chrisvoncsefalvay/vaers-narrative-generation huggingface dataset:
Age: 31.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Angiogram, Blood test, Chest X-ray, Chest discomfort, Chest pain
Clinical narrative: 7/10/2021 l was diagnosed with Myocarditis with a possible slight Pericarditis  7/8/2021 I started to feel like I was getting an allergy attack (Hay Fever) that turned into a real fever.  7/9/2021 I was starting to feel dizzy and my legs were starting to hurt really bad. I also had shortness of breath, a bad headache and a sensitivity to light. In and out of fever 7/10/2021 I woke up with a horrible chest pain (pressure) got up and almost passed out while I had the overwhelming feeling of nausea. In and out of fever. Blood results show that my Troponin levels were 3.730 ng/mL. It took four days for them to start to come back down.
Age: 31.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Dizziness, Dyspnoea, Echocardiogram, Electrocardiogram, Headache
Clinical narrative: 7/10/2021 l was diagnosed with Myocarditis with a possible slight Pericarditis  7/8/2021 I started to feel like I was getting an allergy attack (Hay Fever) that turned into a real fever.  7/9/2021 I was starting to feel dizzy and my legs were starting to hurt really bad. I also had shortness of breath, a bad headache and a sensitivity to light. In and out of fever 7/10/2021 I woke up with a horrible chest pain (pressure) got up and almost passed out while I had the overwhelming feeling of nausea. In and out of fever. Blood results show that my Troponin levels were 3.730 ng/mL. It took four days for them to start to come back down.
Age: 31.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Malaise, Myocarditis, Nausea, Pain in extremity, Photophobia
Clinical narrative: 7/10/2021 l was diagnosed with Myocarditis with a possible slight Pericarditis  7/8/2021 I started to feel like I was getting an allergy attack (Hay Fever) that turned into a real fever.  7/9/2021 I was starting to feel dizzy and my legs were starting to hurt really bad. I also had shortness of breath, a bad headache and a sensitivity to light. In and out of fever 7/10/2021 I woke up with a horrible chest pain (pressure) got up and almost passed out while I had the overwhelming feeling of nausea. In and out of fever. Blood results show that my Troponin levels were 3.730 ng/mL. It took four days for them to start to come back down.
Age: 31.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Presyncope, Pyrexia, Seasonal allergy, Troponin increased
Clinical narrative: 7/10/2021 l was diagnosed with Myocarditis with a possible slight Pericarditis  7/8/2021 I started to feel like I was getting an allergy attack (Hay Fever) that turned into a real fever.  7/9/2021 I was starting to feel dizzy and my legs were starting to hurt really bad. I also had shortness of breath, a bad headache and a sensitivity to light. In and out of fever 7/10/2021 I woke up with a horrible chest pain (pressure) got up and almost passed out while I had the overwhelming feeling of nausea. In and out of fever. Blood results show that my Troponin levels were 3.730 ng/mL. It took four days for them to start to come back down.
Age: 66.0
Sex: F
Vaccine: COVID19
Symptoms: Blister, Herpes zoster, Pain
Clinical narrative: The patient called to see if a prescription had been called in.  Upon finding out nothing had been called in yet, I asked if the doctors office was going to call something in that day, and she said "yes, to take care of the shingles I got after the moderna shot you gave me."  I inquired when the shingles appeared and she told me it was 1 day after the shot.  She denied any problems with the first moderna shot.  She said the blisters were on the right side of her torso and migrating to the right side of her back.  She stated that Tylenol was helping with the pain.  An rx for Valtrex came in later that day for her.
Age: 28.0
Sex: F
Vaccine: COVID19
Symptoms: Hyperhidrosis, Loss of consciousness, Pallor, Urinary incontinence
Clinical narrative: Patient lost consciousness while sitting in chair after vaccine. She also urinated on herself while passed out.  Duration of unconsciousness not known for sure. She came to and was noticed to be sweating and pale. We gave her water, a snack, and a fan. Patient felt better within 15  minutes.
Age: 33.0
Sex: M
Vaccine: COVID19
Symptoms: Asthenia, Dizziness, Fatigue, Headache, Nausea
Clinical narrative: Severe headache, tired, achy, nausea, feverish, slightly dizzy, and generally weak feeling.
Age: 33.0
Sex: M
Vaccine: COVID19
Symptoms: Pain, Pyrexia
Clinical narrative: Severe headache, tired, achy, nausea, feverish, slightly dizzy, and generally weak feeling.
Age: 61.0
Sex: M
Vaccine: COVID19
Symptoms: Injection site erythema, Injection site pain, Injection site swelling, Muscle spasms, Pain
Clinical narrative: Site: Pain at Injection Site-Mild, Site: Redness at Injection Site-Mild, Site: Swelling at Injection Site-Mild, Systemic: Body Aches Generalized-Mild, Systemic: muscle cramps in leg-Mild
Age: 14.0
Sex: F
Vaccine: COVID19
Symptoms: Computerised tomogram head, Dysarthria, Headache
Clinical narrative: Patient presented to emergency center for evaluation of right sided headache for 12 hours with episodic slurred speech day after 2nd dose of  COVID vaccine. Per notes slurred speech already resolved at time of ER visit.
Age: 69.0
Sex: F
Vaccine: COVID19
Symptoms: Acute kidney injury, Arthralgia, Back pain, Blood creatinine increased, Dizziness
Clinical narrative: shoulder pain, back pain, numbness and tingling of fingers, dizziness, acute renal failure, hyperkalemia
Age: 69.0
Sex: F
Vaccine: COVID19
Symptoms: Hyperkalaemia, Hypoaesthesia, Paraesthesia
Clinical narrative: shoulder pain, back pain, numbness and tingling of fingers, dizziness, acute renal failure, hyperkalemia
Age: 36.0
Sex: F
Vaccine: COVID19
Symptoms: Dyspnoea, Fatigue, Gait disturbance, Laboratory test, Paraesthesia oral
Clinical narrative: Patient came into clinic for Pfizer #2, on way in, daughter reported to HCP that "mom was walking like she was drunk". Patient also stated she become suddenly fatigued driving.  patient also reported Intermittent respiratory difficulty and moth tingling. Patient's father also had Guillian Barre patient admitted to Hospital ER
Age: 32.0
Sex: F
Vaccine: COVID19
Symptoms: Chronic fatigue syndrome, Deafness, Injection site pain
Clinical narrative: Site: Pain at Injection Site-Medium, Additional Details: Patient reports hearing loss. Doesn't know if related. Was made worse with home remedies - lead to hosp Due to CFS they do usually knock her out harder. Also reports chronic fatigue syndrome
Age: 43.0
Sex: F
Vaccine: COVID19
Symptoms: Hypersensitivity, Injection site dryness, Injection site erythema, Injection site induration, Injection site pruritus
Clinical narrative: One week after initial shot, allergic reaction. Injection site has 2? red, dry, itchy spot, with a hard raised bump underneath about 4? in diameter. Spot is hot to the touch.
Age: 43.0
Sex: F
Vaccine: COVID19
Symptoms: Injection site swelling, Injection site warmth
Clinical narrative: One week after initial shot, allergic reaction. Injection site has 2? red, dry, itchy spot, with a hard raised bump underneath about 4? in diameter. Spot is hot to the touch.
Age: 46.0
Sex: F
Vaccine: COVID19, COVID19
Symptoms: Dysmenorrhoea, Heavy menstrual bleeding, Thrombosis
Clinical narrative: Period lasted longer than 8 days, then restarted and was very heavy and super painful for 5 more days, lots of clotts.
Age: 49.0
Sex: F
Vaccine: COVID19
Symptoms: Dysphonia, Feeling abnormal, Hypoaesthesia, Paraesthesia, Throat tightness
Clinical narrative: Patient began feeling tingling in her arm, felt left side of face go numb.  Stated she just didn't feel right.  Then stated her throat was starting to close up and became hoarse.  EPI was administered x 1 at clinic and patient transported to ED where she was observed and discharged on Prednisone.
Age: 59.0
Sex: F
Vaccine: VARZOS
Symptoms: Rash, Rash erythematous, Rash pruritic
Clinical narrative: Itchy red rash on jawline across face from ear to ear 3" wide
Age: 25.0
Sex: M
Vaccine: COVID19
Symptoms: COVID-19, Intensive care, Poisoning, SARS-CoV-2 test positive
Clinical narrative: Fully vaccinated patient admitted to hospital and tested positive for COVID.  Admitted for intoxication to ICU.  History of unmedicated schizophrenia.  No s/s of COVID.
Age: 65.0
Sex: F
Vaccine: COVID19
Symptoms: Cardiac disorder, Chest pain, Dyspnoea, Fatigue, Headache
Clinical narrative: June 14, I had the vaccine. June 25, I started having muscle aches, severe headache and sore throat. This continued through the next week along with being extremely tired. July 5, I went to the ER due to severe chest pains (I have NEVER had chest pains before). They sent me home that same day. By July 7th, I felt like my heart was seizing and went back to the ER this time also with shortness of breath and a fever. I was admitted on July 7th and discharge on July 9th, with diagnosis of Pericarditis--a SIDE EFFECT OF THE VACCINE. I am now currently on sick leave as I cannot work. I was told by medical staff to report this so that is what I am doing.
Age: 65.0
Sex: F
Vaccine: COVID19
Symptoms: Impaired work ability, Investigation, Myalgia, Oropharyngeal pain, Pericarditis
Clinical narrative: June 14, I had the vaccine. June 25, I started having muscle aches, severe headache and sore throat. This continued through the next week along with being extremely tired. July 5, I went to the ER due to severe chest pains (I have NEVER had chest pains before). They sent me home that same day. By July 7th, I felt like my heart was seizing and went back to the ER this time also with shortness of breath and a fever. I was admitted on July 7th and discharge on July 9th, with diagnosis of Pericarditis--a SIDE EFFECT OF THE VACCINE. I am now currently on sick leave as I cannot work. I was told by medical staff to report this so that is what I am doing.
Age: 65.0
Sex: F
Vaccine: COVID19
Symptoms: Pyrexia, Vaccination complication
Clinical narrative: June 14, I had the vaccine. June 25, I started having muscle aches, severe headache and sore throat. This continued through the next week along with being extremely tired. July 5, I went to the ER due to severe chest pains (I have NEVER had chest pains before). They sent me home that same day. By July 7th, I felt like my heart was seizing and went back to the ER this time also with shortness of breath and a fever. I was admitted on July 7th and discharge on July 9th, with diagnosis of Pericarditis--a SIDE EFFECT OF THE VACCINE. I am now currently on sick leave as I cannot work. I was told by medical staff to report this so that is what I am doing.
Age: 53.0
Sex: F
Vaccine: COVID19
Symptoms: Dysgeusia
Clinical narrative: Metallic taste in mouth, even when not eating.  Metallic taste continued for approximately 24 hours
Age: 25.0
Sex: M
Vaccine: COVID19
Symptoms: Arrhythmia, Cardiac discomfort, Condition aggravated, Decreased appetite, Dizziness
Clinical narrative: After 5 minutes getting the first dose of Pfizer COVID-19 vaccines I fainted at the pharmacy. The ambulance was called and I was checked in place. ever since I got the vaccine I started feeling my heart rhythm changed, either my heart is slowing down or it beats really fast or get a discomfort  feeling in heart and get the feeling  of passing out again. This made me loose my appetite to eat for several days. On two instances, i went to the emergency room. I've been following up with my doctor about this issue.  The discomfort will happen every several days. Before getting the vaccine I had none of the symptoms.
Age: 25.0
Sex: M
Vaccine: COVID19
Symptoms: Heart rate irregular, Investigation normal, Syncope
Clinical narrative: After 5 minutes getting the first dose of Pfizer COVID-19 vaccines I fainted at the pharmacy. The ambulance was called and I was checked in place. ever since I got the vaccine I started feeling my heart rhythm changed, either my heart is slowing down or it beats really fast or get a discomfort  feeling in heart and get the feeling  of passing out again. This made me loose my appetite to eat for several days. On two instances, i went to the emergency room. I've been following up with my doctor about this issue.  The discomfort will happen every several days. Before getting the vaccine I had none of the symptoms.
Age: 0.5
Sex: M
Vaccine: DTAPHEPBIP, HIBV, PNC13, RV5
Symptoms: Body temperature increased, Rash
Clinical narrative: Pt had a diffuse rash on his face, trunk and extremities. MOC was instructed by clinic MA to give pt 2.5 mL of Benadryl. MOC gave pt the Benadryl, and the rash improved slightly. Pt also had a temperatre of ~101 at home. MOC denies that pt has been exposed to any new soaps, detergents, parental colognes/perfumes, plants, animals, or foods.
Age: 52.0
Sex: F
Vaccine: COVID19
Symptoms: Abnormal uterine bleeding, Condition aggravated, Headache, Transfusion
Clinical narrative: severe headache, worsening irregular menstrual bleed. admitted to hospital for blood transfusion
Age: 35.0
Sex: U
Vaccine: COVID19
Symptoms: Menstrual disorder, Muscle spasms
Clinical narrative: Abnormal menstruation - off schedule, intense cramps, extended duration
Age: 37.0
Sex: F
Vaccine: COVID19
Symptoms: Blood test, Dyspnoea, Lethargy, X-ray
Clinical narrative: next day pt suddenly became lethargic and could not breathe
Age: 33.0
Sex: M
Vaccine: COVID19
Symptoms: Hyperhidrosis, Nausea, Pain, Syncope
Clinical narrative: Within 5 minutes after receiving the vaccination, the patient fainted.  He was probably unconscious for 10-15 seconds per patient.  He then presented as very pale and sweating.  He also complained of being nauseous.   The paramedics were called and he was taken to the hospital for evaluation.
Age: 82.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Arthralgia, Axillary pain, Bladder hypertrophy, Blood pressure increased, Condition aggravated
Clinical narrative: Patient contacted the office 3/31/21 with complaints of arm/shoulder/axillary pains since receiving the vaccines, treated in office 4/5/21 for lump at injection site and continued axillary pain, treated 5/25/21 for shingles outbreak on chest, contacted office again 5/28/21 with elevated bp, heart rate and confusion- possible med reaction, contacted office 6/9/2021 with low blood pressure, dizziness, confusion, increased edema, treated 6/15/21 for urinary tract infection. Treated with oncology - notes from 4/13/21 notes patient is doing well, but with 'knot' on arm and axillary tenderness following COVID vaccine, then notes from oncology 6/24/21 notes patient found to have new retroperitoneal and pelvic lyphadenopathy, along with new splenic lesions with sudden rapid change in mental status and new diagnosed pulmonary hypertension. Patient placed on hospice and deceased as of 7/7/2021
Age: 82.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Confusional state, Death, Dizziness, Heart rate increased, Herpes zoster
Clinical narrative: Patient contacted the office 3/31/21 with complaints of arm/shoulder/axillary pains since receiving the vaccines, treated in office 4/5/21 for lump at injection site and continued axillary pain, treated 5/25/21 for shingles outbreak on chest, contacted office again 5/28/21 with elevated bp, heart rate and confusion- possible med reaction, contacted office 6/9/2021 with low blood pressure, dizziness, confusion, increased edema, treated 6/15/21 for urinary tract infection. Treated with oncology - notes from 4/13/21 notes patient is doing well, but with 'knot' on arm and axillary tenderness following COVID vaccine, then notes from oncology 6/24/21 notes patient found to have new retroperitoneal and pelvic lyphadenopathy, along with new splenic lesions with sudden rapid change in mental status and new diagnosed pulmonary hypertension. Patient placed on hospice and deceased as of 7/7/2021
Age: 82.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Hypotension, Injection site mass, Laboratory test, Lung disorder, Lymphadenectomy
Clinical narrative: Patient contacted the office 3/31/21 with complaints of arm/shoulder/axillary pains since receiving the vaccines, treated in office 4/5/21 for lump at injection site and continued axillary pain, treated 5/25/21 for shingles outbreak on chest, contacted office again 5/28/21 with elevated bp, heart rate and confusion- possible med reaction, contacted office 6/9/2021 with low blood pressure, dizziness, confusion, increased edema, treated 6/15/21 for urinary tract infection. Treated with oncology - notes from 4/13/21 notes patient is doing well, but with 'knot' on arm and axillary tenderness following COVID vaccine, then notes from oncology 6/24/21 notes patient found to have new retroperitoneal and pelvic lyphadenopathy, along with new splenic lesions with sudden rapid change in mental status and new diagnosed pulmonary hypertension. Patient placed on hospice and deceased as of 7/7/2021
Age: 82.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Mental status changes, Oedema, Pain in extremity, Pulmonary artery dilatation, Pulmonary hypertension
Clinical narrative: Patient contacted the office 3/31/21 with complaints of arm/shoulder/axillary pains since receiving the vaccines, treated in office 4/5/21 for lump at injection site and continued axillary pain, treated 5/25/21 for shingles outbreak on chest, contacted office again 5/28/21 with elevated bp, heart rate and confusion- possible med reaction, contacted office 6/9/2021 with low blood pressure, dizziness, confusion, increased edema, treated 6/15/21 for urinary tract infection. Treated with oncology - notes from 4/13/21 notes patient is doing well, but with 'knot' on arm and axillary tenderness following COVID vaccine, then notes from oncology 6/24/21 notes patient found to have new retroperitoneal and pelvic lyphadenopathy, along with new splenic lesions with sudden rapid change in mental status and new diagnosed pulmonary hypertension. Patient placed on hospice and deceased as of 7/7/2021
Age: 82.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Pulmonary mass, Retroperitoneal lymphadenopathy, Splenic lesion, Tenderness, Urinary tract infection
Clinical narrative: Patient contacted the office 3/31/21 with complaints of arm/shoulder/axillary pains since receiving the vaccines, treated in office 4/5/21 for lump at injection site and continued axillary pain, treated 5/25/21 for shingles outbreak on chest, contacted office again 5/28/21 with elevated bp, heart rate and confusion- possible med reaction, contacted office 6/9/2021 with low blood pressure, dizziness, confusion, increased edema, treated 6/15/21 for urinary tract infection. Treated with oncology - notes from 4/13/21 notes patient is doing well, but with 'knot' on arm and axillary tenderness following COVID vaccine, then notes from oncology 6/24/21 notes patient found to have new retroperitoneal and pelvic lyphadenopathy, along with new splenic lesions with sudden rapid change in mental status and new diagnosed pulmonary hypertension. Patient placed on hospice and deceased as of 7/7/2021
Age: 68.0
Sex: M
Vaccine: COVID19
Symptoms: Death
Clinical narrative: Patient passed away 18 days after vaccine receipt.  Patient was not previously COVID-19 positive and did not have any predisposing factors(PMH, allergies, etc.) for experiencing an adverse drug event. The ADR did not occur at the time of the administration of the vaccine nor was there an ADR that occurred between the observation period and the date of death. Patient had end-stage Parkinson's dementia which was the cause of death. Not attributed to vaccination.
Age: 44.0
Sex: M
Vaccine: COVID19
Symptoms: Angiogram cerebral abnormal, Cerebral haemorrhage, Headache, Musculoskeletal stiffness, Neck pain
Clinical narrative: Severe stiffness and pain in upper neck/base of skull.  Severe headaches.  Blurred vision.  No treatment.
Age: 44.0
Sex: M
Vaccine: COVID19
Symptoms: Vision blurred
Clinical narrative: Severe stiffness and pain in upper neck/base of skull.  Severe headaches.  Blurred vision.  No treatment.
Age: 11.0
Sex: M
Vaccine: COVID19
Symptoms: Product administered to patient of inappropriate age
Clinical narrative: Vaccine given to early at age 11 without incident.
Age: 33.0
Sex: M
Vaccine: COVID19
Symptoms: Pulmonary embolism
Clinical narrative: pulmonary embolus
Age: 55.0
Sex: F
Vaccine: COVID19
Symptoms: Back pain, Blood thyroid stimulating hormone increased, Globulins increased, Headache, Metabolic function test
Clinical narrative: 3.2.21 super stiff and it hurts and a terrible headache  4.9.21 Shot #1 Feb NO SIDE EFFECTS Shot 2 -3 weeks after Next day neck was stiff and hard to move to either side x 3 days NOW CAN MOVE BUT STILL FEELS STIFF HA  Comes and goes since 2nd shot Different spots Lingers on right if she lays down Nagging, squeezing No neuro sx in hand No LOC/DIZZINESS/FALLS DIDN'T REPORT  5/4/21 New Back pain 1 week,  +2 mos h/o unprovoked neck and head pain Hurts to sleep, can't sleep sometimes Feels like she had a crick and has to pop it No more pains in legs  6/22/21 Pt called and stated she is still having neck stiffness, headache and back pain with arm tingling since she got the Covid vaccine in February.  7/14/21 Began having neck stiffness, HA, and tingling to left arm afterwards
Age: 55.0
Sex: F
Vaccine: COVID19
Symptoms: Mobility decreased, Musculoskeletal stiffness, Neck pain, Pain, Paraesthesia
Clinical narrative: 3.2.21 super stiff and it hurts and a terrible headache  4.9.21 Shot #1 Feb NO SIDE EFFECTS Shot 2 -3 weeks after Next day neck was stiff and hard to move to either side x 3 days NOW CAN MOVE BUT STILL FEELS STIFF HA  Comes and goes since 2nd shot Different spots Lingers on right if she lays down Nagging, squeezing No neuro sx in hand No LOC/DIZZINESS/FALLS DIDN'T REPORT  5/4/21 New Back pain 1 week,  +2 mos h/o unprovoked neck and head pain Hurts to sleep, can't sleep sometimes Feels like she had a crick and has to pop it No more pains in legs  6/22/21 Pt called and stated she is still having neck stiffness, headache and back pain with arm tingling since she got the Covid vaccine in February.  7/14/21 Began having neck stiffness, HA, and tingling to left arm afterwards
Age: 55.0
Sex: F
Vaccine: COVID19
Symptoms: Sleep disorder
Clinical narrative: 3.2.21 super stiff and it hurts and a terrible headache  4.9.21 Shot #1 Feb NO SIDE EFFECTS Shot 2 -3 weeks after Next day neck was stiff and hard to move to either side x 3 days NOW CAN MOVE BUT STILL FEELS STIFF HA  Comes and goes since 2nd shot Different spots Lingers on right if she lays down Nagging, squeezing No neuro sx in hand No LOC/DIZZINESS/FALLS DIDN'T REPORT  5/4/21 New Back pain 1 week,  +2 mos h/o unprovoked neck and head pain Hurts to sleep, can't sleep sometimes Feels like she had a crick and has to pop it No more pains in legs  6/22/21 Pt called and stated she is still having neck stiffness, headache and back pain with arm tingling since she got the Covid vaccine in February.  7/14/21 Began having neck stiffness, HA, and tingling to left arm afterwards
Age: 16.0
Sex: M
Vaccine: MENB
Symptoms: Rash, Rash pruritic
Clinical narrative: itchy rash on arms and legs
Age: 37.0
Sex: F
Vaccine: COVID19
Symptoms: Acute kidney injury
Clinical narrative: Patient hospitalized for acute kidney injury within 6 weeks of receiving COVID vaccination.
Age: 69.0
Sex: F
Vaccine: COVID19, COVID19
Symptoms: Angiogram, Chest pain, Computerised tomogram abnormal, Electrocardiogram, Epistaxis
Clinical narrative: 1) 911 - On 5/27/2021 at about 7:00pm I started to experience bad chest pain which only increased to severe.   At 2:00pm I contacted a triage nurse associated with the Hospital,  who informed me to hang up and immediately call 911.  I did call 911 and paramedics & ambulance arrived.   I was given EKG, Nitroglycerine, etc. and transported to the ER department.  I was treated by the Dr.  Many lab tests were performed including 2 Troponin tests during the course of my stay.   A CT scan was done as well.    I was told I had chest wall swelling, was treated and released at 5:30am on 5/28/2021. 2)  On 6/12/2021 Experienced a large black & blue spot approx 2" x 6" in the left arm at the original injection site.   Injection site was small hard lump at the onset. 3)  Have been experiencing nose bleeds. (which I have never had before). Note:  I have always been extremely healthy and these symptoms are extremely unusual.   Have had nothing like this prior to my vaccine.    I have had other vaccines in the past with uterly no reactions.....Thank you....
Age: 69.0
Sex: F
Vaccine: COVID19, COVID19
Symptoms: Injection site bruising, Injection site induration, Laboratory test, Swelling, Troponin
Clinical narrative: 1) 911 - On 5/27/2021 at about 7:00pm I started to experience bad chest pain which only increased to severe.   At 2:00pm I contacted a triage nurse associated with the Hospital,  who informed me to hang up and immediately call 911.  I did call 911 and paramedics & ambulance arrived.   I was given EKG, Nitroglycerine, etc. and transported to the ER department.  I was treated by the Dr.  Many lab tests were performed including 2 Troponin tests during the course of my stay.   A CT scan was done as well.    I was told I had chest wall swelling, was treated and released at 5:30am on 5/28/2021. 2)  On 6/12/2021 Experienced a large black & blue spot approx 2" x 6" in the left arm at the original injection site.   Injection site was small hard lump at the onset. 3)  Have been experiencing nose bleeds. (which I have never had before). Note:  I have always been extremely healthy and these symptoms are extremely unusual.   Have had nothing like this prior to my vaccine.    I have had other vaccines in the past with uterly no reactions.....Thank you....
Age: 31.0
Sex: F
Vaccine: COVID19
Symptoms: Anxiety, Blood test, Fatigue, Headache, Heavy menstrual bleeding
Clinical narrative: Excessively heavy menstrual bleeding which began 3 days after the 2nd dose of the vaccine. Heavy bleeding continued for two days. Two days after heavy bleeding ended, symptoms of fatigue/headache/anxiety  began.
Age: 31.0
Sex: F
Vaccine: COVID19
Symptoms: Serum ferritin decreased, Vitamin D decreased
Clinical narrative: Excessively heavy menstrual bleeding which began 3 days after the 2nd dose of the vaccine. Heavy bleeding continued for two days. Two days after heavy bleeding ended, symptoms of fatigue/headache/anxiety  began.
Age: 55.0
Sex: M
Vaccine: COVID19
Symptoms: COVID-19, Vaccine breakthrough infection
Clinical narrative: break thru covid case Tested positive for covid-19 july 15 2021 at local hosptial
Age: 40.0
Sex: F
Vaccine: COVID19
Symptoms: Pyrexia, Rash, Rash pruritic, Vaccination complication, White blood cell count increased
Clinical narrative: "Pt w/ complex medical hx including anorexia, hypothyroidism, PEG, gait difficulty, Dysphagia, bed sores, and COVID hypoxia w/ severe hyponatremia in 2/21.  Complete medical hx not available.  Recent illnesses included severe c-diff infection and proteus UTI requiring ICU admission on 6/29.  Transferred to the floor on 6/30.  Now transfered to Hospital post vaccination for ongoing management. Pt developed rash post vaccination (mildly itchy, mostly on trunk) that has lasted >4days.  Pt also had fever and WBC of 20 w/in 24hrs that was attributed to the vaccine.  Partial Medication List: ? ascorbic acid  500 mg G-Tube Daily ? aspirin  81 mg G-Tube Daily ? cetirizine  10 mg G-Tube Daily ? chlorhexidine  15 mL Swish and Spit BID ? fluocinonide   Topical BID ? Lactobacillus acidophilus  1 capsule G-Tube Daily ? levothyroxine  25 mcg G-Tube Daily (0600) ? melatonin  3 mg G-Tube QHS ? multivitamin with folic acid  1 tablet G-Tube Daily ? neomycin-polymyxin-hydrocortisone  3 drop Left Ear QID ? sertraline  50 mg G-Tube Daily ? vancomycin  125 mg Oral BID"
Age: 17.0
Sex: M
Vaccine: COVID19
Symptoms: Aphasia, Dizziness, Gaze palsy, Tremor
Clinical narrative: Four minutes after vaccination with 2nd dose of Pfizer Covid vaccine, mom and sister reported patient's eyes rolled back, closed eyes, "shook for a moment", and slid down chair. Family yelled for help and I called 911. Patient's eyes reopened and was feeling dizzy; seemed to understand questions but unable to speak immediately after. Wet paper towel was provided to put on forehead and patient was monitored for anaphylactic, seizure, and other symptoms until emergency personnel arrived. Patient was evaluated and fireman stated that patient likely had "syncopal reaction".
Age: 90.0
Sex: M
Vaccine: COVID19
Symptoms: Death, No adverse event
Clinical narrative: death 13 days following receipt of vaccination.  Patient was not previously COVID-19 positive and did not have any predisposing factors(PMH, allergies, etc.) for experiencing an adverse drug event. The ADR did not occur at the time of the administration of the vaccine nor was there an ADR that occurred between the observation period and the date of death. Cause of death not documented. Significant comorbidities include dementia with neuropsychiatric behaviors including anxiety.
Age: 35.0
Sex: F
Vaccine: COVID19
Symptoms: Axillary pain, Physical breast examination, Swelling
Clinical narrative: Left axillary swelling and pain a few days after my left arm Pfizer injection. The aching pain lasted for about 3 weeks.  The swelling gradually declined, but still has not completely resolved. My left axilla is still a bit more swollen than the right. However, there is no pain/aching anymore.
Age: 19.0
Sex: M
Vaccine: COVID19
Symptoms: Unevaluable event
Clinical narrative: Patient hospitalized within 6 weeks of receiving COVID vaccination.
Age: 26.0
Sex: F
Vaccine: COVID19
Symptoms: COVID-19, SARS-CoV-2 test positive, Vaccine breakthrough infection
Clinical narrative: Breakthrough COVID Case. This patient completed moderna series 2/5/21, positive 7/15/21
Age: 25.0
Sex: M
Vaccine: COVID19
Symptoms: Inappropriate schedule of product administration, Incorrect dose administered
Clinical narrative: After vaccination, client stated he already received 1 dose of Moderna vaccine in April 2021 at a different jail.
Age: 50.0
Sex: F
Vaccine: COVID19
Symptoms: Fatigue, Headache, Oral herpes, Oropharyngeal pain, Pain
Clinical narrative: Headache, Fever, Sore Throat, aches, pains, exhaustion, cold sores in and around mouth
Age: 50.0
Sex: F
Vaccine: COVID19
Symptoms: Pyrexia, SARS-CoV-2 test negative
Clinical narrative: Headache, Fever, Sore Throat, aches, pains, exhaustion, cold sores in and around mouth
Age: 42.0
Sex: M
Vaccine: COVID19
Symptoms: Death
Clinical narrative: PT was found on floor in dining room expired by wife on 6/20/21 at approximately 7:30.  Body was hard and cold.  Called EMS immediately , EMS provided treatment.  Declared dead.  Body taken to coroner for autopsy.
Age: 43.0
Sex: F
Vaccine: COVID19
Symptoms: Urticaria
Clinical narrative: generalized urticaria
Age: 79.0
Sex: M
Vaccine: COVID19
Symptoms: Atrial flutter, Electrocardiogram abnormal, Fatigue, Palpitations
Clinical narrative: Patient states he was out looking for a new car when he felt Palps states he did not think anything of it at this time as he just assumed this was possible Anxiety/stress as he was "running around" in search of a new car. Patient states he often however notice he had become more and more fatigued. Shortly after patient presented to the office for evaluation. Patient had an EKG on 5/28/21 at his annual physical. When patient presented for the Palps on 6/16/21 another EKG was performed. This EKG showed changes which included Atrial flutter. Patient was then referred to   (Electrophysiologist). From there he was advised and scheduled for Cardioversion, this is scheduled for 7/28.
Age: 48.0
Sex: F
Vaccine: COVID19
Symptoms: Asthenia, Blood pressure increased, Chest pain, Condition aggravated, Heart rate increased
Clinical narrative: Complained of chest pain 7/10.  Contacted nurse. Nurse questioned and stated that she had not taken b/p meds this morning and was experiencing total body weakness.  B/p elevated pulse elevated volunteer MD on site. 911 contacted for further evaluation.  Patient taken to hospital.
Age: 51.0
Sex: F
Vaccine: VARZOS
Symptoms: Abdominal pain upper, Chills, Erythema, Pain in extremity, Peripheral swelling
Clinical narrative: Chills-shivers arm soreness/swelling/redness low grade fever stomach pain
Age: 51.0
Sex: F
Vaccine: VARZOS
Symptoms: Pyrexia
Clinical narrative: Chills-shivers arm soreness/swelling/redness low grade fever stomach pain
Age: 21.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Alanine aminotransferase increased, Aspartate aminotransferase increased, Blood alkaline phosphatase increased, Cardiac function test abnormal, Gamma-glutamyltransferase normal
Clinical narrative: pericarditis, blood in stool, significantly elevated liver function
Age: 21.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Haematochezia, Hepatitis viral test negative, Liver function test increased, Occult blood negative, Pericarditis
Clinical narrative: pericarditis, blood in stool, significantly elevated liver function
Age: 15.0
Sex: M
Vaccine: COVID19
Symptoms: Hypoaesthesia, Hypoaesthesia oral
Clinical narrative: "Pt c/o of facial and tongue numbness 5 minutes after receiving his vaccine. Denies any hx of allergies or taking any medication. Negative for hives or tongue/throat swelling. Denies difficulty swallowing or breathing.    Water, juice, and Graham crackers given. Vital sign stable BP 115/87, HR 71, RR16, SPO2 100%.    Symptoms resolved 45 min later. ER precaution advised. Pt d/ced in stable condition. "
Age: 27.0
Sex: F
Vaccine: COVID19
Symptoms: COVID-19, SARS-CoV-2 test positive
Clinical narrative: tested positive for covid-19 July 16 2021 after completing covid vaccine series
Age: 26.0
Sex: M
Vaccine: COVID19
Symptoms: Fatigue
Clinical narrative: Extreme fatigue. Starting around June 30th.
Age: 4.0
Sex: F
Vaccine: MMR
Symptoms: Inappropriate schedule of product administration
Clinical narrative: Incorrect spacing in between 2 live vaccines
Age: 30.0
Sex: F
Vaccine: COVID19
Symptoms: Exposure during pregnancy, Presyncope
Clinical narrative: client had just received 1st dose of vaccine @ 1042am, was in observation area@ 1055am. Client disclosed to Observation lead that she was about to "pass out." Nurse assisted client to the floor, NP assessed client as well. EMT on site monitored clients vitals: at 10:55am HR 61 02sat 98%, 10:58am HR 52 o2sat 98%, 11:00am HR 60 O2sat 98% BP 140/83,  @ 11:05 HR 58 O2sat 99% BP 125/73. Client alert and oriented during incident, talking to NP the whole time. client approx 28weeks pregnant. Last vitals taken at 11:29am  HR 63 O2sat 99%. Client was advised to by NP to report to her OB/GYN. Client left site with boyfriend at her side.
Age: 55.0
Sex: F
Vaccine: COVID19, COVID19
Symptoms: Arthralgia
Clinical narrative: left shoulder joint pain 2 weeks after 2nd dose occured
Age: 17.0
Sex: M
Vaccine: COVID19
Symptoms: Condition aggravated, Epistaxis, Facial pain, Nasal cavity packing, Oral pain
Clinical narrative: PATIENT STATES HE WAS PLAYING VIDEO GAMES WITH HIS FRIENDS YESTERDAY WHEN HIS NOSE STARTED TO BLEED. HIS GRANDMOTHER TRIED MULTIPLE METHODS TO STOP THE BLEEDING. PATIENT'S NOSE CONTINUED TO BLEED FOR 2 HOURS WHEN HIS GRANDMOTHER CALLED EMS. PATIENT WAS TAKEN TO SCH ER WHERE A BALLOON WAS PLACED. 7/15/2021 THEY REPORT THEY WERE TOLD THE BALLOON WAS TO REMAIN IN PLACE UNTIL FRIDAY. PATIENT STATES HE HAS HAD PREVIOUS EPISODES OF EPISTAXIS, BUT NOTHING TO THIS DEGREE. PATIENT REPORTS INTENSE PAIN IN HIS NOSE, FACE AND PALATE. HE HAS HAD CLEAR NASAL DISCHARGE FROM AROUND THE BALLOON, BUT NO ACTIVE BLEEDING. PATIENT WAS PRESCRIBED ANTIBIOTIC, BUT HAS NOT FILLED THAT PRESCRIPTION YET. HE IS ASKING FOR THE BALLOON TO BE REMOVED DUE TO THE PAIN.
Age: 17.0
Sex: M
Vaccine: COVID19
Symptoms: Rhinalgia, Rhinorrhoea
Clinical narrative: PATIENT STATES HE WAS PLAYING VIDEO GAMES WITH HIS FRIENDS YESTERDAY WHEN HIS NOSE STARTED TO BLEED. HIS GRANDMOTHER TRIED MULTIPLE METHODS TO STOP THE BLEEDING. PATIENT'S NOSE CONTINUED TO BLEED FOR 2 HOURS WHEN HIS GRANDMOTHER CALLED EMS. PATIENT WAS TAKEN TO SCH ER WHERE A BALLOON WAS PLACED. 7/15/2021 THEY REPORT THEY WERE TOLD THE BALLOON WAS TO REMAIN IN PLACE UNTIL FRIDAY. PATIENT STATES HE HAS HAD PREVIOUS EPISODES OF EPISTAXIS, BUT NOTHING TO THIS DEGREE. PATIENT REPORTS INTENSE PAIN IN HIS NOSE, FACE AND PALATE. HE HAS HAD CLEAR NASAL DISCHARGE FROM AROUND THE BALLOON, BUT NO ACTIVE BLEEDING. PATIENT WAS PRESCRIBED ANTIBIOTIC, BUT HAS NOT FILLED THAT PRESCRIPTION YET. HE IS ASKING FOR THE BALLOON TO BE REMOVED DUE TO THE PAIN.
Age: 12.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Pruritus, Rash
Clinical narrative: Itching began after first dose on 05/17/2021 and then rash began after 2nd dose on 06/07/2021, rash and bumps are on upper arms, bumps are prevalent  on back and other parts of body
Age: 80.0
Sex: F
Vaccine: COVID19
Symptoms: Extra dose administered, Interchange of vaccine products, Wrong patient
Clinical narrative: While administering second doses of Moderna at nursing home, facility LPN brought client and paperwork filled out for vaccine. Client verbalized her name. Moderna dose given and then RN discovered through conversation with client/vaccine card that last name was incorrect. Since there was a question about client identity, facility staff reviewed their information and realized the wrong client had been brought for vaccination. She had previously received Pfizer.
Age: 39.0
Sex: M
Vaccine: COVID19
Symptoms: Heart rate irregular, Palpitations
Clinical narrative: Heart palpitations,  hard irregular beat once every minute or so.
Age: 17.0
Sex: F
Vaccine: COVID19
Symptoms: No adverse event, Product administered to patient of inappropriate age
Clinical narrative: Employee is under 18 years of age . No signs and symptoms reported.
Age: 79.0
Sex: M
Vaccine: COVID19
Symptoms: Blood test normal, Cardiac monitoring, Cardiac stress test normal, Chest discomfort, Echocardiogram normal
Clinical narrative: I was doing light yard work and felt discomfort in my chest. Went in the house to get hydrated and test my blood pressure and pulse. Rapid heart rate of 143. Monitored for 3 hours and was consistently 140-142. Called cardiologist who referred me to the Emergency Room at the hospital ER Administered Cardizen IV and returned to normal heart rate within 45 minutes. I have been experiencing foggy brain since the incident. I consider myself to be in perfect health and am very active.
Age: 79.0
Sex: M
Vaccine: COVID19
Symptoms: Feeling abnormal, Heart rate increased
Clinical narrative: I was doing light yard work and felt discomfort in my chest. Went in the house to get hydrated and test my blood pressure and pulse. Rapid heart rate of 143. Monitored for 3 hours and was consistently 140-142. Called cardiologist who referred me to the Emergency Room at the hospital ER Administered Cardizen IV and returned to normal heart rate within 45 minutes. I have been experiencing foggy brain since the incident. I consider myself to be in perfect health and am very active.
Age: 17.0
Sex: M
Vaccine: COVID19
Symptoms: Product administered to patient of inappropriate age
Clinical narrative: under age for vaccine
Age: 26.0
Sex: M
Vaccine: COVID19
Symptoms: Unevaluable event
Clinical narrative: Patient presented to the ED and was subsequently hospitalized within 6 weeks of receiving COVID vaccination.
Age: 9.0
Sex: M
Vaccine: HEPA, HPV9
Symptoms: Incorrect dose administered
Clinical narrative: Patient was given an adult dose of Hep A instead of a pediatric dose.
Age: 1.5
Sex: F
Vaccine: MMR
Symptoms: Unevaluable event
Clinical narrative: Not enough time in between live vaccines
Age: 54.0
Sex: F
Vaccine: COVID19
Symptoms: Interchange of vaccine products
Clinical narrative: None noted  Patient received a dose of Moderna on 6/16.   Received Jansen on 7/15 in error
Age: 59.0
Sex: F
Vaccine: COVID19
Symptoms: Asthenia, Blood test abnormal, Dehydration, Fatigue, Malaise
Clinical narrative: A fter the vaccine, I initially felt fine. During a bike ride I began to feel weak, tired and my heart was racing. When I got home I tried to take my blood pressure and the machine said error. I was very tired and weak. Before I went bed feeling quite nauseous and felt overall weak and felt ill. Blood pressure was 85/65. During the night I was up often trying to vomit. I had some slight vomiting but mostly dry heaves. I was laying on the bathroom floor. My husband woke up and took me to the hospital. I was admitted for severe dehydration to the point it affected my kidneys. I had IV fluids throughout the day and was able to go home late that afternoon. The weakness continued for about another day and a half. Still a bit off but better as of 7/16/21
Age: 59.0
Sex: F
Vaccine: COVID19
Symptoms: Nausea, Palpitations, Renal impairment, Retching, Sleep disorder
Clinical narrative: A fter the vaccine, I initially felt fine. During a bike ride I began to feel weak, tired and my heart was racing. When I got home I tried to take my blood pressure and the machine said error. I was very tired and weak. Before I went bed feeling quite nauseous and felt overall weak and felt ill. Blood pressure was 85/65. During the night I was up often trying to vomit. I had some slight vomiting but mostly dry heaves. I was laying on the bathroom floor. My husband woke up and took me to the hospital. I was admitted for severe dehydration to the point it affected my kidneys. I had IV fluids throughout the day and was able to go home late that afternoon. The weakness continued for about another day and a half. Still a bit off but better as of 7/16/21
Age: 59.0
Sex: F
Vaccine: COVID19
Symptoms: Vomiting
Clinical narrative: A fter the vaccine, I initially felt fine. During a bike ride I began to feel weak, tired and my heart was racing. When I got home I tried to take my blood pressure and the machine said error. I was very tired and weak. Before I went bed feeling quite nauseous and felt overall weak and felt ill. Blood pressure was 85/65. During the night I was up often trying to vomit. I had some slight vomiting but mostly dry heaves. I was laying on the bathroom floor. My husband woke up and took me to the hospital. I was admitted for severe dehydration to the point it affected my kidneys. I had IV fluids throughout the day and was able to go home late that afternoon. The weakness continued for about another day and a half. Still a bit off but better as of 7/16/21
Age: 64.0
Sex: F
Vaccine: COVID19
Symptoms: Dyspnoea, Feeling cold, Injected limb mobility decreased, Injection site pain, Limb discomfort
Clinical narrative: 6th July: injection in the morning by the afternoon arm is sore. Took 600mg Advil afternoon and 800mg at bedtime. Restless night waking frequently with arm neck and sinus pain.  7th July morning took 800mg Advil by afternoon arm is heavy like I can hardly lift it and pain now radiating to finger tips and down my legs from buttock like severe sciatic nerve pain. Manage to sleep for 3 hrs in the afternoon by evening pain worsening. 6.30pm felt cold even though 29C outside  pain still severe and feels heavy to breath. 7.30 pm hot shower and to bed cramping in arm to finger tips, under breast, severe pain down from buttock to the soles of my feet and scalp tingling. 8.00pm my legs arm and head feel on fire. 8th July morning less cramping and arm still heavy but feel slightly improved from yesterday, sinus pain, neck stiff and breathing still heavy but not as bad. 9th July symptoms improving slowly.
Age: 64.0
Sex: F
Vaccine: COVID19
Symptoms: Musculoskeletal pain, Musculoskeletal stiffness, Neck pain, Neuralgia, Pain
Clinical narrative: 6th July: injection in the morning by the afternoon arm is sore. Took 600mg Advil afternoon and 800mg at bedtime. Restless night waking frequently with arm neck and sinus pain.  7th July morning took 800mg Advil by afternoon arm is heavy like I can hardly lift it and pain now radiating to finger tips and down my legs from buttock like severe sciatic nerve pain. Manage to sleep for 3 hrs in the afternoon by evening pain worsening. 6.30pm felt cold even though 29C outside  pain still severe and feels heavy to breath. 7.30 pm hot shower and to bed cramping in arm to finger tips, under breast, severe pain down from buttock to the soles of my feet and scalp tingling. 8.00pm my legs arm and head feel on fire. 8th July morning less cramping and arm still heavy but feel slightly improved from yesterday, sinus pain, neck stiff and breathing still heavy but not as bad. 9th July symptoms improving slowly.
Age: 64.0
Sex: F
Vaccine: COVID19
Symptoms: Pain in extremity, Restlessness, Sinus pain, Sleep disorder
Clinical narrative: 6th July: injection in the morning by the afternoon arm is sore. Took 600mg Advil afternoon and 800mg at bedtime. Restless night waking frequently with arm neck and sinus pain.  7th July morning took 800mg Advil by afternoon arm is heavy like I can hardly lift it and pain now radiating to finger tips and down my legs from buttock like severe sciatic nerve pain. Manage to sleep for 3 hrs in the afternoon by evening pain worsening. 6.30pm felt cold even though 29C outside  pain still severe and feels heavy to breath. 7.30 pm hot shower and to bed cramping in arm to finger tips, under breast, severe pain down from buttock to the soles of my feet and scalp tingling. 8.00pm my legs arm and head feel on fire. 8th July morning less cramping and arm still heavy but feel slightly improved from yesterday, sinus pain, neck stiff and breathing still heavy but not as bad. 9th July symptoms improving slowly.
Age: 17.0
Sex: M
Vaccine: COVID19
Symptoms: No adverse event, Product administered to patient of inappropriate age
Clinical narrative: No adverse event reported.  Vaccine administered to patient 17 year and 2 months old.
Age: 73.0
Sex: M
Vaccine: COVID19
Symptoms: Antibody test, Biopsy skin, Lichen planus, Myasthenia gravis
Clinical narrative: lichens plantus and myasthenia gravis supportive care.
Age: 69.0
Sex: F
Vaccine: COVID19, COVID19
Symptoms: Colonoscopy abnormal, Computerised tomogram, Diverticulitis, Haemoglobin decreased, Rectal haemorrhage
Clinical narrative: My Hgb is normally above 14 gm/dL. On02/22/21at 5:00 pm I began to pass a large amount of bright red blood rectally. On 05/23/21 I called my Dr. & went to the ER that same morning. They  CT scan & I was admitted. The rectal bleeding continued until 02/26/21. On 02/25/21 after doing a prep, I had a colonoscopy. Results showed bright red blood I colon which made visualization difficult. Conclusion was that bleeding was thought to be result of bleeding from diverticulitis in the sigmoid colon. I never had a rectal bleed before or since. Several meds were discontinued. Asa, ibuprofen, guaifenesin, & tapered off oral budesonide. Hgb was 7.1 on discharge on 02/26/21.
Age: 17.0
Sex: M
Vaccine: COVID19
Symptoms: No adverse event, Product administered to patient of inappropriate age
Clinical narrative: taking vaccine underage.  no problems or reaction
Age: 49.0
Sex: M
Vaccine: COVID19
Symptoms: Blister, Discharge, Pruritus, Scab
Clinical narrative: On the 2nd of July I had blisters; Red and itchy with clear liquid, appear on both of my forearms and right ankle. I used Clotrimazole and Betamethasone Dipropionate cream USP, 1%/0.05% mixed with triple antibiotic ointment once a day in the evenings. I would clean the areas in the morning and use a herbal clay mixture. By the 4th the blisters on my forearms and ankle were healing and becoming scabs. On the 4th of July blisters; clear, itchy with sticky clear liquid, appeared on my left pinky and middle finger plus my right ring finger. I used the same treatment for these blisters. The blisters on my fingers cleared up by Monday the 12th.  On Wednesday the 14th the same blisters reappeared on my left pinky and right ring finger. As of today the blisters on my pinky are scabs again and the right ring finger are starting to scab again.
Age: 17.0
Sex: M
Vaccine: COVID19
Symptoms: Unevaluable event
Clinical narrative: Patient and guardian confirmed DOB and stated his age as 18 years old. Patient did not present his ID. We will implement a strategy of showing a birth certificate if photo ID is not readily available.