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From the 7/16/2021 release of VAERS data:

Found 479,813 cases where Vaccine is COVID19 and Patient Did Not Die



Case Details (Reverse Sorted by Onset Date)

This is page 100 out of 4,799

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VAERS ID: 1407725 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-17
Onset:2021-06-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050C21A / 1 LA / IM

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

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

Write-up: PATIENT HAS FEAR OF NEEDLE AND HAD AN ANXIETY ATTACK WITH SYNCOPE. NEEDED TO LIE DOWN 10 MINUTES TO RECOVER.


VAERS ID: 1407736 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-06-17
Onset:2021-06-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Dyspnoea, Feeling hot
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Denies
Current Illness:
Preexisting Conditions: Arthritis; COVID x2
Allergies: Denies
Diagnostic Lab Data:
CDC Split Type:

Write-up: SOB; dizziness; warmness, tingling on left arm (started before vaccination per patient)


VAERS ID: 1407737 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-17
Onset:2021-06-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 023C21A / 2 LA / IM

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

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

Write-up: Minimum interval between doses not met.


VAERS ID: 1407739 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-17
Onset:2021-06-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036C21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Exposure during pregnancy, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: AFTER THE SECOND DOSE OF THE COVID-19 VACCINE (MODERNA) HAD BEEN ADMINISTERED, THE PATIENT FAINTED WITHIN 15 MINUTES OF OBSERVATION OF THE VACCINE. PATIENT IS APPROXIMATELY 6 MONTHS PREGNANT


VAERS ID: 1407740 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Idaho  
Vaccinated:2021-06-17
Onset:2021-06-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: none
Preexisting Conditions: aspergers
Allergies: None
Diagnostic Lab Data: vitals were normal when paramedics checked 6/17/21 @ 120pm
CDC Split Type:

Write-up: Patient received shot and 5 mins later started having a seizure. I went out and held his head while 911 was called. Seizure lasted 15 seconds. 5 mins later he had another seizure that lasted 30 seconds


VAERS ID: 1407741 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-06-17
Onset:2021-06-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051C21A / 1 LA / IM

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

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

Write-up: Patient was given Moderna vaccine but should have been given Pfizer vaccine based on patient age of 14.


VAERS ID: 1407755 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-17
Onset:2021-06-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 008C21A / 1 RA / IM

Administered by: School       Purchased by: ?
Symptoms: No adverse event, Product administered to patient of inappropriate age
SMQs:, Medication errors (narrow)

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

Write-up: Patient was 16 at the time of event. Experienced no adverse events


VAERS ID: 1407764 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-17
Onset:2021-06-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Loss of consciousness, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

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

Write-up: PATIENT EXPERIENCE SYNCOPE AND PASSED OUT. PATIENT RECOVERED RIGHT AWAY


VAERS ID: 1407784 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-15
Onset:2021-06-17
   Days after vaccination:63
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021C21A / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: No adverse event
SMQs:

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

Write-up: No ASE


VAERS ID: 1407792 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-17
Onset:2021-06-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 1 LA / IM

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

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

Write-up: Lightheadedness, Feeling faint


VAERS ID: 1407805 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-06-16
Onset:2021-06-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009D21A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Naproxen, Celexa, xopenex, atarax, abilify, Vit D2
Current Illness: none
Preexisting Conditions: Asthma & Hyperthyroidism
Allergies: Cats
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Localized reaction to injection site. Red area 2"X2" diameter, sl raised & warm to touch.


VAERS ID: 1407806 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-06-17
Onset:2021-06-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022C21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: none
Preexisting Conditions: not listed
Allergies: penicillin
Diagnostic Lab Data: not applicable
CDC Split Type:

Write-up: 17 year old patient was scheduled to receive a second COVID19 (Moderna Vaccine). VAERS report was initially completed for 1st unintentional COVID19 vaccination administration on 5/23/21. Second COVID19 (Moderna Vaccine) was given per parent/guardian approval and clinical director approval per conditional approval.


VAERS ID: 1407814 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-06-17
Onset:2021-06-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Hyperhidrosis, Hypotension, Immediate post-injection reaction, Unresponsive to stimuli
SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: not reported
Current Illness: not reported
Preexisting Conditions: not reported
Allergies: not reported
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Patient walked into the pharmacy trying to get vaccinated for Covid. Before anything patient was concerned about her previous Covid positive case (not a severe reaction, was eventually tested negative in April) and also her family history of asthma (Patient herself never had an episode so far). I told the patient it would be okay to get vaccinated, per CDC guideline. As patient filled out the consent form, I checked the screening questionnaire, which she answered "no" to everything except "don''t know" to asthma related questions. As everything was set I brought patient into the consultation room, explained what vaccine she is receiving, how long it takes for the vaccine to be fully incorporated into her defense system (2-3 weeks), and what kind of side effects she can expect (muscle pain, elevation in body temperature, redness around injection site). I took extra moments to explain risk vs benefits for blood clotting issue. At this point patient was ready to get vaccinated. I wore gloves, asked patient to roll her sleeves up so I can proceed to wipe the right upper arm area with alcohol and give her an injection. she followed promptly so far to this point. As soon as patient received the vaccination, her body started to slide down the chair. Patient reported to feel dizzy and also reported that she had some "dreams." Fortunately while everything was happening patient''s head did not hit anything and patient was in sitting position the whole time of the event. I asked patient if patient was feeling okay three to four times but I did not get any straight answer from the patient. I asked for help, and pharmacy technicians and store manager offered help. Patient wanted us to call her husband and 911, which we proceeded. In the mean time I also reached out to my district manager to report what was going on. Store manager offered a room temperature water to keep her fluid balanced, as she was sweating heavily. Once 911 got to the site, they measured her BP and HR, and it was a bit low. 911 offered a choice to take patient to ER, which PT and her husband first decided to use their own car, and later decided against going to ER. Husband reported that patient is feeling much better, drank a few ounces of fluid and taken a banana.


VAERS ID: 1407819 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-06-17
Onset:2021-06-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8731 / UNK LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Glipizide ER 5mg daily, 200 mg Ibuprofen Q6 PRN, Metformin HCL 500 MG extended release daily, Lisinopril-hydrochlorothiazide 20-25 mg tablet daily, Depakote ER 500 MG daily, Quetiapine Fumarate 100 mg daily, Gabapentin 300 mg capsule TID
Current Illness:
Preexisting Conditions: Bipolar, obesity, tobacco use, Type 2 diabetes Mellitus, essential hypertension,
Allergies: NKA
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient came to clinic for the second vaccine in her 2 dose COVID-19 vaccine series. Patient had received Moderna for her first dose, when patient arrived clerk gave the patient pfizer paper to complete. The LPN administered a dose of Pfizer before realizing the patient had received Moderna for her first dose. So patient has had one of each type of mRNA vaccine due to error.


VAERS ID: 1407829 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-06-17
Onset:2021-06-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 042B21A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Expired product administered, Product storage error
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: metformin, effexor ER, pravastatin, lisinopril, oxycodone, albuterol inhaler, breo ellipta inhaler, omeprazole, glimepiride, folic acid, flexeril, lactulose
Current Illness: none
Preexisting Conditions: type 2 diabetes, COPD, chronic pain, GERD, opiate induce constipation, hypercholesterolemia, hypertension, depression, liver cirrhosis, lumbar degenerative disc disease
Allergies: penicillin
Diagnostic Lab Data: No testing performed. Patient was monitored in the clinic for approximately 45 minutes, no adverse reaction noted, vital signs within normal range for patient. Contacted Department of Health and was instructed to call 855-MODERNA, made a report with Moderna, and then was emailed info that informed to report here.
CDC Split Type:

Write-up: Bottle of vaccine was not thrown out from Tuesday''s clinic. Nurse was conversing with other staff and did not confirm date on bottle and administered Moderna COVID-19 vaccine, that had been opened Tuesday (06/15/2021) morning at 9:00am, and was approximately 36 hours expired, it had been at room temp since Tuesday morning at 9:00am.


VAERS ID: 1407832 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-06-16
Onset:2021-06-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0169 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Eye pruritus, Ocular hyperaemia
SMQs:, Anaphylactic reaction (broad), Glaucoma (broad)

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

Write-up: Red, Itchy Left Eye


VAERS ID: 1407840 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-17
Onset:2021-06-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821281 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypopnoea, Loss of consciousness, Malaise, Pallor, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Respiratory failure (narrow), Hypoglycaemia (broad)

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

Write-up: patient was asked to stay in the waiting are for 15 minutes.he went and sat down then he got up to talk to his wife at that time he felt sick and passed out. his breathing was shallow and he was unresponsive for 2 minutes. he was pale. paramedics were called and they came right away and assessed him. he did not need any medical help. he felt fine. they did not take him to hospital.


VAERS ID: 1407853 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-06-17
Onset:2021-06-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Panic attack, Paraesthesia, Tremor
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

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

Write-up: Patient became dizzy and shaky within 7 minutes after getting first dose. She stated her hands were tingly and that she felt like she would pass out. The paramedics were immediately called. Paramedics took about 15 minutes to arrive and they attended to the patient. Patient was believed to have a panic attack but they recommended patient to see a md just in case its something different. Patient was able to walk out the store fine after about 40 minutes after the paramedics arrived and helped her out.


VAERS ID: 1407854 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-17
Onset:2021-06-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 1 OT / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Anxiety, Dizziness, Feeling hot
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

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

Write-up: Dizzy, anxiety, feeling hot. Evaluated by EMS-Cleared


VAERS ID: 1407866 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-17
Onset:2021-06-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Pharyngeal swelling, Throat irritation, Throat tightness, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Asthma/bronchospasm (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: pt. injected self with her own epi pen
CDC Split Type:

Write-up: pt. with complaints of throat swelling, feeling of tightness and scratchy, audible expiratory wheezes


VAERS ID: 1407867 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-06-17
Onset:2021-06-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Feeling hot, Hyperhidrosis
SMQs:, Neuroleptic malignant syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin D Lorazepam prn
Current Illness: none
Preexisting Conditions: dysthymic disorder contact dermatitis acne tension headache allergic rhinitis
Allergies: NKDA
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Pt became hot, diaphoretic and felt chest pain within minutes of receiving dose. Pt was layed down, ice packs applied and was given juice. Within minutes, symptoms resolved per patient.


VAERS ID: 1407876 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-06-17
Onset:2021-06-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022B21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Product storage error
SMQs:, Medication errors (narrow)

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

Write-up: Moderna vaccine was administered outside the recommended time outside refrigeration conditions. Called Moderna and asked what was to be expected. They said series was still complete and patient was still fully vaccinated. Called and left message with patient to return call to me so that we can following up with side effects and the patient''s general condition over the next several days.


VAERS ID: 1407878 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-06-17
Onset:2021-06-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0158 / 2 - / IM

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

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

Write-up: DIZZY WENT HOME FINE


VAERS ID: 1407891 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-06-17
Onset:2021-06-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6202 / UNK - / -

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

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

Write-up: Scheduling error. Patient was given Pfizer vaccine at 16 days after first dose instead of 17-21 days after first dose.


VAERS ID: 1407892 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: California  
Vaccinated:2021-04-26
Onset:2021-06-17
   Days after vaccination:52
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006C21A / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dizziness, Feeling drunk, Food allergy, Paranasal sinus discomfort, Vertigo
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: 2nd dose of Shingrix, chills, fever for about 24 hours. Same with 2nd dose of covid vaccine.
Other Medications: Metformin, Glimepiride, red yeast rice, fish oil, magnesium, levothyroxine
Current Illness: None
Preexisting Conditions: Diabetes, low thyroid
Allergies: penicillin, sulfa, statins, cipro
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Rolled onto my right side this morning and the room started spinning. Laid on my back for 30-45 minutes as it stopped. Tried to roll back onto my left side, spinning started again, returned to my back. After about 30 minutes I slowly sat up, little dizzy. Thought it was maybe my sinuses acting up, so went to use my nasal sprays, walking through the house like I was drunk. Nasal sprays relieved some pressure in sinuses. Contacted my business partner who replied "It''s the covid vaccine. My mom and I both had this problem." At work now, a little dizzy on and off, and a little bit of brain fog.


VAERS ID: 1407899 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-06-14
Onset:2021-06-17
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027C21A / 2 LA / IM

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

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

Write-up: Patient was given a COVID vaccine on 6/14/21. On 6/17/21, Medical Clinic called and said the patient presented there with a red, warm-to touch nodule on her arm. She says it was the location where the shot was administered. They sent us a picture, and this was about 6 inches lower than the deltoid muscle. It is unclear if that is the actual vaccine site because it is so low, but they prescribed Augmentin just in case it is a skin infection.


VAERS ID: 1407900 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-06-16
Onset:2021-06-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 0111021A / 2 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Sertraline 50 mg Junel-fe
Current Illness: None
Preexisting Conditions: Asthma
Allergies: Acetaminophen
Diagnostic Lab Data:
CDC Split Type:

Write-up: Swollen, hard lump at injection site. Very painful and red


VAERS ID: 1407911 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-06-17
Onset:2021-06-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6202 / 2 - / -

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

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

Write-up: Patient was given second dose of Pfizer 16 days after first dose instead of 17-21 days after first dose


VAERS ID: 1407916 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-06-17
Onset:2021-06-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021C21A / 2 RA / IM

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

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

Write-up: No adverse events. Patient accidentally vaccinated 16 days after 1st dose, 8 days earlier than minimum interval. Per CDC guidance, no further vaccinations needed. Patient advised of error.


VAERS ID: 1407918 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-06-17
Onset:2021-06-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021C21A / 2 RA / SYR

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

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

Write-up: No adverse events. Patient accidentally vaccinated 16 days after 1st dose, 8 days earlier than minimum interval. Per CDC guidance, no further vaccinations needed. Patient advised of error.


VAERS ID: 1407921 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-06-17
Onset:2021-06-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Face injury, Fall
SMQs:, Accidents and injuries (narrow)

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

Write-up: Patient was administered vaccine around 11:15 am. patient was seated for about 10 minutes then when he walked over in front of the pharmacy counter, we heard a sound that appeared to be the sound of someone falling. I along with my technicians walked outside of the pharmacy and found the patient lying face down on the floor and bleeding from a cut on his chin that happened as a result of the fall. patient remained on the floor until EMTs arrived about 10 minutes later


VAERS ID: 1407928 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-17
Onset:2021-06-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821281 / 1 - / IM

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

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

Write-up: Received vaccine, sat down as advised, 3-mins later felt nauseous (about to vomit), got up and walked away from people around me. Fortunately my wife was there, I called out to her because I was getting dizzy, she came over as I was passing out, I grabbed onto her and we both fell to the floor (I used her to cushion my fall). I passed out on her as she screamed for help. Two male customers assisted me into a chair as I was disoriented, my wife asked me what her name was and I didn''t her name as I was pale, trembling, and sweating. The pharmacy tech thought I was going into convulsions and called 911. The paramedics arrived and fortunately I was breathing and slowly coming back. Paramedics remained there and took all my vital signs and stayed with me. Since my vitals were okay and my color came back, I felt much better and was coherent again. This event was at least 30-minutes or more. I declined going to the hospital with ambulance and the paramedics told me to call 911 if it happens again.


VAERS ID: 1407934 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-06-17
Onset:2021-06-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048B21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Expired product administered, No adverse event
SMQs:, Medication errors (narrow)

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

Write-up: TECHNICIAN HAD ADMINISTERED THE MODERNA DOSE AFTER THE BUD FOR THE VACCINE STABILITY. NO OTHER REACTION, OUTCOME, OR TREATMENT AT THIS TIME.


VAERS ID: 1407935 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-06-17
Onset:2021-06-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8735 / 2 RA / IM

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

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

Write-up: Patient received a monoclonal antibody treatment on 4/24/21, received the first dose of Pfizer on 5/21 and answered "no" to the question "have you had the monoclonal antibody treatment" so the shot was given. She returned today to get the second dose and then told us she had the treatment.


VAERS ID: 1407937 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-06-17
Onset:2021-06-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 1 LA / IM

Administered by: Military       Purchased by: ?
Symptoms: Hypoaesthesia oral, Nasal congestion, Paraesthesia oral, Pharyngeal hypoaesthesia, Pharyngeal paraesthesia
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Amitriptyline 10mg Tablet, Oral TAKE ONE TABLET BY MOUTH EVERY NIGHT #30 RF0 0 Active 10 Jun 2021 omeprazole, 20 MG, CAPSULE DR, ORAL TAKE ONE CAPSULE BY MOUTH EVERY DAY 30-60 MINUTES BEFORE BREAKFAST FOR REFLUX #30 RF0 0 Active 10 Jun 2021
Current Illness: No
Preexisting Conditions: Essential HTN Fibromyalgia Former smoker IBS
Allergies: Sulfa drugs
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient received the COVID-19 vaccine IM in her left arm at 1618. At 1638, she complained of tingling/numbness to her tongue and gums as well as her throat. She also developed marked nasal congestion. At 1644, that patient was administered an Epipen. By 1646, her nasal congestion resolved and there was no progression of her tingling/numbness however these both lasted until transfer to ED by 1645 for close observation/follow-on therapy. Patients vital signs remained appropriate for interventions.


VAERS ID: 1407956 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-17
Onset:2021-06-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Blood glucose normal, Chest discomfort, Diplopia, Dyspnoea, Electrocardiogram normal, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Ocular motility disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Pt reported taking no medication at time of vaccination.
Current Illness: Pt reports having an elevated Red blood cells - Was to f/u with PCP in the next week per pt report
Preexisting Conditions: Pt reports hx of anxiety
Allergies: Pt reports allergies to amoxicillin
Diagnostic Lab Data: Vitals, Blood Glucose - 91, EKG - WNL all completed on 06/17/2021
CDC Split Type:

Write-up: Pt. reports 15 minutes post vaccination experience double vision and tightness of the chest, causing it to be difficult to breath. This nurse was notified and vitals were 120/96, HR 110, O2 98. This nurse waited 5 minutes and took vitals again. They were - 120/88, HR 89, O2 99. After 15 additional minutes of patient resting on the cot, vitals were 118/20, HR81, and O2 99. Pt then began to be vomitous, experiencing increased chest tightness, and difficulty breathing. This nurse asked the pt if they would like to have EMS called and they obliged. Upon EMS arriving, pt vitals were stable and all tests done in the field came back WNL. Pt still wanted to be transferred to the nearest facility to be evaluated further. Pt. did state hx of elevated Red cell and was to follow up with PCP next week.


VAERS ID: 1407958 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-06-17
Onset:2021-06-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Nausea, Pallor
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE LISTED
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: NKDA
Diagnostic Lab Data: Vitals 1505 BP 110/70 P 78 02 SAT 95% ON RA RR 14 1520 BP 108/60 P 76 RR 12 O2 SAT 98 % RA
CDC Split Type:

Write-up: Patient became nauseated and pale after receiving her first vaccine. Patients vital signs were evaluated and patient was kept for an extra 15 minutes. Patients mom was advised that if her symptoms continued to either take her to her family doctor or an urgent care or call EMS if her symptoms became worse. As her symptoms did not completely go away prior to leaving.


VAERS ID: 1407959 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-17
Onset:2021-06-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017C21A / 2 UN / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Product storage error
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vaccine had been drawn at 12:45PM and picked up 6/16/2021. It was placed in a freezer at Nursing and Rehab center and given the morning of 6/17/2021
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was given vaccine that had been drawn up and brought to room temp. Drawn 12:45 6/16/21. It was taken by nurse to a nursing and rehab center to give to a client of theirs. It was placed in the freezer and given the next morning of 6/17/21


VAERS ID: 1407962 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-06-17
Onset:2021-06-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 2 LA / SYR

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

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

Write-up: Wrong shot administered. My vaccination card states Moderna was the first vaccine administered, but with little care, was administered Pfizer today for shot #2. This shot has little testing known on it if the same vaccine is administered, let alone mixed shots which is not advised by the CDC. And of course no one will give me anything concrete to make me feel as though I won''t receive an actual health event that hospitalized me due to this error. The the administering health employee says they frequently administer mixed shots to those who had a bad reaction the the first shot. This is not recommended by the cdc and I highly doubt that is the case. I am requiring a phone call back to my cell in the next 24 hours with concrete information to assist me in my next steps. . Please call me this is not something to mess with people life like what happened today by mixing vaccines which are untested and which don''t have approval.


VAERS ID: 1407968 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-17
Onset:2021-06-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fall, Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: pt gets dizzy or faint when he gets medication via IV
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient blacked out and fell on his side to the ground about 5-10 minutes after the shot. 911 was called but pt declined EMT or Emergency services. He said he felt better after we gave him some orange juice.


VAERS ID: 1407969 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-06-17
Onset:2021-06-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 054C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Flushing, Nausea
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypersensitivity (broad)

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

Write-up: Within 5-10 minutes of receiving vaccine, patient stated she was dizzy, nauseated, and felt flushed. She didn''t appear pale, sweaty, or flushed, but she said she had passed out once before when giving blood. I kept her for observation for about 35 minutes and had her lower her head between her knees. I offered her water or soda, but she declined. She did accept a peppermint and stated that it helped her nausea tremendously. She declined further medical help (e.g. EMS) and left with her boyfriend. She stated she felt better and wanted to go home. I told her to call me and give me a follow up.


VAERS ID: 1407975 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-17
Onset:2021-06-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Pharyngeal paraesthesia
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Pfizer/biontech
Other Medications: Not on medications, Benadryl provided and patient consented on taking ir
Current Illness: After First dose of Pfizer COVID-19 vaccine, he stated ?my whole body tingled, i didn?t tell nobody and left. I was fine.?
Preexisting Conditions: None.
Allergies: No allergies
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Tingling sensation of throat at 2:12pm. Monitored patient and he stated ?i feel fine this happened last time i got my first dose, but my whole body was tingling.? Continued to monitor and asked if he has health conditions or took medications/drugs etc, felt dizzy, felt his through closing up and he stated ?no.? Water provided, and continued to monitor, suggested to wait an extra 30 minutes for monitoring. After 10 minutes, he felt better. Benadryl provided at 2:24pm, educated patient about the therapeutic effects, and potential side effects of Benadryl. He consented to taking it. He waited until 2:45-2:50 pm and chose to leave because he felt better. Educated patient about the Pfizer information sheet and advised to call 911 or go to nearest hospital (ER) if the states severe effects occur.


VAERS ID: 1407979 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-06-17
Onset:2021-06-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dizziness, Headache, Immediate post-injection reaction
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypersensitivity (narrow)

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

Write-up: minutes after the vaccine patient states he felt light headed. Stated it had been a while since he had eaten. Given water and crackers. Took a sip and ate 2 crackers. Given ice pack for neck. O2Sat 99%, Pulse 70, RR 20, BP 145/104. State he is suppose to take medication for HTN but has not had them for a while. Continued to feel light headed. Placed in recovery position laying down. After laying him down he states his head was hurting. Talkative and alert. BP 160/120, Pulse 62. Respiratory Rate 16, O2sat 94%. At this time he stated he wanted to go to the hospital. EMS called and he was transported to Hospital.


VAERS ID: 1407982 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-06-17
Onset:2021-06-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Heart rate increased, Hyperhidrosis
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Vestibular disorders (broad), Hypoglycaemia (broad), Dehydration (broad)

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

Write-up: DIZZY , LIGHTHEADED, RACING PULSE , SWEATING,


VAERS ID: 1407989 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-17
Onset:2021-06-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dizziness, Dry throat, Oropharyngeal discomfort, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Vestibular disorders (broad), Hypersensitivity (broad), Dehydration (broad)

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

Write-up: Felt lightheaded, dizzy, throat slightly "closing" (2 on a scale of 1-10 of "throat closing") and dry/scratchy. 1430 VS 144/92, 99% RA, P90, RR22 Gave Benadryl 25mg at 2:40pm. 1441 VS 146/88, 97% RA, P88, RR22 PT states felt site originally felt "inflammation" on L side of throat and has now felt it on R side of throat, no longer feels on L 1450 PT reports throat feeling "going away" 1 out of 10. sitting up. feeling lightheaded but getting better 1455 VS 138/82, RR 20, 97% RA, P78 1504 VS 138/82, RR20, 98% RA, P 74 0 out of 10 sensation in throat, sat up, longer lightheaded, feeling better 1511 Went home w/ daughter, advised daughter to drive. Rest at home, seek medical attention if necessary.


VAERS ID: 1407997 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-06-16
Onset:2021-06-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 2 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Feeling hot, Hyperhidrosis, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypoglycaemia (broad)

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

Write-up: Vomiting, feeling warm and sweating


VAERS ID: 1408000 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-06-13
Onset:2021-06-17
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: C-reactive protein increased, Electrocardiogram abnormal, Myocarditis, Troponin I increased
SMQs:, Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Abnormal ECG, Troponin I 6700 ng/dl, CRP 3.4
CDC Split Type:

Write-up: Myocarditis


VAERS ID: 1408005 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-16
Onset:2021-06-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Back pain, Fatigue, Groin pain, Headache
SMQs:, Retroperitoneal fibrosis (broad), Osteonecrosis (broad), Arthritis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Zoloft, prenatal vitamin
Current Illness: None
Preexisting Conditions: Depression, thalassemia minor
Allergies: Nka
Diagnostic Lab Data: N/a
CDC Split Type:

Write-up: Feeling lower back pain, groin pain, joint pain, headache, fatigue morning after vaccination


VAERS ID: 1408019 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: Hawaii  
Vaccinated:2021-05-21
Onset:2021-06-17
   Days after vaccination:27
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0175 / 2 LA / IM

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

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

Write-up: Hives


VAERS ID: 1408028 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-17
Onset:2021-06-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 - / IM

Administered by: Public       Purchased by: ?
Symptoms: Cold sweat, Dizziness, Feeling cold, Flushing, Hyperhidrosis, Oropharyngeal discomfort, Rash, Tunnel vision
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Optic nerve disorders (broad), Retinal disorders (narrow), Vestibular disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Client received the Janssen COVID vaccine lot #205A21A and expiration date 6/23/21 at approximately 3:01PM. Client arrives to the vaccine observation room and within 10 minutes reports feeling lightheaded and having tunnel vision to EMTs. EMT takes vitals: blood pressure 170/92, heart rate 80 and oxygen sat: 94%. PHNs arrive to assess client. Client is upright in chair alert and oriented x 4. Client denies any shortness of breath. PHNs observe sweating and rashes on left and right arms. Client reports his oxygen is normal for him since he has COPD. Client reports having a history of severe anaphylaxis allergy to penicillin, client reports taking morphine, lexapro, tizanidine, lyrica, and remeron. At 1:15pm client reports feeling "clammy and cold". Clients face is flushed and rash is spreading to neck, upper chest, lower left leg. PHN offers client Benadryl and he accepts. PHN starts calling 911 at 1315. PHN administered 50 mg of IM Benadryl at 1:17pm. At 1:17pm, vitals by EMT: heart rate:88 and oxygen: 94%. Client reports he "feels something in his throat" at 1:18PM. At 1:20pm client reports feeling in his throat is improving. At 1:20pm paramedics arrive and assume care. Client left facility wheeled out on a gurney at 1:27pm. Client will get transported to hospital. PHN alert security that a car left here overnight might belong to client being transported.


VAERS ID: 1408030 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-06-17
Onset:2021-06-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 049C21A / 1 RA / IM

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

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

Write-up: patient got extremely dizzy immediately after administration, I had him place his head between his legs and he fainted. I then applied a cool compress to the back of his neck and called his name and he responded almost immediately. I gave him a bottle of water and sat with him for 15 minutes at which time he stated that he was feeling much better. I then had him remain in the post-vaccination area for an additional 15 minutes for observation. He was feeling well when he left the pharmacy


VAERS ID: 1408031 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-06-17
Onset:2021-06-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Immediate post-injection reaction, Pain, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Hypersensitivity (narrow)

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

Write-up: immediately post vaccination pt arm felt tingly she said. 15 mins later it radiated to her lower arm. pt waited additional time and pt wanted to leave. bp is 113/80 pulse rate 91


VAERS ID: 1408039 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-06-16
Onset:2021-06-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal lymphadenopathy, Chills, Fatigue, Injection site erythema, Injection site inflammation, Injection site pain, Injection site urticaria, Injection site warmth, Lymphadenopathy, Migraine, Pain, Sinus congestion
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Large painful red welt on injection sight appeared around 10 am the next day. Around 11 pm after recieveing the injection at 4:30 pm I became very fatigued more so than normal. My arm started hurting around 6pm progressively getting more painful and inflammed. Around 2 am i starting having chills and shakes, migrane, as well as body aches and progressively got worse around 11 am the following morning the shakes stopped i woke up with congested sinuses and a migrane as well as enlarged lymph nodes in my underarms and under my chin and jaw. I had extreme fatigue all day following. Currently at 7pm the injection site is red, hot to touch, raised in a circle around the size of a half dollar, it also is very painful to move my arm and very painful to touch.


VAERS ID: 1408192 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-06-17
Onset:2021-06-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 054C21A / 2 LA / IM

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

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

Write-up: after leaving pharmacy area , patient became very light headed but did not fall. was able to get on floor. patient called family doctor .. i spoke to patient later in the day. he was feeling fine, believes it happened due to sever fear on injections and watched girlfriend get hers


VAERS ID: 1408194 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-06-17
Onset:2021-06-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 2 LA / IM

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

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

Write-up: Patient received 1st dose June 3, 2021 and then came in June 17, 2021 to receive 2nd dose however it was too early to get second dose


VAERS ID: 1408196 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-05-27
Onset:2021-06-17
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821288 / 1 LA / IM

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

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

Write-up: swollen lymphnode on left clavical


VAERS ID: 1408198 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-17
Onset:2021-06-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Aphonia, Dyspnoea, Immediate post-injection reaction
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: albuterol inh, asa 81 mg
Current Illness:
Preexisting Conditions: asthma
Allergies: sulfa, shingles vaccine
Diagnostic Lab Data:
CDC Split Type:

Write-up: sob, loss of voice immediately after vaccination. used her own albuterol inh. felt better within 5-10 minutes. no difficulty breathing, tongue swelling, chest pain, headache. bp 130/84, hr 86, O2sat 99


VAERS ID: 1408199 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-06-17
Onset:2021-06-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 2 RA / IM

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

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

Write-up: Mother brought patient in for second dose of pfizer but received the dose too early. 1st dose was 06/03/21 so their second dose should have been 06/24/21


VAERS ID: 1408209 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-06-17
Onset:2021-06-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fall, Feeling hot, Hyperhidrosis, Hypotension, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: After the incident, the staff was informed he has fainted from vaccines in the past. No details on which vaccines or when
Other Medications: none listed
Current Illness: none listed
Preexisting Conditions: none listed
Allergies: none
Diagnostic Lab Data: Blood pressure and other tests measured by paramedics. Possible other tests at the hospital.
CDC Split Type:

Write-up: Patient was administered the COVID19 vaccine and 5 minutes later, while in the observation chair, fainted and fell to the ground. His mother was present with him and the pharmacy staff rushed over to help. He came to after a minute or 2, but the paramedics were called immediately. Patient was a sweaty, hot. Paramedics arrived, did some test and said his blood pressure was low. They proceeded to take him to the hospital. Mom called around 3pm 6/17 and informed the pharmacy staff he was administered fluid, they ran more tests and he was waiting to be released.


VAERS ID: 1408212 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-06-17
Onset:2021-06-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood glucose abnormal, Feeling cold, Hypotension, Malaise, Nausea, Syncope, Tremor
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

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

Write-up: Patient complained of not feeling well after being administered with pfizer vaccine, she said she was cold, a little shaky, & nauseous. Checked her BP it was very low, elevated her feet, checked her BP several times after that and BP went up to 120/78. Called 911 because she was still not feeling well. EMS checked glucose level and it was low (patient did not have a meal all day). EMS said it was vasovagal syncope however patient did not pass out. Patient recovered while EMS was still on site.


VAERS ID: 1408215 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-17
Onset:2021-06-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Product preparation error
SMQs:, Medication errors (narrow)

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

Write-up: Pt. was administered undiluted vaccine as his 2nd covid dose


VAERS ID: 1408223 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-17
Onset:2021-06-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 1 OT / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Anxiety, Panic attack
SMQs:, Hypoglycaemia (broad)

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

Write-up: anxiety and panic attack. Evaluated by EMS-Cleared


VAERS ID: 1408224 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-06-01
Onset:2021-06-17
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8730 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dysgeusia, Fatigue, Headache
SMQs:, Taste and smell disorders (narrow)

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

Write-up: Developed headache 6/16/21 Developed metallic taste in mouth 6/17 Developed exhaustion 6/17 Vaccinated 6/15/21


VAERS ID: 1408225 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-06-01
Onset:2021-06-17
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anxiety, Dizziness, Vision blurred
SMQs:, Anticholinergic syndrome (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

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

Write-up: The patient felt dizzy and had blurry vision about 5 minutes after the vaccine administration. I talked to the patient and mother who reported a history of anxiety that may be contributing. They asked if he could lay down in the vaccine room and upon entering he lost his balance and fell to his knees but did not get injured or lose consciousness. The patient said he was not hurt but I called 911. they arrived about 15 minutes later and evaluated the patient. The patient revealed he had ran 2 miles earlier that day and had nothing to eat or drink besides a Yoo-hoo all day. The EMTs said he was very dehydrated. The patient felt fine after another 10 minutes and the mother declined medical transport.


VAERS ID: 1408231 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-06-17
Onset:2021-06-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026D21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Hyperhidrosis, Pallor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Not sure of which vaccines, patient''s wife said that this happens often after a shot and after he has blood drawn.
Other Medications:
Current Illness:
Preexisting Conditions: High cholesterol, takes blood pressure medications, has had a bypass procedure, has had a stroke in the past.
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: After receiving his second dose of vaccine, patient walked and sat down in the waiting area to be monitored and soon started feeling light headed. I approached him and he was losing consciousness and starting turning pale. He was also profusely sweating. I called 911 and EMS soon arrived and took his vitals. His wife gave EMS his history and told them this happens when he has blood drawn. This did not happen after his first dose of Moderna vaccine. He was lying down on his side. EMS took an EKG and said his heart looked good. His blood pressure was 120/90. After 10 minutes patient said he was feeling fine and did not want to go to the hospital. He answered all of EMS''s questions correctly such as "Where are you?" "What year is it?" "Who is the president?" " How many quarters are in a dollar?" Patient went home with his wife and said he will follow up with his doctor. I will call him tomorrow on 6-18-21 to see how he is doing.


VAERS ID: 1408237 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-17
Onset:2021-06-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Body temperature decreased, Dizziness, Hyperhidrosis, Pallor, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: n/a
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: No known allergy to medications. Mom reported that patient had allergy to peanuts.
Diagnostic Lab Data: Temperature at 94.6''F
CDC Split Type:

Write-up: Patient was siting at the waiting area after about 10 minutes receiving first Covid19 Pfizer shot. Mom reported to pharmacist staff that patient turned pale and felt dizzy. Pharmacist suggested patient to drink water and continued to rest while pharmacist monitored patient. Pharmacist tried to take patient''s blood pressure but pharmacy didn''t have the right cuff so she was unable to obtain patient''s blood pressure. Patient then was sweating and mom continued to give her water while pharmacist checked patient''s temperature (recorded 94.6''F). Few minutes later, patient vomited. Mom gave patient water after she was done vomiting. Patient reported she felt better afterwards. Patient was monitored for about 15 minutes and she was able to walk herself and left the pharmacy waiting area with mother. Pharmacist suggested mother to call doctor for follow up advice.


VAERS ID: 1408241 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-06-09
Onset:2021-06-17
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009D21A / 2 LA / IM

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

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

Write-up: Pt did not show for second appt and upon contacting him- his family indicated that he got it last week. Dose 1 was 5/20/21- he got dose 2 on 6/9/21-- closer than the 28 day schedule. ( No known ADR beyond dosing at lesser interval)


VAERS ID: 1408242 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-17
Onset:2021-06-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026D21A / 2 LA / IM

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

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

Write-up: PATIENT WAS GIVEN A DOSE THAT WAS PAST OVER EXCURSION PERIOD OF TIME THAT VACCINE IS VIABLE IN PERIOD OF 12 HOURS AFTER 1ST PUNCTURED. THE VIAL THAT THE DOSE WITHDRAWN WAS 1ST PUNCTURED AT 6/16/2021 09:30 AM. VACCINED IS 26 HOURS OF EXCURSION TABLE WHEN VACCINE WAS GIVEN.


VAERS ID: 1408247 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-06-17
Onset:2021-06-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8727 / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dyspnoea, Headache, Moaning, Presyncope
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: Patient was taken to Hospital for further observation.
CDC Split Type:

Write-up: At around 9:25 am on Thursday, June 17th, 2021, a seventeen-year-old Foreign-speaking patient walked into the vaccination site. She was accompanied by two guardians, along with 14 other minors. The minors came in for their 2nd shot of Pfizer Covid-19 vaccines. Patient signed all necessary consent forms and pre-vaccination checklist requirements with guardian and entered the vaccination section at around 9:30 am. The Pfizer vaccine was administered at 9:37 am. Observation nurse reported that around 10:04 am the patient complained about having a severe headache. The observation nurse notified charge nurse that she needs assistance. The charge nurse immediately obtained a pulse oximetry reading of 99% and a pulse of 88. The charge nurse assessed if the patient is experiencing any symptoms of hives or redness, shortness of breath, or any difficulty breathing or swallowing. The patient stated to the observation nurse that she was having difficulty breathing. At 10:06 am the charge nurse called 911. While the charge nurse was standing and speaking with the 911 operator, the patient started to faint and laid her head on charge nurse''s stomach while she was sitting. The patient looked like she was sleeping and making some whimpering sounds for about 2 minutes. At the same time, these events were taking place, observation nurse reported that another 17-year-old minor started complaining of a severe headache and ?seeing stars?. First responder paramedics came on the scene at around 10:09 am and took over care of the patient. At that point charge nurse attended to another patient, 17-year-old minor. Patient was also exhibiting a reaction to the Pfizer Covid-19 vaccine. First responder paramedics left with patient at around 10:15 am and she was taken to hospital for further observation.


VAERS ID: 1408249 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-06-17
Onset:2021-06-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Fall, Muscle rigidity, Muscle twitching, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Not known
Current Illness: None known
Preexisting Conditions: None disclosed by patient
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Technician (licensed to vaccinate) administered vaccine to patient near pharmacist. 20 seconds or so after administration, patient stated felt dizzy and immediately became unresponsive and head dropped to chest. Technician stated he then lifted the patients head because he heard a "snoring" sound indicating airway may be constricted due to positioning. Technician stated the patient''s body twitched and became ridged, throwing her belongings. He called pharmacist (myself) for assistance. I immediately checked for breathing and pulse, both of which were evident. I observed pt vitals for about 20 seconds before the pt opened her eyes and was responsive and able to talk to me. Blood pressure was 120/69. Pt remained in the pharmacy waiting area for 30 minutes after. Patient said that in the past she has nearly passed out from piercings she has had, but has never fainted before and has no history of seizures.


VAERS ID: 1408251 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-17
Onset:2021-06-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026D21A / 2 LA / IM

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

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

Write-up: VACCINE THAT WAS GIVEN TO PATIENT IS PASS OUT OF EXCURSION TIME TABLE OF VIABILITY. DOSE THAT WAS GIVEN IS WITHDRAWN FROM A VIAL THAT WAS 1ST PUNCTURED ON 06/16/2021 9:30 AM. VACCINE WAS GIVEN 26HOURS OUT EXCURSION TIME TABLE.


VAERS ID: 1408407 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Hawaii  
Vaccinated:2021-06-17
Onset:2021-06-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

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

Write-up: Swelling of tongue (subjective)


VAERS ID: 1408409 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-17
Onset:2021-06-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Syringe issue
SMQs:, Medication errors (broad)

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

Write-up: When receiving the vaccination some of the vaccine leaked out from the base of the syringe.


VAERS ID: 1408410 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-06-17
Onset:2021-06-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821287 / N/A LA / IM

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

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

Write-up: Patient received Janssen vaccine and passed out/threw up after receiving vaccine. She told us ahead of time that she occasionally passes out with blood draws, but never had any issue after a vaccine. About 3-5 minutes after the vaccine, the patient turned very pale and passed out in her chair. She did not fall on the floor but slumped to the side as we held her in place. After she came to she threw up. We had called 911 because it took her a while to wake up. EMS arrived and she was already feeling much better. They took her blood pressure and cleared her. Patient waited another 30 minutes after they left to make sure she was still feeling okay.


VAERS ID: 1408411 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-17
Onset:2021-06-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 1 RA / IM

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

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

Write-up: Less than 50% of the vaccine dose was administered and a full dose was immediately given in the opposite arm according to CDC Medication Error and Deviation Guidelines.


VAERS ID: 1408415 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-17
Onset:2021-06-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 021C21A / UNK - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: NONE
Diagnostic Lab Data: THERE WERE NO ADVERSE EVENTS NOTED.
CDC Split Type:

Write-up: THE PATIENT WAS GIVEN A PFIZER AS A 2ND DOSE WHEN 1ST DOSE WAS MODERNA. SHE WAS OBSERVED FOR 15 MINUTES AND THERE WERE NO ADVERSE EVENTS NOTED. THE MISTAKE WAS NOTICED WHEN THE PATIENT WAS CHECKING OUT.


VAERS ID: 1408420 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-06-17
Onset:2021-06-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009D21A / 1 LA / IM

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

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

Write-up: Vaccine was administered to patient. He had a history of fear of needles, fainting, etc. Approximately 5 minutes after administration, patient did faint with possible seizure activity. Paramedics were called. No further adverse events were observed. Patient was conversational and walked out on his own power.


VAERS ID: 1408422 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-06-17
Onset:2021-06-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8727 / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Chest pain, Confusional state, Disorientation, Dizziness, Dyspnoea, Headache, Loss of consciousness, Malaise, Unresponsive to stimuli, Visual impairment
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (narrow), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Glaucoma (broad), Optic nerve disorders (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: Patient was taken by first responder paramedics to hospital for further evaluation
CDC Split Type:

Write-up: At around 9:25 am on Thursday, June 17th, 2021, seventeen-year-old patient walked into the vaccination site. She was accompanied by two guardians, along with 14 other minors. The minors came in for their 2nd shot of Pfizer Covid-19 vaccines. Patient signed all necessary consent forms and pre-vaccination checklist requirements with guardian and entered the vaccination section at around 9:35 am. The Pfizer vaccine was administered at 9:39 am. Observation nurse reported that around 10:06 am the patient complained about having a severe headache, ?seeing stars?, feeling very dizzy, and not feeling well. Nurse assisted patient to lay down on the mat in case the patient may faint. Charge nurse obtained a pulse oximetry reading of 95% and a pulse of 96. Charge nurse checked if the patient experienced any symptoms of hives/redness, shortness of breath, or any difficulty breathing or swallowing. The patient complained to observation nurse that she was having a hard time breathing, severe headache, and chest pain. Observation nurse instructed patient to be calm and to relax. Charge nurse instructed the patient to take deep slow breaths to help increase O2 levels but the patient complained to the observation nurse that she cannot breathe through her nose. At 10:15 am charge nurse continuously monitored the patient?s B/P, pulse, and O2 level readings. The BP reading was 117/64 with a pulse of 78 and an O2 level of 100%. At approximately 10:16 am, patient started showing signs of change in LOC and lost consciousness for a few seconds. First responder paramedics from the first minor incident were still at the scene waiting for the 2nd ambulance to arrive. The first responder paramedic did a sternum rub using his knuckles with a closed fist to the center of the patient?s chest and immediately after the patient gasped for air and regained consciousness. The patient remained in a sitting position on the floor to be able to breathe easier. At approximately, 10:18 am charge nurse took another BP reading of 121/76, a pulse of 96, and O2 level of 99%. At approximately 10:20 am, patient started exhibiting a change in LOC and was very disoriented again. Observation nurse kept calling the patient?s name but did not get a response. This lasted for around 30 seconds while the patient gasped for air before becoming responsive again. At this time observation nurse observed that patient could not recall her name and did not know how she got there. At approximately 10:22 am, charge nurse took another BP reading of 165/133, a pulse of 122, and an O2 level of 96%. At around 10:24 am, the charge nurse took another BP reading of 112/78 and pulse of 112 with an O2 level of 96%. The second ambulance arrived at approximately 10:26 am and took over. The second ambulance?s first responder paramedics left with patient at approx. 10:29 am and took her to hospital for further observation.


VAERS ID: 1408427 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-06-17
Onset:2021-06-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 RA / IM

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

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

Write-up: Pt passed out 5 minutes after shot


VAERS ID: 1408428 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: New York  
Vaccinated:2021-06-17
Onset:2021-06-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Erythema, Oral pruritus, Pruritus, Rash macular
SMQs:, Anaphylactic reaction (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: About 20 minutes after patient received the vaccine her face appeared red and blotchy. Patient stated itching all over her body and itching in the mouth. Patient was advised to go to emergency department (ED) at Hospital, 1.5 blocks away from the store. Pharmacy staff contacted patient about a half hour later and patient stated that she was in the ED being checked out.


VAERS ID: 1408439 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-17
Onset:2021-06-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: none known
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: bp 144/92 57
CDC Split Type:

Write-up: Patient felt faint, said this happens to him when he gives blood and layed down on the floor. I asked him to put his knees up. after about five minutes he said he felt better and sat up in a chair but I looked at him and noted that he was sweating. He felt dizzy again and layed down a second time. I took his blood pressure at 3:40pm it was 144/92 57. I gave him some water. He said he felt better and left with his two friends at about 4:45pm


VAERS ID: 1408441 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-17
Onset:2021-06-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011D21A / 2 LA / IM

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

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

Write-up: Patient received her second dose of her Covid shot (Moderna). After vaccination, patient stated that she felt very anxious, light-headed and had a headache. Tried to get up and stated that she almost fell and began crying. Counseled the patient on potential effects of the vaccine and offered to call emergency services, which she declined. She stated that she would have someone else pick her up since she felt like she couldn''t drive and felt dizzy. Patient tolerated 1st vaccine and no allergic reaction present. Patient left under her own power from the pharmacy for her ride. Sent message to prescriber as well regarding patient and incident.


VAERS ID: 1408443 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-17
Onset:2021-06-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA MODERNA / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anxiety, Asthenia
SMQs:, Guillain-Barre syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Patient felt weak and anxious as the vaccine was given, asked to lay down, and we helped her onto a mat, gave a bottle of water and in 5 minutes patient was back in chair, waited 30 minutes, felt ok and left


VAERS ID: 1408445 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: Louisiana  
Vaccinated:2021-06-17
Onset:2021-06-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 2 LA / IM

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

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

Write-up: Patient was administered a higher concentration dose of Pfizer due to improper preparation. The vaccine vial was prepared with 1.4mL of normal saline instead of 1.8mL. Patient was informed and pharmacist contacted Pfizer for more information on monitoring the patient. Patient later reported a headache, which is unsurely related to the higher concentration dose than approved.


VAERS ID: 1408447 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-06-17
Onset:2021-06-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 2 LA / IM

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

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

Write-up: Patient had fainted roughly 2-5 minutes after vaccination. Patient had been told to wait for 15 minutes after vaccination but was thirsty and went to her car to grab some water. When outside, patient felt dizzy and fainted, falling and hurting her head and leg. Ambulance was called but patient refused any care and wanted to go home. We had the patient call a friend/family to pick her up. When asked, patient reported not having eaten today and vaccination was given approximately at 2:30 pm.


VAERS ID: 1408647 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-06-17
Onset:2021-06-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8727 / 2 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Headache, Hyperventilation, Increased bronchial secretion, Loss of consciousness, Respiratory rate increased, Syncope, Unresponsive to stimuli, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Asthma/bronchospasm (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: Patient was taken by first responder paramedic to hospital for further evaluation.
CDC Split Type:

Write-up: At around 9:25 am on Thursday, June 17th, 2021, a fifteen-year-old patient walked into the vaccination site. She was accompanied by two guardians, along with 14 other minors. The minors came in for their 2nd shot of Pfizer Covid-19 vaccines. Patient signed all necessary consent forms and pre-vaccination checklist requirements with guardian and entered the vaccination section at approx. 9:38 am. The Pfizer vaccine was administered at 9:45 am. Patient was one of the first minor patients of the group that complained of a severe headache to observation nurse. Observation nurse gave Gatorade to the patient and she took a sip of Gatorade and was calm afterward. One of the patient?s guardians instructed her to head back to the van with the rest of the group. At approximately 10:33 am observation nurse notified charge nurse that another minor patient was having a reaction to the vaccine in the parking lot area. One of our site specialists was the first to attend to patient. Site specialist stated that she saw the patient walking with one of her guardians in the parking lot and looked like she was about to faint. Charge nurse hooked up patient to the pulse oximetry and called 911 at approx. 10:34 am. The patient?s O2 level was 83 with a pulse of 107. The charge nurse observed that the patient was under a lot of stress and was hyperventilating and unable to verbalize how she was feeling. Shortly after, the patient fainted due to hyperventilation. Observation nurse advised the patient to calm down and take deep breaths but the patient did not comply and continued rapid breathing. The patient started to vomit and made some gurgling sounds in her mouth and the charge nurse with the help of site specialist laid the patient on her left side. Shortly after, the patient stopped breathing. Observation nurse administered the epi-pen on the patient?s right thigh. Immediately after administering the epi-pen, patient started to breathe again with an O2 level of 98 with a pulse of 110; but the patient was still unconscious and unresponsive. At approx. 10:36 am first responder paramedics arrived at the scene and took the patient to hospital for further evaluation.


VAERS ID: 1408648 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-17
Onset:2021-06-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 008C21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood glucose increased, Dizziness
SMQs:, Hyperglycaemia/new onset diabetes mellitus (narrow), Anticholinergic syndrome (broad), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: busPIRone (BUSPAR) 5 mg Oral Tab Take 1 tablet by mouth 2 times a day ARIPiprazole (ABILIFY) 20 mg Oral Tab Take 1 tablet by mouth daily Insulin Regular hum U-500 conc (HUMULIN R U-500, CONC, KWIKPEN) 500 unit/mL (3 mL) SubQ Insulin Pen I
Current Illness: diabetes, history of falls
Preexisting Conditions: ESSENTIAL HTN DM 2 W DYSLIPIDEMIA DM 2 W POLYNEUROPATHY DM 2 W PERIPHERAL NEUROPATHY ADULT OBSTRUCTIVE SLEEP APNEA DM 2 W HYPERGLYCEMIA Other SCHIZOAFFECTIVE DISORDER, UNSPECIFIED TYPE UMBILICAL HERNIA HX OF SMOKING VENTRICULAR TACHYCARDIA MODERATE ALCOHOL USE DISORDER, IN SUSTAINED REMISSION GERD (GASTROESOPHAGEAL REFLUX DISEASE) LEFT HEARING LOSS INSOMNIA HX OF SEXUAL ABUSE IN CHILDHOOD ATYPICAL CHEST PAIN POSTNASAL DRIP OBESITY, BMI 35-39.9, ADULT VITAMIN D DEFICIENCY MILD METHAMPHETAMINE USE DISORDER, IN SUSTAINED REMISSION HX OF DIABETIC FOOT ULCER SCREENING FOR DIABETIC FOOT DISEASE, CATEGORY 3 - FOOT AT HIGH RISK ONYCHOMYCOSIS CAD W UNSPECIFIED TYPE ANGINA
Allergies: Risperdone
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient is a 56 year old male who has completed a 15 minute observation period with the following signs and symptoms of an adverse reaction: dizzyness . #1 in series administered. Vitals: 06/17/21 1714 06/17/21 1725 06/17/21 1745 06/17/21 1809 BP: 115/77 117/78 128/78 111/75 Pulse: 79 88 90 75 Resp: 15 18 15 18 SpO2: 96% 96% 96% 97% Action(s) taken: monitored for 45min. No improvement. refused to go to ED or urgent care. Still feels dizzy, advised to go to ED. Patient agreed.Called paramedics. Blood sugar checked,445. Sent to ED Patient advised to discuss second dose considerations with a clinician and have a driver for 2nd dose appt


VAERS ID: 1408650 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-06-17
Onset:2021-06-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036C21A / 1 RA / IM

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

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

Write-up: PATIENT IS UNDERAGE. LOOKED UP RECOMMENDATION ON CDC WEBSITE. PATIENT STILL ADVISED TO GET 2ND DOSE OF MODERNA.


VAERS ID: 1408663 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-06-17
Onset:2021-06-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 2 LA / IM

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

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

Write-up: Pt received Moderna for first dose but received Pfizer for second dose. Pt forgot his Immunization Card and said he needed Pfizer. We later found out he originally received Moderna.


VAERS ID: 1408669 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-06-17
Onset:2021-06-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Loss of consciousness, Seizure like phenomena
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

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

Write-up: Pt passed out and appeared to seize. Pt was no aware of person place or time. 911 was called and paramedics took to the ER to evaluate


VAERS ID: 1408859 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Nevada  
Vaccinated:2021-06-17
Onset:2021-06-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NOT KNOWN
Current Illness: NOT KNOWN
Preexisting Conditions: NOT KNOWN
Allergies: NONE
Diagnostic Lab Data:
CDC Split Type:

Write-up: AFTER PATIENT RECEIVED THE JANSSEN VACCINE, PATIENT WENT TO GO SIT DOWN FOR 15 MINUTES. ABOUT 1 MINUTE LATER, PATIENT FELT DIZZY, BLACKED OUT AND FELL ONTO THE GROUND FROM THE CHAIR. PATIENTS BROTHER WAS WITH HIM AT THE TIME AND PATIENT REGAINED CONSCIOUSNESS A FEW SECONDS LATER. PATIENT WAS SWEATING AND FELT WARM TO THE TOUCH. WE HELPED HIM BACK TO THE CHAIR AND I ASKED SEVERAL TIMES IF I CAN CALL EMS FOR HIM, PATIENT REFUSED MULTIPLE TIMES AND STATED HE FEELS A LOT BETTER AND WILL HAVE HIS GIRLFRIEND DRIVE HIM HOME. I HAD PATIENT SIT DOWN FOR ANOTHER 20 MINUTES BEFORE LETTING HIM GO HOME. I ADVISED PATIENT IF HE FEELS ANY SYMPTOMS AT ALL, WHILE AT HOME, TO CALL EMS IMMEDIATELY. PATIENT AND HIS BROTHER UNDERSTOOD AND THEY LEFT.


VAERS ID: 1408863 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-17
Onset:2021-06-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 1 - / IM

Administered by: Public       Purchased by: ?
Symptoms: Chills, Feeling hot, Flushing, Pruritus
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: claritin, unable to recall name for hypertension pill
Current Illness:
Preexisting Conditions: hypertension
Allergies: penicillin, bees
Diagnostic Lab Data:
CDC Split Type:

Write-up: At 1635 client approached EMTs to let them know she was feeling chills and warmth. EMT gave client water and snack. PHN joined at 1640. Upon arrival client sitting upright in chair, alert and oriented x4. Client reported history of hypertension, current medications estrogen and "one pill for hypertension" and severe allergy to penicillin. PHN observed client''s face flushing. Client reported feeling itchy on face. Client denied shortness of breath, throat closing. PHN offered client Bendaryl, client advised on Benadryl causing drowsiness. Client declined due to not having anyone to pick her up. PHN offered client paramedics and client declined. Vitals at 1647 by EMT: blood pressure 132/88, pulse 79, oxygen sat 100%. Client reported itchiness spreading to chest and left arm. Vitals at 1654: blood pressure 136/90, pulse 80, oxygen sat 100%. PHN offered client Benadryl again and client accepted. PHN administered 50mg Benadryl orally at 1657. Vitals at 1701: blood pressure 136/88, pulse 78, oxygen sat 100%. Client reported chills has resolved. Itchiness of face and left arm the same. Vitals at 1707: blood pressure 140/90, pulse 78, oxygen sat 100%. Per client itchiness still present but improving. Vitals at 1713: blood pressure 142/90, pulse 83, oxygen sat 100%. Per client some itchiness still in face and at site of vaccination in left arm. Flushing of face improving. Vitals at 1717: blood pressure 140/90, pulse 79, oxygen sat 100%. Client reported feeling "better". PHN advised client to follow up with provider and gave ER precautions. Last vitals at 1723: blood pressure 138/86, pulse 73, oxygen sat 100%. Per client feeling "fine to drive" and that she lives less than 10 mins away. PHN discussed with client if someone could pick her up, taxi, or Uber due to drowsiness. Client left facility against medical advise regarding driving at 1724 with steady gait.


VAERS ID: 1408864 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: New York  
Vaccinated:2021-06-17
Onset:2021-06-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, Anaphylactic reaction, Chest pain, Dyspnoea, Wheezing
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (broad), Asthma/bronchospasm (broad), Retroperitoneal fibrosis (broad), Anaphylactic/anaphylactoid shock conditions (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow)

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

Write-up: chest pain, shortness of breath, wheezing, abdominal pain, anaphylaxis


VAERS ID: 1408867 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-06-16
Onset:2021-06-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Breast discharge, Breast pain, Exposure during pregnancy, Rash, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Lipodystrophy (broad), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: I am 30 weeks pregnant and got the covid shot and the next day i woke up with a rash all over my neck arms on the inside and on my belly and on the side of my. Belly and a rash on my vagina and swellimg and my left boob hurting and leaking


VAERS ID: 1408979 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-17
Onset:2021-06-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 2 LA / IM

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

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

Write-up: HPI: 14-year-old female 1 minute post-vaccination developed 1 syncopal episode, lasting 5 seconds. Patient was caught by her father prior to falling off her seat and regained consciousness. She was able to verbally communicate and respond to commands. No falls or head trauma witnessed. Patient reported a similar episode with her first dose of Pfizer; she was seen at her PCP the following day and was told she could get her second dose. Patient denied shortness of breath, pruritus, difficulty breathing, fatigue, diaphoresis, tongue or lip swelling. Patient was fully assessed by medical staff and given PO fluids and cold compress. She was monitored for 30 minutes with no further progression of symptoms. Upon leaving the patient reported a full recovery of any adverse symptoms and was driven home by her father. Patient and parent were educated to call for EMS if symptoms returned and to follow-up with her PCP. Physical Assessment: BP: 96/60 mmHg left arm, sitting position HR: 79 bpm RR: 18 breaths per minute SpO2: 97% RA Constitutional: No acute distress. Non-diaphoretic. Lungs: Clear to auscultation bilaterally. Heart: Regular rate & rhythm. No murmurs, rubs, or gallops. Neurology: A&O x3. Normal speech and gait. Skin: Warm and dry.


VAERS ID: 1408981 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: New York  
Vaccinated:2021-05-26
Onset:2021-06-17
   Days after vaccination:22
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Chills, Injection site pain, Pain, Somnolence
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Hypoglycaemia (broad)

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

Write-up: Drowsiness lasting periodically for 2 days, soreness around the injection site, body aches lasting 30 minutes, chills lasts periodically for over 3 hours


VAERS ID: 1409981 (history)  
Form: Version 1.0  
Age:   
Sex: Unknown  
Location: Texas  
Vaccinated:2021-06-17
Onset:2021-06-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / UNK AR / IM

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

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

Write-up: After administrating vaccine in the immunization room, patient proceed to waiting room. Patient stood up to walk toward the door and suddenly fainted. (hit his head on the door before falling to the ground.)


VAERS ID: 1408988 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-17
Onset:2021-06-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Hypoaesthesia, Lip discolouration, Loss of consciousness, Pallor
SMQs:, Torsade de pointes/QT prolongation (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: not available
Current Illness:
Preexisting Conditions: Basilar Invagination
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: About 3 minutes after receving the vaccine patient was losing consciousness. Patient looked very pale and lips were turning blue/purple. We laid the patient flat on the ground and gave him some space and called 911 right away. Paramedics arrived within 5-10 minutes and by the time they came patient regained consciousness but was telling them he was feeling very weak and numb.


VAERS ID: 1408996 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-17
Onset:2021-06-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0171 / 2 LA / IM

Administered by: School       Purchased by: ?
Symptoms: Anxiety, Chest discomfort, Dizziness, Immediate post-injection reaction, Nervousness
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Hypoglycaemia (broad)

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

Write-up: 1625: Received vaccine. 1626: Pt slumped over in chair and was laid down by myself left lateral. Pt denies loss on consciousness. Moved pt to back area for observation with EMT. 1628: Pt states that she felt lightheaded and nervous but is breathing unlabored without distress. Pt denied previous reaction to the first dose when he received it in the car. Pt''s dad stated that she has no prior medical hx. Pt initial VS: BP 108/64, HR 84, SpO2 99%, RR 14. Pt repeat VS was 80/46 pt stated that she was feeling light headed again and that she had some chest tightness. Pt appeared anxious. SpO2 98% HR 64. Pt stated that she was feeling the same way as before she got dizzy the 1st time. Pt was laid on the floor and pt stated that she felt better. pt repeat BP 98/58, HR 78, and SpO2 was still 99%. Pt laid on the floor for approximately 5 minutes and given water and snack. Pt sat up slowly and stated that her chest felt better and ate snack. Pt was kept for approximately 10 more minutes under monitoring. Pt in total was monitored for 34 minutes. Pt was released with father. pt stated that she felt like she was back to normal again. Pt last set of vitals were: BP 116/58 HR 78 SpO2 99. Pt was released to her father.


VAERS ID: 1409509 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-06-10
Onset:2021-06-17
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-06-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

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

Write-up: Itchy, painfully, swollen and hard patch at injection site Started on the night of June 16th


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