more adverse effects.
Age: 65.0
Sex: F
Vaccine: COVID19
Symptoms: Fatigue, Hypersomnia
Clinical narrative: I went to stay with my son after the vaccine and I couldn't wake up for 1-2 days. I was very very tired.
Age: 33.0
Sex: F
Vaccine: COVID19
Symptoms: Hypoaesthesia
Clinical narrative: At 1230, patient reported numbness in left palm to EMT. Patient denied itchiness, rashes, and hives. Patient reported taking Advil before her vaccine to prevent side effects. Patient moved to gravity chair. At 1235, EMT assessed vital signs: blood pressure 102/70 mmHg, pulse 73 beats/minute, and SpO2 98%. Patient given water and advised to wait for further observation. At 1245 EMT reassessed vital signs: blood pressure 112/80 mmHg, pulse 67 beats/minute, and SpO2 98%. Patient stated her left palm felt "less numb". At 1300, EMT reassessed vital signs: blood pressure 106/72 mmHg, pulse 68 beats/minute, and SpO2 98%. Patient reported less numbness in her left palm. At 1301, RN  educated patient to not take medications before vaccination, signs/symptoms of when to seek emergency care, to sign up on v-safe, and to follow up with primary care provider. At approximately 1305, patient left facility with unlabored respirations and steady gait.
Age: 13.0
Sex: M
Vaccine: COVID19
Symptoms: Brain natriuretic peptide, Cough, Full blood count, Malaise, Metabolic function test
Clinical narrative: fever, cough, malaiase
Age: 13.0
Sex: M
Vaccine: COVID19
Symptoms: Pyrexia, Troponin
Clinical narrative: fever, cough, malaiase
Age: 84.0
Sex: F
Vaccine: COVID19, COVID19
Symptoms: Asthenia, COVID-19, Cough, Death, Dyspnoea
Clinical narrative: cough, difficulty breathing, productive cough, 02 requirement, weakness resulting in hospitalization and death. received treatment : Azithromycin and Decadron  02/09/2021-02/19/2020
Age: 84.0
Sex: F
Vaccine: COVID19, COVID19
Symptoms: Productive cough, SARS-CoV-2 test positive
Clinical narrative: cough, difficulty breathing, productive cough, 02 requirement, weakness resulting in hospitalization and death. received treatment : Azithromycin and Decadron  02/09/2021-02/19/2020
Age: 39.0
Sex: F
Vaccine: COVID19
Symptoms: Burning sensation, Paraesthesia oral
Clinical narrative: Perioral tingling, developed into burning sensation.  No shortness of breath or respiratory distress.  This developed about 50 minutes after her event.
Age: 40.0
Sex: F
Vaccine: COVID19
Symptoms: Anticoagulant therapy, Back pain, Computerised tomogram abdomen, Computerised tomogram thorax abnormal, Culture urine
Clinical narrative: 2nd COVID shot o 1/27 (Wednesday). Started having right sided lower back pain on Friday that continued to become worse each day. By Tuesday 2/2/21 the pain was significant. I went to ER.  During the time at the ER - lab work was completed and a abdominal CT. Then a chest CT and was diagnosed with a Pulmonary Embolism. I was then started on Eliquis 10 mg BID (eventually moved down to 5 mg BID).   I then followed up with my PCP. I was then referred to a Hematologist. I was on Eliquis for 3 months starting February 2, 2021 and was on light duty with both my work and with my teaching of karate.
Age: 40.0
Sex: F
Vaccine: COVID19
Symptoms: Full blood count, Laboratory test, Pulmonary embolism
Clinical narrative: 2nd COVID shot o 1/27 (Wednesday). Started having right sided lower back pain on Friday that continued to become worse each day. By Tuesday 2/2/21 the pain was significant. I went to ER.  During the time at the ER - lab work was completed and a abdominal CT. Then a chest CT and was diagnosed with a Pulmonary Embolism. I was then started on Eliquis 10 mg BID (eventually moved down to 5 mg BID).   I then followed up with my PCP. I was then referred to a Hematologist. I was on Eliquis for 3 months starting February 2, 2021 and was on light duty with both my work and with my teaching of karate.
Age: 59.0
Sex: F
Vaccine: COVID19
Symptoms: Arthralgia, Bone pain, Mobility decreased
Clinical narrative: My shoulder and arm bones are hurting still from the day of the shot over a month ago. Difficult to lift my arm or carry anything heavy.
Age: 28.0
Sex: F
Vaccine: COVID19
Symptoms: Injection site erythema, Injection site pain, Injection site pruritus, Injection site swelling, Injection site urticaria
Clinical narrative: One week after injection, developed a swollen, red, tender, and itchy patch on L arm. Itchiness began 02/21 and progressed overnight to warmth, swelling, and tenderness in addition to severe itchiness. This patch originated at the site of injection and grew in size over the next 3 days to cover approximately half of my upper arm. The patch lasted around 5-7 days, but the severity of symptoms resolved after 3-4 days. Pain was minor (around 3/10) and well managed with occasional tylenol. Itch was the most bothersome symptom and was poorly controlled with itch cream and ice.
Age: 30.0
Sex: M
Vaccine: COVID19
Symptoms: Rash, Rash pruritic
Clinical narrative: patient experienced a small, pin point rash over the body which resembled poison ivy. it was a little itchy as the patient described but went away on its own.
Age: 65.0
Sex: M
Vaccine: COVID19
Symptoms: Injection site mass, Injection site pain, Mobility decreased
Clinical narrative: I have had a lump at the injection point as well as decreased use of my left arm since March 4, 2021 with increasing pain and decreasing use of the left arm
Age: 78.0
Sex: F
Vaccine: COVID19, COVID19
Symptoms: Arthralgia, Musculoskeletal stiffness, Pain in extremity
Clinical narrative: Beginning approximately two days after my first vaccine shot, I have experienced joint pain and stiffness.  It is most prevalent in my left shoulder and the middle finger of my right hand.  I have not had pain in these places before.  I have also had pain and stiffness in my knees and lower back, and I have had problems in these places before.  The pain is not debilitating and is relieved with Advil and Tylenol.  I expected it to just resolve itself, but it has not.  I have communicated this to my health care provider, Dr. , by telemedicine.
Age: 38.0
Sex: F
Vaccine: COVID19
Symptoms: Chills, Pyrexia
Clinical narrative: Fever and chills for 18 hours - treated with tylenol or ibuprofen. Full recovery after 18 hours.
Age: 41.0
Sex: M
Vaccine: COVID19
Symptoms: Interchange of vaccine products
Clinical narrative: AFTER ADMINISTERING VACCINE SAW ON PT CARD THAT THEIR FIRST DOSE HAD BEEN MODERNA ADMINISTERED AT A DIFFERENT PHARMACY.    1ST DOSE WAS MODERNA 006C21A, GIVEN  1014, ON 5/17/2021
Age: 15.0
Sex: F
Vaccine: COVID19
Symptoms: Fall, Nausea
Clinical narrative: Patient feel in parking lot twice. Felt nauseous. Was responsive when ambulance arrived
Age: 61.0
Sex: F
Vaccine: VARZOS
Symptoms: Inflammation, Pain, Pain in extremity
Clinical narrative: Extreme arm pain and inflamamtion radiating down to her fingers
Age: 24.0
Sex: M
Vaccine: VARCEL
Symptoms: Pruritus, Urticaria, Varicella
Clinical narrative: PATIENT HAD A FEVER FOR 3 DAYS, BROKE OUT WITH CHICKEN POX; FOURTH DAY OK; ON FIFTH DAY, HIVES ALL OVER THE BODY WITH ITCHING. ITCHING WAS STILL PRESENT WHEN REPORTED TO ME AT 6-21-21
Age: 49.0
Sex: F
Vaccine: COVID19
Symptoms: Arthralgia, Blister, Headache, Herpes zoster, Muscle tightness
Clinical narrative: I was diagnosed with Shingles on 11-JUN-2021 after presenting with nerve pain and blistering rash on back and front left shoulder and left and back of the neck. 22-MAY-2021: Itchiness and red blotchiness appeared on left front chest and shoulder.  Lasted for several hours and then resolved.  No doctor contacted. 31-MAY-2021: 2nd round of itchiness on front left shoulder and left side neck.  Lasted several hours and resolved itself. No doctor contacted. 07-JUN-2021: Left front and back shoulder was sore to the touch, hot like a sunburn, and tight muscle pain thru shoulder and left neck. 08-JUN-2021: Symptoms worsened throughout day and then nerve pain was present during the night thru left shoulder and left side and back of the neck. 09-JUN-2021: Had a teladoc doctor visit about severe shoulder/neck pain.  Pain medicine was prescribed and instructed to see PCP if symptoms did not resolve. Small bumps appeared on left back shoulder as if bitten by a bug.  10-JUN-2021:  Shoulder/neck pain still present and took motrin every 4 hours for pain.  Used heat pad for pain.  More bumps appeared on front left chest and back left shoulder. 11-JUN-2021: Rash worsened with blisters forming and spreading further on left chest and shoulder and up left and back of the neck.  Pain was still present.  Teladoc was called again and shown pictures of rash.  Diagnosed with Shingles and prescribed Valtrex. 12-17-JUN-2021: Pain and rash still present with ice pick headaches occurring every few seconds many times a day. 18-JUN-2021 to present: Rash and pain began to recover but still present to date.
Age: 49.0
Sex: F
Vaccine: COVID19
Symptoms: Neck pain, Neuralgia, Pruritus, Rash, Rash macular
Clinical narrative: I was diagnosed with Shingles on 11-JUN-2021 after presenting with nerve pain and blistering rash on back and front left shoulder and left and back of the neck. 22-MAY-2021: Itchiness and red blotchiness appeared on left front chest and shoulder.  Lasted for several hours and then resolved.  No doctor contacted. 31-MAY-2021: 2nd round of itchiness on front left shoulder and left side neck.  Lasted several hours and resolved itself. No doctor contacted. 07-JUN-2021: Left front and back shoulder was sore to the touch, hot like a sunburn, and tight muscle pain thru shoulder and left neck. 08-JUN-2021: Symptoms worsened throughout day and then nerve pain was present during the night thru left shoulder and left side and back of the neck. 09-JUN-2021: Had a teladoc doctor visit about severe shoulder/neck pain.  Pain medicine was prescribed and instructed to see PCP if symptoms did not resolve. Small bumps appeared on left back shoulder as if bitten by a bug.  10-JUN-2021:  Shoulder/neck pain still present and took motrin every 4 hours for pain.  Used heat pad for pain.  More bumps appeared on front left chest and back left shoulder. 11-JUN-2021: Rash worsened with blisters forming and spreading further on left chest and shoulder and up left and back of the neck.  Pain was still present.  Teladoc was called again and shown pictures of rash.  Diagnosed with Shingles and prescribed Valtrex. 12-17-JUN-2021: Pain and rash still present with ice pick headaches occurring every few seconds many times a day. 18-JUN-2021 to present: Rash and pain began to recover but still present to date.
Age: 49.0
Sex: F
Vaccine: COVID19
Symptoms: Skin warm, Tenderness
Clinical narrative: I was diagnosed with Shingles on 11-JUN-2021 after presenting with nerve pain and blistering rash on back and front left shoulder and left and back of the neck. 22-MAY-2021: Itchiness and red blotchiness appeared on left front chest and shoulder.  Lasted for several hours and then resolved.  No doctor contacted. 31-MAY-2021: 2nd round of itchiness on front left shoulder and left side neck.  Lasted several hours and resolved itself. No doctor contacted. 07-JUN-2021: Left front and back shoulder was sore to the touch, hot like a sunburn, and tight muscle pain thru shoulder and left neck. 08-JUN-2021: Symptoms worsened throughout day and then nerve pain was present during the night thru left shoulder and left side and back of the neck. 09-JUN-2021: Had a teladoc doctor visit about severe shoulder/neck pain.  Pain medicine was prescribed and instructed to see PCP if symptoms did not resolve. Small bumps appeared on left back shoulder as if bitten by a bug.  10-JUN-2021:  Shoulder/neck pain still present and took motrin every 4 hours for pain.  Used heat pad for pain.  More bumps appeared on front left chest and back left shoulder. 11-JUN-2021: Rash worsened with blisters forming and spreading further on left chest and shoulder and up left and back of the neck.  Pain was still present.  Teladoc was called again and shown pictures of rash.  Diagnosed with Shingles and prescribed Valtrex. 12-17-JUN-2021: Pain and rash still present with ice pick headaches occurring every few seconds many times a day. 18-JUN-2021 to present: Rash and pain began to recover but still present to date.
Age: 28.0
Sex: F
Vaccine: COVID19
Symptoms: Injection site pain, Injection site pruritus, Injection site swelling, Injection site warmth
Clinical narrative: Developed a similar reaction to the 2nd dose of the vaccine as to the first (also reported through vaers) but with a shorter time course. About a day after receiving the vaccine, developed itchiness at vaccine site. This developed into a tender, warm, swollen, and mildly painful patch within the 2nd day after my vaccine. The pain was mild and well controlled with tylenol and the itchiness was severe and poorly controlled with itch cream and ice. However, the patch did not last as long as the one after the first vaccine and had resolved within about 5 days with severe symptoms only lasting around 2-3 days. The patch was also smaller in size than the one seen after my first dose.
Age: 24.0
Sex: F
Vaccine: COVID19
Symptoms: Blood test normal, Fatigue, Hypersomnia
Clinical narrative: Constant fatigue and hypersomnia.  Blood tests normal, waiting to see sleep specialist.
Age: 15.0
Sex: F
Vaccine: COVID19
Symptoms: Dizziness, Pain in extremity
Clinical narrative: Patient complained of pain in left arm (injection arm) and dizziness.  I monitored patient for anaphylaxis.  Patient showed no signs of anaphylaxis. I took her blood pressure and temperature.  BP was 75/35, heart rate = 68 and temperature 98.7.  I monitored patient for 30 minutes. After sipping on orange juice, she started to feel better.  Her mother was present.  I asked her mother who the child's doctor is and she stated that daughter has no doctor.  I recommended that her doctor be seen today to monitor.
Age: 56.0
Sex: M
Vaccine: COVID19
Symptoms: Interchange of vaccine products
Clinical narrative: patient wanted Johnson & Johnson?s Janssen COVID19 vaccine but was accidentally given Pfizer vaccine instead
Age: 37.0
Sex: F
Vaccine: COVID19, COVID19
Symptoms: Injection site discolouration
Clinical narrative: Large skin discoloration around the area in shot location. Pinkish color
Age: 69.0
Sex: M
Vaccine: COVID19
Symptoms: Flank pain, Nephrolithiasis, Ultrasound abdomen
Clinical narrative: Likely kidney stone, intermittent severe pain in left flank, cleared up in three weeks.
Age: 16.0
Sex: F
Vaccine: COVID19
Symptoms: Erythema, Limb discomfort, Peripheral swelling
Clinical narrative: Patient began to notice her arm was extremely heavy, red, and swollen approx. 27 hours after the vaccination.  Ice and Ibuprofen were used to control the swelling and discomfort.
Age: 27.0
Sex: M
Vaccine: COVID19
Symptoms: Loss of consciousness, Syncope
Clinical narrative: syncopal episode during observation period, patient regained consciousness after seconds, provided water and support, patient was able to exit the premesis under his own control, denied any further needs
Age: 62.0
Sex: M
Vaccine: COVID19
Symptoms: Balance disorder, Blood test, Dizziness, Gait disturbance, Magnetic resonance imaging
Clinical narrative: On the first day after taking the shot: couldn't walk well; very dizzy; loss of balance; blurry vision; couldn't focus; difficulty riding my bike. I went to the doctor and I was recommended to see a neurologist. I gradually got better over time. I still have soreness in my ribs and I can walk somewhat normally. I feel like I have 90% recovered.
Age: 62.0
Sex: M
Vaccine: COVID19
Symptoms: Musculoskeletal chest pain, Vision blurred
Clinical narrative: On the first day after taking the shot: couldn't walk well; very dizzy; loss of balance; blurry vision; couldn't focus; difficulty riding my bike. I went to the doctor and I was recommended to see a neurologist. I gradually got better over time. I still have soreness in my ribs and I can walk somewhat normally. I feel like I have 90% recovered.
Age: 16.0
Sex: F
Vaccine: HPV9
Symptoms: Wrong product administered
Clinical narrative: Pt should have received 2nd dose of Bexsero vaccine; pt was given 3rd dose of HPV instead.
Age: 30.0
Sex: M
Vaccine: COVID19
Symptoms: Syncope
Clinical narrative: About 3 minutes after administration, patient experienced syncope lasting about 20 seconds.  Fully regained consciousness, and was aware of time, place, and situation.  Denied any pain or other discomfort or abnormal sensation. Patient was advise to stay for paramedics to arrive for evaluation and observation. Patient and his spouse remained in counseling room  for about 15 minutes.  Refused paramedic call and left under own cognition.
Age: 37.0
Sex: M
Vaccine: COVID19
Symptoms: Blood glucose, Dizziness, Dyspnoea, Hyperhidrosis, Nervousness
Clinical narrative: Near syncope, shaky, sweating profusely, labored breathing, light headed
Age: 37.0
Sex: M
Vaccine: COVID19
Symptoms: Presyncope
Clinical narrative: Near syncope, shaky, sweating profusely, labored breathing, light headed
Age: 33.0
Sex: F
Vaccine: COVID19, COVID19
Symptoms: Abdominal pain upper, Arthralgia, Back pain, Diarrhoea, Fatigue
Clinical narrative: On-going symptoms: extreme muscle pain, soreness and swelling in entire left arm and upper left back and left shoulder. Tingling pain and numbness in entire left arm. Other symptoms: tiredness fatigue headaches diarrhea stomach pain
Age: 33.0
Sex: F
Vaccine: COVID19, COVID19
Symptoms: Headache, Hypoaesthesia, Myalgia, Pain in extremity, Paraesthesia
Clinical narrative: On-going symptoms: extreme muscle pain, soreness and swelling in entire left arm and upper left back and left shoulder. Tingling pain and numbness in entire left arm. Other symptoms: tiredness fatigue headaches diarrhea stomach pain
Age: 33.0
Sex: F
Vaccine: COVID19, COVID19
Symptoms: Peripheral swelling, X-ray
Clinical narrative: On-going symptoms: extreme muscle pain, soreness and swelling in entire left arm and upper left back and left shoulder. Tingling pain and numbness in entire left arm. Other symptoms: tiredness fatigue headaches diarrhea stomach pain
Age: 13.0
Sex: F
Vaccine: HPV9
Symptoms: Asthenia, Cardiac ablation, Echocardiogram, Electrocardiogram, Exercise tolerance decreased
Clinical narrative: progressive debilitating fatigue, exercise intolerance, pSVT requiring radiofrequency ablation 6/28/2021
Age: 13.0
Sex: F
Vaccine: HPV9
Symptoms: Fatigue, Supraventricular tachycardia
Clinical narrative: progressive debilitating fatigue, exercise intolerance, pSVT requiring radiofrequency ablation 6/28/2021
Age: 27.0
Sex: M
Vaccine: COVID19
Symptoms: Blood test, Electrocardiogram, Seizure
Clinical narrative: Seizure
Age: 91.0
Sex: F
Vaccine: COVID19
Symptoms: Asthma, Condition aggravated
Clinical narrative: Patient was confusing but it sounds like she developed an asthma exacerbation 3 days after Covid vaccine.  Resolved with her normal inhalers and she may have used albuterol more often than usual.  She cannot tell us how long it took for the symptoms to resolve.  She dealt with the symptoms at home and told me about it 2 months later at a routine and unrelated office visit.
Age: 67.0
Sex: F
Vaccine: COVID19
Symptoms: Erythema, Swelling face
Clinical narrative: - Pt had taken benadryl 50mg at 4:35pm prior to vaccination due to facial swelling with 1st vaccine reportedly (administrator was aware). 2nd pfizer vaccine was administered at 4:50pm. Pt left clinic at 5:05pm but shortly returned due to some new R cheek swelling. Checked on pt at 5:20pm - no throat swelling, no significant facial swelling - slight erythema to R cheek, RRR, non-labored breathing. Pt was provided water. She remained stable at 2nd check (CN V, CN VII, CN XII tests wnl, non-labored breathing, no throat/neck/eye swelling but R cheek swelling still persisted -did not worsen). Pt opted to leave clinic and monitor symptoms closely at home. Strict ER precautions provided. Advised pt that she can repeat benadryl dose in 2-4 hrs as needed. Pt left with husband at 5:39pm from clinic.
Age: 17.0
Sex: F
Vaccine: COVID19
Symptoms: Pruritus
Clinical narrative: Left arm puritis, site of injection..  50mg benadryl with improvement.  No sob, wheezing, oral/airway swelling
Age: 55.0
Sex: F
Vaccine: FLU4
Symptoms: Injection site pain, Pain in extremity
Clinical narrative: Patient reported lingering pain in the left arm / shoulder post vaccination. She indicated she was going to physical therapy to help with the pain.