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From the 9/10/2021 release of VAERS data:

Found 686,636 cases where Vaccine is COVID19 and Patient Did Not Die



Case Details (Reverse Sorted by Onset Date)

This is page 101 out of 6,867

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VAERS ID: 1681893 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-08-20
Onset:2021-08-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH KC3182 / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Fatigue, Feeling abnormal, Pain, Rhinorrhoea
SMQs:, Dementia (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: USPFIZER INC202101091867

Write-up: I never had this intense Runny nose in my whole life; that is not the common side effect of the vaccine and I feel so bad; it may be I have Covid; I feel so bad after my 2nd shot; Fatigue; Pain and body ache; This is a spontaneous report from a contactable consumer (patient). A patient of an unspecified age and gender received bnt162b2 (BNT162B2, Formulation: solution for injection, Lot/Batch No: KC3182, expiry date not provided), via an unknown route of administration, administered on 20Aug2021 12:00, as DOSE 2, SINGLE for covid-19 immunisation. The patient medical history and concomitant medications were not reported. Historical vaccine included BNT162B2, Dose 1 for covid-19 immunisation. On 20Aug2021 after the second shot of the vaccine beginning at night, the patient experienced like a common side effect of fatigue, pain/body ache. After 24 hours of second shot on 21Aug2021, the patient experienced intense runny nose. The patient reported that when the patient looked online, it said the runny nose that did not mean it might be covid because that was not the common side effect. The patient also felt so bad after second shot. The patient wanted to report about common side effect of the runny nose. The patient reported that it never had this intense runny nose in whole life. The outcome of the events was unknown. Follow-up attempts completed. No further information is expected.


VAERS ID: 1681915 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-08-20
Onset:2021-08-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 LA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Asthma, Chest discomfort, Cough, Pain in extremity, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: IBUPROFEN; TYLENOL; NURTEC ODT
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Arthritis; Asthma; Drug allergy; Hypoglycemia; Latex allergy
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101097736

Write-up: Severe sore arm; asthmatic flare-ups for past 4 days (not improving with inhalers). Not severe enough to go to ER, but not able to go about my day without wheezing and having tightness in chest and induced cough due to the tightness.; Severe sore arm; asthmatic flare-ups for past 4 days (not improving with inhalers). Not severe enough to go to ER, but not able to go about my day without wheezing and having tightness in chest and induced cough due to the tightness.; Severe sore arm; asthmatic flare-ups for past 4 days (not improving with inhalers). Not severe enough to go to ER, but not able to go about my day without wheezing and having tightness in chest and induced cough due to the tightness.; Severe sore arm; asthmatic flare-ups for past 4 days (not improving with inhalers). Not severe enough to go to ER, but not able to go about my day without wheezing and having tightness in chest and induced cough due to the tightness.; Severe sore arm; asthmatic flare-ups for past 4 days (not improving with inhalers). Not severe enough to go to ER, but not able to go about my day without wheezing and having tightness in chest and induced cough due to the tightness.; This is a spontaneous report from a contactable consumer (patient). A 40-year-old non-pregnant female patient received bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE), dose 1 via an unspecified route of administration, administered in Arm Left on 20Aug2021 18:00 (at the age of 40-years-old) (Batch/Lot Number: FA7485) as DOSE 1, SINGLE for covid-19 immunisation. Medical history included asthma, hypoglycaemia, arthritis, Allergy: Latex, Known Allergies: oral steroids. Concomitant medications included ibuprofen (IBUPROFEN); paracetamol (TYLENOL); rimegepant sulfate (NURTEC ODT). The patient has Known Allergies: morphine, and external iodine. On 20Aug2021 21:00, the patient experienced Severe sore arm; asthmatic flare-ups for past 4 days (not improving with inhalers). Not severe enough to go to ER, but not able to go about her day without wheezing and having tightness in chest and induced cough due to the tightness. Therapeutic measures were taken as a result of the events. The outcome of the events was not recovered. The patient did not have COVID prior vaccination, and was not COVID tested post vaccination. Follow-up attempts are completed. No further information is expected.


VAERS ID: 1682009 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: North Carolina  
Vaccinated:2021-01-01
Onset:2021-08-20
   Days after vaccination:231
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Drug ineffective, SARS-CoV-2 test
SMQs:, Lack of efficacy/effect (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210820; Test Name: SARS-CoV-2 test; Result Unstructured Data: Test Result:positive
CDC Split Type: USPFIZER INC202101120071

Write-up: Covid-19 virus; Covid-19 virus; This is a spontaneous report from a Pfizer sponsored program regulatory authority Support from a contactable consumer reported for a male patient (father). A male patient of an unspecified age received bnt162b2 (Formulation: Solution for injection; Batch/Lot number was not reported), dose 1 via an unspecified route of administration on an unspecified date of Jan2021 as dose 1, single, dose 2 via an unspecified route of administration on 10Feb2021 (Batch/Lot number was not reported) as dose 2, single for COVID-19 immunisation. The patient''s medical history and concomitant medications were not reported. Reporter''s daddy got vaccines same date as reporter''s mama did and his positive Covid test was done the night of the 20Aug2021. Reporter''s daddy was getting a monoclonal antibody infusion at this moment. She declined to complete report for her daddy. The patient was doing ok; and they know that the vaccine was not going to stop you from doing it, it''s just supposed to stop you from being hospitalized. They called reporter''s Daddy in from the parking lot and tested him for Covid. They told him it would be a couple of hours before they got the results; so, he told them to just put it in his chart. The patient underwent lab tests and procedures which included sars-cov-2 test: positive on 20Aug2021. The outcome of the events was unknown. Information about lot/batch number has been requested.


VAERS ID: 1682158 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Mississippi  
Vaccinated:2021-08-19
Onset:2021-08-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Amenorrhoea, Dysmenorrhoea
SMQs:, Fertility disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: List of non-encoded Patient Relevant History: Patient Other Relevant History 1: None
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101154433

Write-up: Had cramps but no period; Had cramps but no period; This is a spontaneous report from a contactable consumer, the patient. A 31-year-old non-pregnant female patient received first dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: FD8448) via an unspecified route of administration in the left arm on 19Aug2021 at 12:00 (at the age of 31-years old) as a single dose for COVID-19 immunisation. The patient had no medical history. The patient had no known allergies. Prior to the vaccination, the patient was not diagnosed with COVID-19. The patient did not receive any other vaccines within four weeks prior to the vaccination. The patient did not receive any concomitant medications. It was reported that the patient was about to start a new cycle the week of the first vaccination shot. On 20Aug2021, the patient experienced cramps but no period. The patient had reported this to multiple doctors and to obstetrician-gynaecologist (OB-GYN). This was not normal and the patient had never missed a period. The patient''s last period was on 19Jul2021 and the normal cycle was usually between 28-30 days. The events resulted in doctors or other healthcare professional office/clinic visit. Therapeutic measures were not taken as a result of the reported events. Since the vaccination, the patient had not been tested for COVID-19. The clinical outcome of the event cramps but no period was not resolved at the time of this report.


VAERS ID: 1682496 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-05-06
Onset:2021-08-20
   Days after vaccination:106
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 2 - / IM

Administered by: Public       Purchased by: ?
Symptoms: COVID-19, Cough, Dyspnoea, Refusal of treatment by patient, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 8 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen (TYLENOL) 325 MG tablet calcium acetate (PHOSLO) 667 MG capsule Cholecalciferol (VITAMIN D3) 2000 UNIT TABS cyclobenzaprine (FLEXERIL) 10 MG tablet gabapentin (NEURONTIN) 300 MG capsule guaiFENesin (HUMIBID LA) 600 MG SR table
Current Illness: None known
Preexisting Conditions: History of cocaine abuse, end stage renal disease, arthritis, asthma, COPD, depression, diabetes, diabetic neuropathy, dialysis, hypertension, hyperlipidemia, lupus
Allergies: Lisinopril (cough), morphine (hives), penicillins (rash)
Diagnostic Lab Data: COVID-19 positive on 8/20/2021.
CDC Split Type:

Write-up: Patient presented to emergency department on 8/28/2021 with cough and difficulty breathing. She was diagnosed with COVID-19 infection on 8/20/2021 at her dialysis facility. Patient was admitted for further management. She was discharged on 9/5/2021. She was admitted previously on 8/19/2021 to 8/20/2021 in which she was found to be COVID-19 positive but left against medical advice.


VAERS ID: 1682560 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-04-07
Onset:2021-08-20
   Days after vaccination:135
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 041A / 1 UN / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Ageusia, Anosmia, COVID-19, Dyspnoea, Fatigue, Headache, Nasal congestion, Oropharyngeal pain, Pyrexia, Rhinorrhoea, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: stage 4 colon cancer, chemotherapy
Allergies:
Diagnostic Lab Data: 08/25/2021 Antigen + COVID-19 test at ONCOLOGY,
CDC Split Type:

Write-up: Fever $g100.4, New loss of taste or smell, Runny nose/Congestion, Sore throat, Shortness of breath or difficulty breathing, Fatigue or tiredness, Headache


VAERS ID: 1682641 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-03-24
Onset:2021-08-20
   Days after vaccination:149
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8732 / 2 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, COVID-19 pneumonia, Chills, Cough, Dyspnoea, Fatigue, Feeling cold, Headache, Intensive care, Nausea, Organ failure, Pyrexia, SARS-CoV-2 test positive, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Cardiovascular disease, Hypertension/High Blood Pressure, Former smoker, gastroparesis
Allergies:
Diagnostic Lab Data: 08/20/2021 PCR+ COVID-19 test at Hospital
CDC Split Type:

Write-up: Fever $g100.4, Subjective fever (felt feverish), Chills, Cough (new onset or worsening of chronic cough), Shortness of breath or difficulty breathing, Fatigue or tiredness, Nausea or vomiting, Headache, Hospitalization, ICU admission. Patient states on 8/20/2021 she was cold in the house and went outside on her deck and fell asleep, in the heat, Patient husband thought she had had a heat stroke and called 911. Patient was taken to the hospital, she was tested for Covid was positive and was admitted and stayed in the hospital until 8/26/2021 and returned home with home oxygen but states her SATS are at 100% and she is not using the oxygen. Patient said she started to go into organ failure and had Covid pneumonia and possible PE''s.


VAERS ID: 1682714 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-08-18
Onset:2021-08-20
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Anxiety, Bone pain, Cough, Lower respiratory tract congestion, Pruritus, Pyrexia, Rash, Urticaria
SMQs:, Cardiac failure (broad), Anaphylactic reaction (narrow), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Osteonecrosis (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (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: aspirin 81 m Vitamin D3 50 mcg (2,000 unit) capsule atorvastatin 10 mg tablet Xanax 0.5 mg tablet valsartan 160 mg tablet amlodipine 5 mg tablet ibuprofen 600 mg tablet
Current Illness: none reported
Preexisting Conditions: HTN , anxiety
Allergies: FLU shot
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Itching hives , sever rash all over , anxiety cough and chest congestion fever , bone ache


VAERS ID: 1682823 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-08-09
Onset:2021-08-20
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Abdominal discomfort, Arthralgia, Breast tenderness, Dizziness, Headache, Injection site pain, Loss of personal independence in daily activities, Malaise, Mobility decreased, Myalgia, Nausea, Respiratory tract congestion
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: 1st Covid Vaccine: Pfizer 8/9/21 Symptoms: dizziness, headache, extreme nausea + digestive upset, congestion, muscle + joint aches, tender breasts and painful injection site -Day after vaccine: unable to function, feeling extremely ill, in bed -Headache, dizziness, nausea + digestive upset, muscle aches, tender breasts continue until 8/18 -Nausea + digestive upset and tender breasts continue until today Question: Great concern in regard to receiving 2nd vaccine. If yes, when? If no, letter of exemption? If yes: optimal wait time until 2nd shot, supporting body with second shot, teaching until receiving second shot? If no: Exemption from vaccine, recommendation for medical leave? Teaching without second vaccine? Safety measures?


VAERS ID: 1683237 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-03-04
Onset:2021-08-20
   Days after vaccination:169
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805031 / 1 LA / -

Administered by: Private       Purchased by: ?
Symptoms: Bronchospasm, Chest X-ray normal, Cough, Oropharyngeal pain, SARS-CoV-2 test negative, Streptococcus test negative
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), COVID-19 (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: Albuterolsulfate inhaler 108MCG/ACT 90 mcg 2 puffs as needed; oxybutynin chloride tab sr24hrs 15 mg; Omeprazolecap delayed release 20 mg 1 capsule daily;
Current Illness: None
Preexisting Conditions: Pe/dot Overactive bladder
Allergies: Sulphate Erythromycin Amoxicilin
Diagnostic Lab Data: See above
CDC Split Type:

Write-up: Sever cough, sore throat, bronchial spasms Had 3 dr visits: Aug 23, 2021; Aug 26, 2021; Sept 6, 2021 Had covid test at each appt. all three tests were negative Had chest X-rays at each visit, all were normal Had strep test at 1st visit was negative


VAERS ID: 1683353 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: New Mexico  
Vaccinated:2021-08-20
Onset:2021-08-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002C21A / 1 RA / IM

Administered by: Pharmacy       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? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient is 14 years old and received a Moderna vaccine at a school based vaccination clinic. He reported no adverse reaction.


VAERS ID: 1683359 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: New Mexico  
Vaccinated:2021-08-20
Onset:2021-08-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002C21A / 1 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? 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 is 17 years old but received a Moderna COVID19 vaccine at a school based clinic.


VAERS ID: 1683364 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2021-08-20
Onset:2021-08-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002C21A / 1 RA / -

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? 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 is 17 years old but received a Moderna vaccination at a school based immunization clinic.


VAERS ID: 1683370 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2021-08-20
Onset:2021-08-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002C21A / 1 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? 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 is 15 years old but received a Moderna vaccination at school based immunization clinic.


VAERS ID: 1683484 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-08-20
Onset:2021-08-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Pantoprazole once daily 40mg
Current Illness: None
Preexisting Conditions: gastroesophageal reflux disease
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Developed a hissing and ringing in the ears. (Tinnitus) around 9:30PM the same day I got the shot. Never had symptoms like those before. And the ringing has continued and remains to this day at the time of report. With no improvement.


VAERS ID: 1683584 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-02-10
Onset:2021-08-20
   Days after vaccination:191
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038K20A / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Allergy to vaccine, Decreased appetite, Diarrhoea, Fatigue, Myalgia, Nasopharyngitis, Pain, Pyrexia, Sinus disorder
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: CLONAZEPAM
Current Illness:
Preexisting Conditions: Comments: No medical history was reported
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: diarrhea; feels very sinusy but nose is not running; it feels like when you have an allergy; cold like symptoms mainly in nose and eyes; pain; loss of appetite; fatigue; body aches/arm was sore; runned a fever of a 100; This spontaneous case was reported by a consumer and describes the occurrence of PAIN (pain), DECREASED APPETITE (loss of appetite), NASOPHARYNGITIS (cold like symptoms mainly in nose and eyes), DIARRHOEA (diarrhea) and SINUS DISORDER (feels very sinusy but nose is not running) in a 66-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 038K20A, 27A21A and 038K20A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No medical history was reported. Concomitant products included CLONAZEPAM for an unknown indication. On 10-Feb-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 10-Mar-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 20-Aug-2021, received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 20-Aug-2021, the patient experienced PAIN (pain), DECREASED APPETITE (loss of appetite), FATIGUE (fatigue), MYALGIA (body aches/arm was sore) and PYREXIA (runned a fever of a 100). On 21-Aug-2021, the patient experienced NASOPHARYNGITIS (cold like symptoms mainly in nose and eyes), SINUS DISORDER (feels very sinusy but nose is not running) and ALLERGY TO VACCINE (it feels like when you have an allergy). On 23-Aug-2021, the patient experienced DIARRHOEA (diarrhea). On 21-Aug-2021, DECREASED APPETITE (loss of appetite) and PYREXIA (runned a fever of a 100) had resolved. On 22-Aug-2021, PAIN (pain) and MYALGIA (body aches/arm was sore) had resolved. On 24-Aug-2021, DIARRHOEA (diarrhea) had resolved. At the time of the report, NASOPHARYNGITIS (cold like symptoms mainly in nose and eyes), SINUS DISORDER (feels very sinusy but nose is not running), ALLERGY TO VACCINE (it feels like when you have an allergy) and FATIGUE (fatigue) outcome was unknown. Patient is immunocompromised since she had her spleen removed No treatment information was received This case was linked to MOD-2021-295308 (Patient Link).


VAERS ID: 1683585 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-08-20
Onset:2021-08-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Cheilitis, Hypoaesthesia oral, Lip pain, Lip pruritus, Lip swelling, Loss of personal independence in daily activities, Swelling face
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Dementia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: TYLENOL
Current Illness: Tooth ache
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: it hurts; it is numb; itchy; irritated; she can''t really do nothing; she has the left side of her lip swollen, the right side is not swollen anymore; right side of her jaw started swelling on that night; right side of her lip swelling on that night/she had the right side of her lip swollen/she had both sides swollen of her bottom lip; This spontaneous case was reported by a consumer and describes the occurrence of LIP SWELLING (right side of her lip swelling on that night/she had the right side of her lip swollen/she had both sides swollen of her bottom lip), LIP SWELLING (she has the left side of her lip swollen, the right side is not swollen anymore), SWELLING FACE (right side of her jaw started swelling on that night), LIP PAIN (it hurts) and HYPOAESTHESIA ORAL (it is numb) in a 30-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. Concurrent medical conditions included Tooth ache. Concomitant products included PARACETAMOL (TYLENOL) for Tooth ache. On 20-Aug-2021 at 11:00 AM, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 20-Aug-2021, the patient experienced LIP SWELLING (right side of her lip swelling on that night/she had the right side of her lip swollen/she had both sides swollen of her bottom lip) and SWELLING FACE (right side of her jaw started swelling on that night). On 24-Aug-2021, the patient experienced LIP SWELLING (she has the left side of her lip swollen, the right side is not swollen anymore), LIP PAIN (it hurts), HYPOAESTHESIA ORAL (it is numb), LIP PRURITUS (itchy), CHEILITIS (irritated) and LOSS OF PERSONAL INDEPENDENCE IN DAILY ACTIVITIES (she can''t really do nothing). On 24-Aug-2021, LIP SWELLING (right side of her lip swelling on that night/she had the right side of her lip swollen/she had both sides swollen of her bottom lip) had resolved, SWELLING FACE (right side of her jaw started swelling on that night) outcome was unknown. At the time of the report, LIP SWELLING (she has the left side of her lip swollen, the right side is not swollen anymore), LIP PAIN (it hurts), HYPOAESTHESIA ORAL (it is numb), LIP PRURITUS (itchy), CHEILITIS (irritated) and LOSS OF PERSONAL INDEPENDENCE IN DAILY ACTIVITIES (she can''t really do nothing) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. Other concomitant medication included birth control . The first dose of moderna Covid-19 Vaccine taken on 20-Aug-2021 at around 11 am. The patient had right side of her lip and jaw started swelling on that night. It was stated Friday night and Saturday 21-Aug-2021, she had the right side of her lip and jaw swollen. It started going down, but on 22-Aug-2021 she had both sides swollen of her bottom lip, and jaw just in the right side. This lasted until 24-Aug-2021, but on 24-Aug-2021 she has the left side of her lip swollen, the right side was not swollen anymore. No Treatment medications were reported.


VAERS ID: 1683633 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-08-18
Onset:2021-08-20
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037A21B / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Burning sensation, Gastrooesophageal reflux disease
SMQs:, Peripheral neuropathy (broad), Gastrointestinal nonspecific dysfunction (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: SYNTHROID; LINZESS; PROZAC; CLARITINE; PHENTERMINE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: She also has burning sensation.; She started noticing that everything that she drank or ate, she feels that she gets reflux; This spontaneous case was reported by a consumer and describes the occurrence of GASTROOESOPHAGEAL REFLUX DISEASE (She started noticing that everything that she drank or ate, she feels that she gets reflux) and BURNING SENSATION (She also has burning sensation.) in a 43-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 037A21B) for COVID-19 vaccination. Concomitant products included LEVOTHYROXINE SODIUM (SYNTHROID), LINACLOTIDE (LINZESS), FLUOXETINE HYDROCHLORIDE (PROZAC), LORATADINE (CLARITINE) and PHENTERMINE for an unknown indication. On 18-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 20-Aug-2021, the patient experienced GASTROOESOPHAGEAL REFLUX DISEASE (She started noticing that everything that she drank or ate, she feels that she gets reflux). On an unknown date, the patient experienced BURNING SENSATION (She also has burning sensation.). The patient was treated with ACETYLSALICYLIC ACID (ALKA SELTZER [ACETYLSALICYLIC ACID]) for Acid reflux (esophageal) and Burning sensation, at an unspecified dose and frequency and SIMETICONE (GAS RELIEF) for Acid reflux (esophageal) and Burning sensation, at an unspecified dose and frequency. At the time of the report, GASTROOESOPHAGEAL REFLUX DISEASE (She started noticing that everything that she drank or ate, she feels that she gets reflux) and BURNING SENSATION (She also has burning sensation.) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown.


VAERS ID: 1683908 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-04-26
Onset:2021-08-20
   Days after vaccination:116
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8727 / 2 RA / IM

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

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

Write-up: COVID positive


VAERS ID: 1684774 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-08-12
Onset:2021-08-20
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052E21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Feeling abnormal
SMQs:, Dementia (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: Pt reports severe fatigue and brain fog. Considered seeking medical treatment but decided against it.


VAERS ID: 1684878 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-08-18
Onset:2021-08-20
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 008C21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Injection site erythema, 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:
Current Illness:
Preexisting Conditions:
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Left deltoid, red, raised, itchy, size of a 50 cent piece. Gave patient Benadryl oral and applied ice.


VAERS ID: 1684894 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-08-20
Onset:2021-08-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002F27A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cellulitis, Cough, Dyspnoea, Sneezing, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? Yes
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: 2005 age 31 Varicella
Other Medications: Lisinopril
Current Illness: NKA
Preexisting Conditions: N/A
Allergies: Iodine and varicella
Diagnostic Lab Data:
CDC Split Type:

Write-up: I broke out in hives on both my arms and back, shortness of breathe, cough, sneezing, developed cellulitis.


VAERS ID: 1685026 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: New Mexico  
Vaccinated:2021-06-11
Onset:2021-08-20
   Days after vaccination:70
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN AMP5758 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Cough, Fatigue, Influenza A virus test negative, Influenza B virus test, Myalgia, Respiratory syncytial virus test negative, Rhinorrhoea, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Apixaban, diltiazem, guaifensesin
Current Illness: None
Preexisting Conditions: Meralgia Paresthetica, HTN, Low back pain Adtrial fibrillation
Allergies: No known allergis
Diagnostic Lab Data: Aug 20, 2021@12:14:56 FLU A (CEPHEID) NEGATIVE , FLU B (CEPHEID) NEGATIVE, RSV (CEPHEID) NEGATIVE _COVID-19 (CEPHEID) POSITIVEA*
CDC Split Type:

Write-up: 8.20.21 Asymptomatic day of test. 8.24.2021 Dry Cough, Muscle Aches, Fatigue, Runny nose


VAERS ID: 1685071 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Puerto Rico  
Vaccinated:2021-08-19
Onset:2021-08-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: influenza vaccine
Other Medications: none
Current Illness: none
Preexisting Conditions: asthma
Allergies: had allergies to the influenza vaccine in the past
Diagnostic Lab Data: At the moment the patient had not had any studies or treatments
CDC Split Type:

Write-up: 30 year old patient comes to the COVID-19 vaccination area in the Hospital to administer his second dose of PFIZER vaccine. When obtaining information patient informs having an allergic reaction to the first dose of COVID vaccine PFIZER; he refers "after getting the first dose vaccine of PFIZER I began to present the next day with a rash on my arms and back with itching and redness in my skin, this happened to me before with the influenza vaccine". It is recommended to visit his primary doctor before administering his second dose. He wants it and authorizes the administration of the second dose and signs a consent. He is advised in case of presenting a rash, redness in the area and itching again to visit the nearest emergency room. He understands and we administered the second dose with aseptic measures. Patient did not have an adverse reaction during the 15 minute wait and returns home.


VAERS ID: 1685141 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2021-02-18
Onset:2021-08-20
   Days after vaccination:183
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Asymptomatic COVID-19, COVID-19, Influenza A virus test negative, Influenza B virus test, Respiratory syncytial virus test negative, SARS-CoV-2 test positive
SMQs:, Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Unknown
Diagnostic Lab Data: Aug 20, 2021@18:00:32 FLU A NEGATIVE, FLU B NEGATIVE, RSV NEGATIVE COVID-19 POSITIVEA*
CDC Split Type:

Write-up: Asymptomatic, Screening.


VAERS ID: 1685390 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-03-10
Onset:2021-08-20
   Days after vaccination:163
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Cough, Dyspnoea, Endotracheal intubation, Pyrexia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 21 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Clonidine, Tylenol, Eliquis, Aspirin, Digoxin, Zetia, gLIMEpiride, metoprolol, Zofran, Crestor, Calcium, Vitamin D, diltiazem, ferrous sulfate, metformin, MVI, Vit B12, Avalide
Current Illness: None known
Preexisting Conditions: Diabetes, Hypertension, Hypercholesterolemia, Sarcoidosis, Sleep apnea, Osteoarthritis,
Allergies: Actos, Latex, Tetracycline
Diagnostic Lab Data: COVID NAAT 8/20/21
CDC Split Type:

Write-up: Admitted 8/20/21 with dyspnea, cough for 9 days, fever. Tested positive for COVID. Intubated 8/27/21, compassionate extubation planned for 9/10/21. Baricitib, , Decadron, Vancomycin IV, Cefepime


VAERS ID: 1685554 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-04
Onset:2021-08-20
   Days after vaccination:169
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030A21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Chills, Exposure to SARS-CoV-2, Feeling abnormal, Headache, Malaise, Pain, Pyrexia, Respiratory tract congestion, SARS-CoV-2 test positive
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Tamsulosin 0.4 g capsules
Current Illness: None
Preexisting Conditions: None
Allergies: None that I am aware of
Diagnostic Lab Data: See above
CDC Split Type:

Write-up: On August 18, 2021, my adult son (who lives with me) tested positive for Covid-19. I was tested later that day, and my results were negative. On August 20, 2021, which was five and a half months after my second dose, I started getting Covid-19 symptoms. These included fever, chills, headaches, body aches, brain fog, and congestion. On August 21, 2021, I tested positive for Covid-19.


VAERS ID: 1686019 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-20
Onset:2021-08-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 053E21A / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test, Condition aggravated, Epistaxis, Hypersomnia, Pain, Pyrexia, Thrombosis
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Depression (excl suicide and self injury) (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: exemestane 25 mg
Current Illness: no
Preexisting Conditions: breast cancer 3 years ago, I have been cancer free for 2 years
Allergies: sulfa drugs; shellfish; almonds
Diagnostic Lab Data: Blood work -have not received the results yet.
CDC Split Type: vsafe

Write-up: On 08/20/2021, the night of the vaccination, I had 104 fever for 36 hours and that was with Tylenol and Motrin. I slept for almost 36 hrs. straight. When I walked the body pain was so severe that I almost had to crawl. On that Sunday, 3rd day i started getting really bad bloody noses, with huge clots. They are very heavy and vey thick, and a lot, like 2 or 3 times a day. The clots are the size from anywhere from a dime to a quarter. I would say unknown if I have recovered from the AEs because in the past 2 days the bloody noses have slowed down. Now they are maybe once a day. Before my vaccine, 2nd dose of Moderna. I would get bloody noses once a month, depending on the season, but my bloody noses were never heavy like they are now. I have been sending the doctor messages through the portal on 08/25/2021, She said there was not much she could do and to use a humidifier.


VAERS ID: 1686209 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-20
Onset:2021-08-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 1 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Dry skin, Nausea, Pallor, Paraesthesia, Retching, Secretion discharge, Skin warm
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Dehydration (broad)

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

Write-up: Pt had nausea, retched clear. Mucus fluid. Appered pale, skin warm, dry. Tingling in fingers BP 163/100


VAERS ID: 1686216 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-08-20
Onset:2021-08-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052E21A / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Dizziness, Fatigue, Headache, Heart rate increased, Hypokalaemia, Infusion, Nausea, Pyrexia, Urinary incontinence, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad), Hypokalaemia (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: amlodipine 5 mg tablet daily, Nexium PO, ferrous gluconate 324 mg tablet, folic acid 1 mg tablet daily, methotrexate 25 mg/mL injection - 0.8 mLs IM once weekly
Current Illness: None
Preexisting Conditions: HTN, heart murmur, hypothyroidism, pleural effusion, gout, rheumatoid arthritis, renal insufficiency, anemia, limited systemic sclerosis,
Allergies: Lisinopril - cough and headache
Diagnostic Lab Data: Infusion of 2 L of lactated ringers, 20 meq oral KCl and 10 meq IV KCl with improvement in symptoms. Discharged with 3 tablets of potassium 20 mEq CR tablet - take 1 tablet by mouth daily and ondansetron 8 mg disintegrating tablet, PRN for nausea.
CDC Split Type:

Write-up: Several hours after receiving Moderna COVID-19 vaccine she developed a headache which progressed through the afternoon into feeling weak and dizzy, increased fatigue. Symptoms persisted through the night with addition of nausea, incontinence of urine, vomiting and sensation of fever. Pt unable to keep food down. Walk in clinic visit on 8/21/21 recorded temperature of 99 F and HR elevated to 92, pt was instructed to visit ED. ED diagnosed pt with vaccine reaction including intractability of vomiting and hypokalemia.


VAERS ID: 1686224 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: California  
Vaccinated:1998-05-28
Onset:2021-08-20
   Days after vaccination:8485
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0282 / 1 - / SYR

Administered by: Private       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: n/a
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: n/a
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Pt had not eaten today, stated that he is affraid of injections. Felt like he wanted to vomit, had nothing in his stomach, looked pale


VAERS ID: 1686448 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-18
Onset:2021-08-20
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 637B21A / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Burning sensation, Erythema
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: IBS-D, rosacea
Allergies: Sulfa
Diagnostic Lab Data: ED visit on 8/28/21, Doctor visit on 9/9/21
CDC Split Type:

Write-up: Burning sensation and fluttering in chest, facial redness and burning


VAERS ID: 1687706 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-08-20
Onset:2021-08-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / -

Administered by: Private       Purchased by: ?
Symptoms: Body temperature abnormal, Burning sensation, Feeling hot, Hyperhidrosis, Mobility decreased, Pain, Peripheral swelling, Pruritus
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Body temp regulation has been off, I am now always hot and sweaty. Im usually cold and sleep with a heating blanket all year. now I can''t even wear clothes to bed and need a fan or air conditioner on. Also had a very itchy swollen arm, which went away, however it came back exactly week later, I couldn''t even move my arm. Also I feel stinging, burning and itching starting Thursday Thur Friday every week


VAERS ID: 1688654 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-08-19
Onset:2021-08-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Dyspnoea, Therapeutic response unexpected
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

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

Write-up: Chest pain and trouble breathing. My knee pain I''ve had for years, went away.


VAERS ID: 1591689 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-08-19
Onset:2021-08-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Hyperhidrosis
SMQs:, Neuroleptic malignant syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Chills, sweating.


VAERS ID: 1592586 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-08-20
Onset:2021-08-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Hyperventilation
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (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: not known
Current Illness: none stated
Preexisting Conditions: none stated
Allergies: none stated
Diagnostic Lab Data: none known or stated
CDC Split Type:

Write-up: patient administer covid 19 pfizer shot at appprox 5:33 pm patient exited both indicated to parent that has was dizzy and began to hyperventilate the tech ician and paret alerted the pharmacist and pharmacist came to assist patient with epipen and ice pack. gave epipen shot at 5:35pm and called 911. patient started to calm and breath normally after epipen dosage got patient to sitting postion and attended patient until ems arrived at 5:45p. ems then assisted patient. patient was taken by ems


VAERS ID: 1602667 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-08-19
Onset:2021-08-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3593 / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Amnesia, Arthralgia, Dizziness, Fatigue
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalopathy/delirium (broad), Vestibular disorders (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: Levofloxacino, Litium, Modafinilo Loratadina Herbal remedies
Current Illness: Alergies
Preexisting Conditions: Depresion
Allergies: pollen
Diagnostic Lab Data: None
CDC Split Type:

Write-up: exhausted Joint pain especially those with previous injuries Temperature Uncoordination Dizziness Memory loss All in two days


VAERS ID: 1642811 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-08-20
Onset:2021-08-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / -

Administered by: Other       Purchased by: ?
Symptoms: Inappropriate schedule of product administration, Product administered at inappropriate site, SARS-CoV-2 test
SMQs:, Drug abuse and dependence (broad), Medication errors (narrow), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: COVID-19
Allergies:
Diagnostic Lab Data: Test Date: 20210803; Test Name: Pcr; Test Result: Negative ; Comments: Nasal Swab
CDC Split Type: TRPFIZER INC202101082656

Write-up: 1st dose received on 10Aug2021 14:30, 2nd dose received on 20Aug2021 12:00; administered in left leg; This is a spontaneous report from a contactable physician (patient) via COVAES. A 18-year-old male patient received bnt162b2 received via an unspecified route of administration, administered in left leg on 20Aug2021 12:00 (Batch/Lot Number: Unknown) as dose 2, single at the age of 18-year-old for covid-19 immunisation. Historic vaccine was bnt162b2, dose 1 via an unspecified route of administration, administered in left arm on 10Aug2021 14:30 (Batch/Lot Number: Unknown) as dose 1, single at the age of 18-year-old for COVID-19 immunisation. Medical history included covid prior vaccination. Concomitant medications were not reported. "Why is turkey not here?" had been asked (adverse event) on 22Aug2021 00:30. The seriousness of this adverse event was hospitalization, and life threatening with outcome of not recovered. The patient''s hospitalization was prolonged as a result of ''why is turkey not here?'' has been asked. (adverse event). Therapeutic measures were taken as a result of ''why is turkey not here?'' has been asked (adverse event) which included cold water. The patient underwent lab tests and procedures which included PCR Nasal Swab: negative on 03Aug2021. Why is Turkey not here? resulted in doctor or other healthcare professional office/clinic visit and emergency room/department. The patient did not receive any other vaccines within 4 weeks prior to the COVID vaccine. Prior to vaccination, the patient was diagnosed with COVID-19. Since the vaccination, the patient had been tested for COVID-19. The patient did not receive any other medications within 2 weeks of vaccination. Event occurred in a country different from that of the reporter. This may be a duplicate if the reporter also submitted directly to his local agency. The lot number for bnt162b2 was not provided and will be requested during follow up.


VAERS ID: 1657376 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-08-20
Onset:2021-08-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF3319 / 1 - / -

Administered by: Other       Purchased by: ?
Symptoms: Fatigue, Vaccination site pain
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: GBPFIZER INC202101092760

Write-up: Tiredness; Injection site muscle pain; This is a solicited report from the regulatory authority program from a contactable consumer. This is a report received from the regulatory authority. The regulatory authority report number is GB-MHRA-YCVM-202108211721512760-WNDA4, Safety Report Unique Identifier GB-MHRA-ADR 25832721. A 17-years-old non-pregnant female patient received first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE, Formulation: Solution for injection, Lot Number: FF3319), via an unspecified route of administration on 20Aug2021 (at the age of 17-years-old) as dose 1, single for covid-19 immunization. The patient''s medical history and concomitant medications were not reported. Patient last menstrual period date was 30Jul2021. Patient has not had symptoms associated with COVID-19, not had a COVID-19 test and patient was not currently breastfeeding. On 20Aug2021, the patient experienced tiredness and injection site muscle pain. Patient was not enrolled in clinical trial. The reporter (health authority) considered the event as serious (medically significant). The outcome of events tiredness and injection site muscle pain was not recovered. The reporter assessment of the causal relationship of the tiredness, injection site muscle pain with the suspect product was not provided at the time of this report. Since no determination had been received, the case was managed based on the company causality assessment. No follow-up attempts are possible. No further information is expected.; Sender''s Comments: Based on the description given in the narrative, there is reasonable possibility of causal association between the events Fatigue, Vaccination site pain and the suspect BNT162B2. The impact of this report on the benefit/risk profile of the Pfizer drug is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to Regulatory Authorities, Ethics Committees and Investigators, as appropriate.


VAERS ID: 1657561 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-08-04
Onset:2021-08-20
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Angina pectoris, Pain
SMQs:, Other ischaemic heart disease (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: Deep burning pain in heart.


VAERS ID: 1667736 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-08-18
Onset:2021-08-20
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, Balance disorder, Chest discomfort, Chest pain, Chills, Decreased appetite, Diarrhoea, Dysgeusia, Dysphagia, Dyspnoea, Faeces soft, Fatigue, Headache, Heart rate increased, Hypertension, Hypopnoea, Insomnia, Lymph node pain, Lymphadenopathy, Malaise, Muscle spasms, Musculoskeletal discomfort, Musculoskeletal stiffness, Nausea, Neuralgia, Pain in jaw, Palpitations, Paraesthesia, Paraesthesia oral, Respiratory rate decreased, Sleep disorder, Sluggishness, Tinnitus, Tremor, Vertigo
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (narrow), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Pseudomembranous colitis (broad), Dystonia (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (narrow), Cardiomyopathy (broad), Hearing impairment (narrow), Vestibular disorders (narrow), Osteonecrosis (broad), Arthritis (broad), Noninfectious diarrhoea (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Yaz
Current Illness: Yaz
Preexisting Conditions: Tinnitus
Allergies: Brazil nuts
Diagnostic Lab Data:
CDC Split Type:

Write-up: Tinnitus worsened after a week, parastheisa in hands, arms, legs, hands, feet, buttocks, lower back, lower abdomen, chest, neck, jaw, back of head, face, scalp, vertigo when standing up, off-balance when walking, malaise, nerve pain in same areas as parasthesia that aches and goes away intermittently, back pain in lower back, and back of neck rushing sensations and diarrhoea, difficulty breathing - sometimes shallow and slow,, high blood pressure intermittently, accelerated heart rate intermittently, extreme fatigue, heart palpitations, muscle spasm in arms, hands, shoulders, chest, legs, feet, buttocks, head pressure around ears and temples, neck stiffness and discomfort when moving neck, chest pain, sometimes when breathing, swollen lymph nodes in both armpits and side of neck, and groin, chest tightness, nausea, insomnia, disrupted sleep, lack of appetite, headache, softer than usual stool, sluggish, pain along jaw muscle, metallic taste in mouth and when breathing, tingling in gums, TMJ pain, chills, internal tremors, leg tremors, joint pain, pain in lymph nodes, difficulty swallowing


VAERS ID: 1584214 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA NOT SURE / 3 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chills, Extra dose administered, Fatigue, Headache, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Extreme fatigue, shivering they would not stop until taking a hot bath. Uncontrollable shivering, fever and headache. Shivering like if I was having a seizure. This is my booster shot and it?s approximately 10 hours after injection


VAERS ID: 1585389 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-01
Onset:2021-08-19
   Days after vaccination:199
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL4101 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Cardiac murmur, Inappropriate schedule of product administration
SMQs:, Pulmonary hypertension (broad), Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NO went for in May this year, the cardiac murmur was diagnosed which shocked me
Current Illness: nil
Preexisting Conditions: NIL
Allergies: nil
Diagnostic Lab Data: awaiting scan nxt week
CDC Split Type:

Write-up: Had 2 injections for COVID Pifzer vaccines given on 14/01/2021 and 1.4.21 mainly possible myocardictis due to vaccines -New cardiac murmur


VAERS ID: 1586513 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: New York  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Dysphonia, Myalgia, Oropharyngeal candidiasis, Oropharyngeal pain, Thirst
SMQs:, Rhabdomyolysis/myopathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Oropharyngeal infections (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Dehydration (broad), Opportunistic infections (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: pt does not make antibodies to polysaccaride or protein vaccines
Other Medications: KLONOPIN, ivig ,zofran, prilosec, mito mix
Current Illness:
Preexisting Conditions: cvid, sjogrens, mitochondrial myopathy, s/p nasopharyngeal cancer
Allergies: sulfa, aveloz, cipro
Diagnostic Lab Data: none, dx made upon clinical exam
CDC Split Type:

Write-up: hoarse voice, intense thirst, myalgias chills, sore throat with thrush infection in mouth and throat (started 2 days after vaccine and sore throat). cleareed with diflucan


VAERS ID: 1586542 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-08-07
Onset:2021-08-19
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain upper, Dysmenorrhoea, Heavy menstrual bleeding, Menstrual disorder, Menstruation delayed
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Fertility disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Melatonin in evening
Current Illness: none
Preexisting Conditions: no
Allergies: no
Diagnostic Lab Data: None so far I will be following up
CDC Split Type:

Write-up: Patient has had cycles for about a year. They aren''t always regular timing but pretty close. She always starts day 1 with light cramping and light bleeding with day 2-4 or 5 heavy and moderate cramping. She should have started her cycle on 8/15 but did not. August 6 she came in before school complaining of stomach cramps which I attributed to time for her cycle. She also complain on the 17 & 18th along with staying that she felt like something was wrong. Last night she did start her cycle but immediately heavier than she''s ever had and with clots and severe cramps.


VAERS ID: 1586553 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 1 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Injury associated with device
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: Pt with special needs arm being held by family/POA member, upon sticking patient, patient rapidly moved arm and the needle withdrew. No vaccination was administered at this time. New vaccine was obtained and given.


VAERS ID: 1586614 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-08-16
Onset:2021-08-19
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Condition aggravated, Hypertension
SMQs:, Neuroleptic malignant syndrome (broad), Hypertension (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Blood pressure and vitamin supplements
Current Illness: None
Preexisting Conditions: High blood pressure and high triglycerides.
Allergies: None
Diagnostic Lab Data: Pending
CDC Split Type:

Write-up: High blood pressure. Blood pressure not going down.


VAERS ID: 1586630 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-25
Onset:2021-08-19
   Days after vaccination:175
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Unevaluable event
SMQs:

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

Write-up: hospitalized 8/19/21


VAERS ID: 1586678 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 LA / SYR

Administered by: Public       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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: Cognitive
Allergies: N/A
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: Patient is 17yrs old and was administered Janssen (Johnson & Johnson) vaccine. No adverse reactions noted during time at clinic.


VAERS ID: 1586718 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017E21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypoaesthesia, Hypoaesthesia oral
SMQs:, Peripheral neuropathy (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Sexual dysfunction (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: Prilosec and flonase
Current Illness: None
Preexisting Conditions: Diabetes, asthma, bradycardia, heart murmur, TIA, migraines
Allergies: Demerol, Ditropan, Bactrim, sulfa based antibiotics, Lisinopril, Advair diskus, Metformin and Norvasc.
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Numbness of the left side of head, face, lips, neck, shoulder down to elbow.


VAERS ID: 1586722 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Burning sensation, Immediate post-injection reaction, Rash
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Patient''s first dose presented an adverse reaction. Rash and body itching.
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: Benadryl, Tramadol, Nyquil, Cinnamon
Diagnostic Lab Data: 10:15am Saturation: 97%; Pulse: 86/min; B/P: 144/97; 10:50am B/P: 127/93 Respirations: 18 (clear), Pulse: 86, Saturation: 98%; Temperature: Normal to the touch
CDC Split Type:

Write-up: 9:50am I received the PFIZER vaccine, I instantly had a reaction of body rash, burning. Hand no difficulty with breathing.


VAERS ID: 1586742 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: Louisiana  
Vaccinated:2021-08-18
Onset:2021-08-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain upper, Headache, Myalgia, Pyrexia, SARS-CoV-2 antibody test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: I give blood every 8 weeks. Dec 2020 I had antibodies, meaning I had covid and was asymptomatic. May 2020 the antibody count was low. July 2021 the antibody count was high. This leads me to believe I had covid last year, and more recently the delta variant. Both asymptomatic. After the vaccine, I have a fever, headache, stomachache, and muscle aches all over.


VAERS ID: 1586750 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-11
Onset:2021-08-19
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 091D21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site pain, Injection site rash
SMQs:, Extravasation events (injections, infusions and implants) (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: 150MG Sertraline HCL
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Developed sore arm on 8th day after shot around injection site and 2 rashes have developed at shot site and and below shot site.


VAERS ID: 1586764 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-08-18
Onset:2021-08-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Developed fever, nausea, headache, and body aches 8-9 hours after receiving vaccination.


VAERS ID: 1586767 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: New York  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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 PRESENTED TO RECEIVE 2ND DOSE OF PFIZER VACCINE. ANSWERED NO TO THE QUESTION: In the last 10 days, have you had a COVID-19 test because you had symptoms and are still awaiting your test results or been told by a health care provider or health department to isolate or quarantine at home due to COVID-19 infection or exposure? AFTER PT RECEIVED VACCINE AND LEFT THE CLINIC IT WAS DISCOVERED THAT SHE WAS REPORTED AS TESTING POSITIVE FOR COVID, TESTED 8/16/21 AT WELLNOW URGENT CARE ACCESSION NUMBER WNY01405105. NOTIFIED EXPOSED STAFF AND MEDICAL PROVIDER ON CALL. NO OTHER PTS HAD CLOSE CONTACT. NO IMMEDIATE ADVERSE REACTIONS REPORTED BY PT AFTER RECEIVING VACCINE. CALLED PT TO INFORM HER THAT IT IS NOT RECOMMENDED TO GET VACCINE DOSE WHILE COVID+ DUE TO RISK OF EXPOSING OTHER UNVACCINATED PTS TO COVID, AND POSSIBILITY OF SIDE EFFECTS. RECOMMENDED PT CALL HER HEALTHCARE PROVIDER IF SHE HAS ANY CONCERNS ABOUT SIDE EFFECTS THAT OCCUR.


VAERS ID: 1586802 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-08-17
Onset:2021-08-19
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002F21A / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Diarrhoea, Fatigue, Injection site rash
SMQs:, Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Metaphorim 500mg, Nexium 20mg, Coquetin, Probiotic, Gabapentin 300mg, Nurco 7.5, Plavix 75mg, Matopralia, Prozac 20mg
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: Contrast Dye
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Pt. states that after receiving the 2nd dose of Moderna 08/17/2021, started experiencing symptoms 08/19/2021 of lose stool, rash at the injection site, and fatigue. Contact with Pharmacists stating they were putting in a report on Pt.''s behalf.


VAERS ID: 1586817 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cold sweat, Hyperhidrosis, 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? No
Hospitalized? No
Previous Vaccinations: AFTER REACTION (NOT ON PAPERWORK) MOTHER DISCLOSED PT FAINTED ABOUT 1 YEAR AGO WHEN HE RECIEVED THE HPV SHOT AT DOCTORS OFFICE.
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: NONE
Diagnostic Lab Data:
CDC Split Type:

Write-up: PATIENT PASSED OUT WITHIN 1 MINUTE OF RECIEVING VACCINE (BECAME CLAMY, EYES CLOSED, AND WAS SWEATING) AND PHARMACIST HELD HEAD UP, USED WET CLOTH TO WIPE FACE, TOOK PULSE, BLOOD PRESSURE, ELEVATED FEET, AND CALLED 911. AMBULANCE CAME WITHIN 10 MINUTES OF ADMINISTRATION=CHECKED ALL VITALS AND SAID PATIENT COULD BE TAKEN TO HOSPITAL FOR FURTHER TREATMENT OR WAS OK TO GO. MOM REFUSED MEDICAL TREATMENT AS PATIENT RECOVERED AND HAD EXPECTED REACTION OF SYNCOPE.


VAERS ID: 1586850 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-17
Onset:2021-08-19
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Axillary mass
SMQs:

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

Write-up: Golf ball sized knot under arm. Started 2 days after vaccination.


VAERS ID: 1586863 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-08-12
Onset:2021-08-19
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 023C21A / 1 RA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Injection site pain, Injection site pruritus, Injection site urticaria
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (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: none
Current Illness: none
Preexisting Conditions: none
Allergies: None
Diagnostic Lab Data: none- just started and so far not bad enough
CDC Split Type:

Write-up: 1 week post injection (minus 6 hours) itching , urticaria, half dollar circumference at injection site Prior to this, there was pain at injection site post injection x 4 days


VAERS ID: 1586864 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0170 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: COVID-19 immunisation
SMQs:, COVID-19 (narrow)

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

Write-up: Patient requested the Janssen vaccine but was mistakenly given the Pfizer vaccine.


VAERS ID: 1586897 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 088D21A / 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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: n/a
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: nka
Diagnostic Lab Data:
CDC Split Type:

Write-up: patient passed out within 5 minutes of receiving the vaccine. he was sitting in a chair during the 15 minute observation period and the mother yelled out to my technician and myself to "help, call 911" when we went to check on him he just woke up from syncope. He was given gatorade, water, an ice pack for his neck , and his feet were elevated. the police and local EMT showed up and examined him and determined him to be okay. after about 40 minutes the patient was able to stand comfortably and walk out.


VAERS ID: 1586901 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-01
Onset:2021-08-19
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034121A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Pruritus, Throat irritation, Throat tightness
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), 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: hydroCHLOROthiazide (ESIDRIX/HYDRODIURIL) 25 mg Oral Tab Clotrimazole (LOTRIMIN AF/MYCELEX) 1 % Top Crea Albuterol (PROAIR/PROVENTIL/VENTOLIN) 90 mcg/actuation Inhl HFAA Ciclesonide (ALVESCO) 80 mcg/actuation Inhl HFAA hydroCHLOROthiazide (
Current Illness: n/a
Preexisting Conditions: ASTHMA, UNSPECIFIED HTN (HYPERTENSION) GERD OBESITY, BMI 30-34.9, ADULT ECZEMA IRRITABLE BOWEL SYNDROME UTERINE FIBROIDS
Allergies: Dicyclomine Benzocaine Co-trimoxazole Codeine Erythromycin Base Hyoscyamine Penicillin V Potassium Sulfa (sulfonamide Antibiotics)
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Pt received 2nd dose of Moderna vaccine #034121A at approximately 0830. At about 0840: Pt reported feeling a mild "itch in the throat, right arm, and back". Pt stated she felt her throat "closing a little" Pt was brought back to the oberservation unit at 0841. Pt took her own diphenhydramine 50 mg at approximately 0842. Lung sounds clear and no stridor indicated. Continue to monitor. Vitals :0845 Temp: 97.5 BP: 157/91 HR: 65 RR: 18 O2: 99 on RA 0900: Pt stated her symptoms are not getting worse. Pt was able to drink water and carry a normal conversation with this RN. Continue to monitor. Follow up vitals at 0915: BP: 153/100 HR: 65 RR: 18 O2: 100 on RA Lung sounds are clear and no stridor indicated. Pt stated she is not feeling worse. Pt is working on her phone and taking phone calls and able to carry a conversation. No complaints of SOB. Continue to monitor. Follow up vitals at 0930: BP: 159/89 HR: 60 RR: 18 O2: 100 on RA Pt stated symptoms are getting better. Itching is resolving. Throat doesn''t feel constricted anymore. Lung sounds clear and no stridor indicated. Continue to monitor. Follow up vitals: 0945: BP: 136/95 HR: 55 RR: 18 O2: 100 on RA Pt feeling much better. No other symptoms reported besides mild itching to the stop of scalp and chin. Dr. was updated on pt''s progress and current status and cleared pt to go home. Pt was educated on precautions to take if worsening symptoms develop. Pt advised not to drive. Pt passed walking test and swallowing test.


VAERS ID: 1586908 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-08-18
Onset:2021-08-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Gemfibrozil Metformin Humilin U 500 Insulin Fish Oil 2000mg BID Losartan/HCTZ 25 mg qD Aspirin 81 mg Low dose qD
Current Illness: None
Preexisting Conditions: Diabetes, CKD, Hyperlipedemia, HTN
Allergies: Pioglitazone
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Fever Headache Body Aches Lethargy Chills Loss of Appetite


VAERS ID: 1586917 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-18
Onset:2021-08-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN0171 / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain upper, Gastrointestinal disorder
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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: Synthroid 100mcg
Current Illness:
Preexisting Conditions: Have been previously diagnosed (many years ago) with ulcerative colitis.
Allergies:
Diagnostic Lab Data: I called Dr. (gastroenterologist) to report symptoms. Still waiting on a call back on advice on what to do.
CDC Split Type:

Write-up: I woke up this morning around 7:45am with severe stomach cramping and pain and had to go to the bathroom. I noticed my intestinal lining shedding when I went to the bathroom. I feel like I am having a flare up of my ulcerative colitis.


VAERS ID: 1586996 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Dysarthria, Feeling abnormal, Swollen tongue
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Anticholinergic syndrome (broad), Dementia (broad), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), 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: Norvasc Vitamin C Calcium Carbonate Vitamin D3 Temovate Ointment Lotrisone Cream Premarin Cream Folic Acid Ibuprofen Multivitamin Prilosec
Current Illness: We are unaware of any illnesses prior to vaccination or at time of vaccination.
Preexisting Conditions: Gastritis with intestinal metaplasia of stomach Diffuse connective tissue disease GERD Sjogren''s syndrome SOB Palpitations Grade 3 Hemorrhoids Pulmonary embolism Chest Pain Near Syncope Essential Hypertension Lichen sclerosus
Allergies: Monosodium Glutamate Oxycodone Shellfish Derived Spinach Sulfated Mucopolysaccharides Tomato Codeine Morphine Chicken Derived Cinnamon Potato Red Dye Soy Strawberry
Diagnostic Lab Data: N/A-Patient went to emergency department for evaluation
CDC Split Type:

Write-up: Patient reported to front desk staff that she was "feeling funny". Nursing staff overheard this conversation and immediately brought patient into an exam room for evaluation. Patient has many allergies and history of anaphylaxis. Patient carries her own Benadryl and EpiPen. Patient reported tongue swelling, slurred speech and dizziness. Dr. was asked to evaluate patient and instructed her to take the Benadryl. Patient took the Benadryl that she had brought along to the appointment. There was a nurse in the room to observe the patient and the patient was not left alone at any point in the visit. EMS was called and patient was transported to the emergency department for further evaluation. Patient reported that her symptoms were improving prior to going with EMS to the ED.


VAERS ID: 1586998 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021C21A / 1 LA / IM

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

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

Write-up: 12:17 PM Patient started feeling lightheaded and felt heart rate up. Feeling pressure behind ears. Vitals were taken: BP 152/102, Pulse 115, O2 98%, Respiration 18, Temp 97.9 12:22PM Patient started feeling better, stated episode had passed. High blood pressure runs in his family. Offered to retake vitals, patient refused. Advised to monitor blood pressure and see his primary care doctor. Monitored for additional 15 minutes, patient stated he felt better. Patient was cleared.


VAERS ID: 1587005 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-08-18
Onset:2021-08-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site pain, Pyrexia, Tinnitus
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Hearing impairment (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Soreness in arm at injection sight, fever, ringing in ears


VAERS ID: 1587011 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Dysgeusia, Feeling hot
SMQs:, Taste and smell disorders (narrow), 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: fainting
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Light-headedness, metallic taste in mouth, felt like fainting and felt hot.


VAERS ID: 1587012 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 LA / IM

Administered by: Public       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: Latuda, LamoTRIgine,
Current Illness: NA
Preexisting Conditions: Seisure, anxiety, mild depression
Allergies: NKDA
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: Pt received the Janssen (Johnson & Johnson) vaccine at age 17.


VAERS ID: 1587018 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: New York  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Feeling hot, Headache, Pain in extremity, Paraesthesia, Tremor
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

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

Write-up: Shortly after vaccine was administered patient complained of Tingling in arms and shakiness in hands. He stated his head felt warm (99.4) and had a slight headache. After sitting in store for a while (20-30 minutes) patient felt better and went home with a slightly sore arm.


VAERS ID: 1587021 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-18
Onset:2021-08-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Headache, Muscle spasms, Myalgia, Pyrexia, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Experienced chills/fever, painful muscle spasms afterwards and during the night (they have improved the next day), emesis occurred at 3 am, headache


VAERS ID: 1587022 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-03-25
Onset:2021-08-19
   Days after vaccination:147
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 044A21A / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Angioedema, COVID-19, Malaise, SARS-CoV-2 test positive, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Angioedema (narrow), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal allergic conditions (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: METOPROLOL ER 25MG, INDOMETHACIN 50MG, ALLOPURINOL 300MG, TRAZODONE 100MG, ATROVAZTAN 40MG
Current Illness:
Preexisting Conditions: HYPERTENSION, IV DRUG ABUSE, CHF, HYPERCHOLESTEROLAEMIA
Allergies: NKA
Diagnostic Lab Data: SARS COV2 COVID19 PCR POSITIVE
CDC Split Type:

Write-up: Fully Covid-19 vaccinated with Covid-19 positive test and Covid-19 symptoms. Syncope and Angioedema


VAERS ID: 1587024 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Feeling abnormal
SMQs:, Dementia (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: Bisoprolol, Alopurinol, Zyrtec
Current Illness: Dermatitis, Tinea Corporis
Preexisting Conditions: Moderate Hypertension
Allergies: Yes
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Stay there 20 minutes after vaccine. Right after I left started to feel strange stopped at the store down the street went inside for 40 minutes until it passed. Was like doing 4 shots of tequila in 2 minutes. Leaned up against shelf and my shopping cart for about 5 minutes at one point. Walked around the store for a while and then drove home, now 2 hours later and I am fine.


VAERS ID: 1587042 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-06-12
Onset:2021-08-19
   Days after vaccination:68
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Injected limb mobility decreased, Pain in extremity
SMQs:, Tendinopathies and ligament disorders (broad)

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

Write-up: Symptoms like described with Parsonage Aldren Turner Syndrome. Severe arm pain in brachialis. Happened over night. Intense. Trouble straightening arm.


VAERS ID: 1587052 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032B21A / 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? 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: 2nd dose of vaccine was given 3 days to early.


VAERS ID: 1587073 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 088D21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Flushing, Hyperhidrosis, Tremor
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Vestibular disorders (broad), Hypersensitivity (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: Systemic: Dizziness / Lightheadness-Mild, Systemic: feeling like he was going to pass out-Mild, Systemic: Flushed / Sweating-Mild, Systemic: Shakiness-Mild, Additional Details: Laid patient on floor in Pharmacy, legs elevated, fan on, patient never passed out, but was observed for 30 minutes, recovered and feeling fine when he left the store


VAERS ID: 1587083 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Nebraska  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 1 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest discomfort, Headache, Photosensitivity reaction, Pruritus
SMQs:, Anaphylactic reaction (narrow), Systemic lupus erythematosus (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: flu vaccine in 2019
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: reported allergy to egg component of flu vaccine in 2019. also reported allergy to cat''s claw.
Diagnostic Lab Data: referred to ER when she reported chest tightness
CDC Split Type:

Write-up: about 20 mins after admin, she reported frontal Headache and photosensitivity. then 30 mins after that reported general pruritis and chest tightness. Vital signs were stable throughout, WNL BP and pulse and SAO2 consistently $g95%.


VAERS ID: 1587088 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Feeling hot, Hyperhidrosis, Nausea
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Vaccine was administer at 12:45 pm. While patient was in the observation area at approximately 12:58 pm she began to experience light-headedness, nausea, and sweating (felt warm). The pharmacist had the patient lie down and she was given juice after approximately 5 minutes of lying down. She was observed for 15 minutes while she remained in a seated position on the floor and drank juice. All symptoms resolved by 1:20 pm. She was observed for another 15 minutes and demonstrated that should could stand up without symptoms at 1:35 pm.


VAERS ID: 1587115 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Mississippi  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH W0175 / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Dyspnoea, Rash, Throat tightness
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Alprazolam 0.5, Aripiprazole 10, Trintellix 5 mg, Zafemy 150 mcg-35 mcg/24 hr transdermal patch
Current Illness: None
Preexisting Conditions: None
Allergies: NKA
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient complained of a tightness in her throat and feeling short of breath within minutes following vaccination. She also felt dizzy and light headed. She was immediately taken to an exam room and vital signs were taken. Vital signs were stable. Sa02 was 99%. Several minutes later she developed a rash on the left side of her neck. Benadryl 25 mg po was given. Patient remained in exam room and monitored for 1 hour. About 15-20 minutes after injection the shortness of breath and throat discomfort resolved. 1 hour after vaccine all symptoms were resolved.


VAERS ID: 1587117 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0175 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blindness, Feeling hot, Hyperhidrosis
SMQs:, Neuroleptic malignant syndrome (broad), Glaucoma (broad), Optic nerve disorders (broad), Retinal 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: multivitamin
Current Illness: none known
Preexisting Conditions: none known
Allergies: amoxicillin = skin reaction
Diagnostic Lab Data: none known at this time
CDC Split Type:

Write-up: Patient stated that her vision blacked out - had loss of vision and was overheated - pt described as "hot and sweaty". Patient was alert and responsive and had no difficulty breathing. Patient did not have any swelling of mouth, face, lips, or throat and did not experience any nausea or dizziness. Attempted to take patient''s blood pressure and when the cuff expanded, patient stated she was losing vision again. Patient began to lose vision ~5 minutes after initially receiving vaccine and regained vision shortly after. Paramedics were called to the pharmacy.


VAERS ID: 1587120 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-08-17
Onset:2021-08-19
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 1 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Cold sweat, Hypoaesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Hypoglycaemia (broad), Sexual dysfunction (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: Lisinopril- 10mg daily, Otezla-30mg daily, Lexapro- 15mg daily
Current Illness: None
Preexisting Conditions: Psoriasis
Allergies: No
Diagnostic Lab Data: None. They told me not to worry
CDC Split Type:

Write-up: I am breaking out in cold sweats and the right side of my forehead is numb as if I have been to the dentist and received a shot of Novocain.


VAERS ID: 1587138 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Chest discomfort, Feeling cold, Feeling hot, Joint stiffness, Tenderness
SMQs:, Anaphylactic reaction (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: states that as a child after the polio vaccine he developed a rash
Other Medications: Aspirin, "water pill"
Current Illness: None
Preexisting Conditions: hypetension, "low blood sugar", anxiety
Allergies: codeine - rash
Diagnostic Lab Data: None on site
CDC Split Type:

Write-up: Patient intially stated that "everything is bright" and felt hot and then cold. He also c/o "tightness" of the left chest and shoulder without radiation down the arm or to the neck. HR 88, heart normal S1, S2 no m/g/r, lungs clear to ausculation with normal respiration effort and rate, radial pulse 2+ b/l. + focal tenderness to palpation of the left chest wall at rib 3 costochondral junction and also more laterally (patient stated he was lifting heavy equipment earlier in the day). No pressure, no dizziness or syncope, no sweating. Patient rested and given water to drink. Symptoms of brightness and hot/cold resolved. After 40 minutes patient still c/o feeling of tightness in chest - not worse but still present, no change in physical exam. Patient to go by private car to ED for further evaluation but not driving himself. He left vaccination room with site manager who was to assist him with a ride, wife was on way to the site. Instructed that if pain significantly worsened or he developed any SOB in the meatime that ambulance should be called.


VAERS ID: 1587177 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Female  
Location: Montana  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 1 - / IM

Administered by: Other       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: na
Current Illness: na
Preexisting Conditions: na
Allergies: na
Diagnostic Lab Data: na
CDC Split Type:

Write-up: Patient presented to the clinic without a form of ID. Mother and child confirmed her date of birth on paperwork and verbally to the staff. First dose of pfizer was given and patient was discharged after 15 minute waiting period. Data entry personnel found patient''s information in two different vaccine tracking systems. Her birthdate was not what was originally reported. 3 attempts to reach the mother were unsuccessful. The patient was flagged in the clinic''s tracking system and will have staff re-educate mother on the need to wait until the patient turns 12 in November 2021. No adverse reaction to the vaccine was noted in the clinic prior to discharge.


VAERS ID: 1587182 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 1 LA / IM

Administered by: Military       Purchased by: ?
Symptoms: Flushing, Nausea, Pruritus, Rash, Rash erythematous, Rash pruritic, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: xeljanz bid ibuprofen prn prednisone 5mg qDaily
Current Illness: None
Preexisting Conditions: Rheumatoid arthritis
Allergies: benadryl, amoxicillin, PCN, iodine, ASA, morphine, latex, tylenol w/ codeine, shellfish
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Pt administered vaccine at 1413, at around 1430 pt started feeling flushed, nauseous, and pruritic, pt vomited x1 and felt marginally improved, but still had pruritic erythematous rash on chest. Pt''s vitals at 1440 were 99% spO2, HR 120, BP 142/93, patient was protecting airway, oropharynx clear, denied dyspnea or SOB. Pt was not administered any benadryl as she has an allergy to it. Patient was observed by a medic and felt much better by 1500, vitals then were 100% spO2, HR 109, BP 128/82, RR 12, no audible wheezes, no acute distress. Patient was given some water to drink, given ER precautions, and allowed to leave with her son.


VAERS ID: 1587188 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 2 RA / 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? 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: n/a
CDC Split Type:

Write-up: Patient received Moderna first dose 7/22, but was accidentally scheduled for Pfizer 2nd dose, Vaccinator gave Pfizer without looking at the card or patient record first. Patient was informed of error and what to expect as far as side effects.


VAERS ID: 1587192 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest discomfort, Dizziness, Dyspnoea
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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: meperdine, phenylephedrine pseudowphedrine sulfa
Diagnostic Lab Data: none
CDC Split Type:

Write-up: SOB , feeling like she was going to pass out. chest pressure


VAERS ID: 1587206 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Dizziness, Formication, Headache, Palpitations, Throat irritation
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: cephalosporin- rash and shortness of breath. Nickel- rash. PCN- vasovagal at age 10 years. Zinc-rash
Diagnostic Lab Data:
CDC Split Type:

Write-up: Here with husband for Pfizer Covid vaccine #2 dose. Member states she felt dizzy last time after her 1st covid vaccine . Member taken to holding room. Member laid down on stretcher. 11:20 am Pfizer covid vaccine given to member in RD. Bed rail up. 11:23 am member c/ of itchy throat like ants crawling and Headache. No c/o of throat closing or swelling of tongue. HOB up 45 degree angle. Color normal. VS:BP 107/58, 99% O2 sats 71 pulse, 20 RR 11:30 VS BP 106/63, 75 P, 96% O2 sat. At 11:35 am c/o headache increased pain scale 10/10, dizzy, R side chest Pain and little palpitation. 11:36 Dr. notified via CHAT 11:38 Accu check 115 11:42 member states she has no CP, no tingling in throat, but still has little palpitation. No throat pain or tongue swelling. VS BP 110/58 82 P, O2 sat 96%. 11:44 am Dr. called. Information aboive given to MD. Per Dr., member to be monitored for now. 11:48 Pt handed to RN for care. RN aware of member''s situation. 12:20 VS 110/77 BP. 80 Pulse. 98% O2Sat. 12:40 HA pain now 6/10. Mbr feels better. Left in no distress. 12:15pm Dr aware that the only symptom that pt complains about now is a h/a. Painscale 10/10. Per Dr , tylenol 1000 mg po x 1 dose for h/a, given and tol.


VAERS ID: 1587222 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: prenatal vitamins preparation for pregnancy
Current Illness: denies
Preexisting Conditions: denies
Allergies: denies
Diagnostic Lab Data: Vital signs stable elevated patients feet applied ice pack BP Readings from Last 3 Encounters: 08/19/21 138/87 08/19/21 (!) 144/90 07/17/21 109/80 Pulse Readings from Last 3 Encounters: 08/19/21 77 08/19/21 92 07/17/21 55 transferred patient to Urgent Care
CDC Split Type:

Write-up: patient became dizzy and nauseated 4 minutes post vaccine administration


VAERS ID: 1587232 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 RA / IM

Administered by: Work       Purchased by: ?
Symptoms: Epistaxis, Rhinorrhoea
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow)

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

Write-up: reports that starting the same evening @ 2130 he noticed drainage from his nose. reports that it was blood. states that this intermittently happened x4 days. each episode lasting less than 5 min. resolved on it''s own. did not need to seek emergency treatment.


VAERS ID: 1587250 (history)  
Form: Version 2.0  
Age: 10.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 1 RA / IM

Administered by: Private       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: N/A
Current Illness: no
Preexisting Conditions: no
Allergies: none
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Vaccination Error. 10 year old patient received Pfizer BioNTech vaccine. Patient was observed for 30mins with no adverse reaction noted.


VAERS ID: 1587254 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0170 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Loss of consciousness, Malaise, Respiratory arrest
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (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), Hypersensitivity (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: No Medical history per spouse
Allergies: Penicillin - Hives Shellfish, Nickel, Cobalt
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Approximately 5 minutes after administration of the vaccine, the patient mentioned to her husband that she did not feel well. She then became unconscious and stopped breathing. Immediately after, 0.3 mg of epinephrine was administered to the right thigh. The patient did not respond to this dose, so another 0.3 mg was administered. The patient then began to breathe and responding to my voice. The patient was then able to speak and sit up shortly after. EMS arrived, took vitals, and took her to the nearest hospital.


VAERS ID: 1587271 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-01
Onset:2021-08-19
   Days after vaccination:49
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (UNKNOWN)) / UNKNOWN MANUFACTURER - / 1 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Epidural catheter placement, Epidural haemorrhage, Exposure during pregnancy, Gestational hypertension, Haematocrit decreased, Haemoglobin decreased, Induced labour, Platelet count normal, Postpartum haemorrhage, Thrombosis
SMQs:, Haematopoietic erythropenia (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (broad), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Accidents and injuries (broad), Hypertension (narrow), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (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? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: NKDA
Diagnostic Lab Data: labs drawn 8/19/2021 before delivery: - hemoglobin: 11.3 g/dL - hematocrit: 33% - platelet count: 206,000
CDC Split Type:

Write-up: pt was 39 weeks and 4 days pregnant. mild pregnancy-induced hypertension at end of pregnancy. Induced labor. Delivered on 08/19/2021, viable newborn weighed 7lb 8oz. Pt had abnormal/prolonged bleeding after IV stick, epidural placement, and post partum/post-delivery. Difficulty controlling bleeding from epidural sight even with continuous applied pressure. Heavy post partum bleeding requiring multi-drug therapy and manual clot extraction to control bleeding.


VAERS ID: 1587282 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Blood glucose normal, Hyperhidrosis, Loss of consciousness, Pallor, 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Zyprexa
Current Illness: NA
Preexisting Conditions: Anxiety, Autistic
Allergies: NKDA
Diagnostic Lab Data: 1328 BP 96/58 P 68 02 SAT RA 98% 1335 BP 120/62 P62 99% RA BG 126
CDC Split Type:

Write-up: Pt became pale after receiving his vaccination and passed out and had seizure like activity and became diaperetic


VAERS ID: 1587286 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-08-16
Onset:2021-08-19
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 049B21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Ear swelling
SMQs:, Angioedema (broad), Hypersensitivity (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: No Chronic Conditions
Allergies: Dog Hair, Dust Mites, some beauty products
Diagnostic Lab Data:
CDC Split Type:

Write-up: My left ear lobe is swelling. Woke up with it. Took Allegra and it''s held steady so far. This happened on my Dose # 1 as well, except it got out of hand and both ears swelled. Dose No. 1 was 00ZC21A (cannot tell if Z or 2 as written on card) given on 5/5/2021. I also had mysterious swellings in my eyelids, nose area, and face (but not moon shaped). I also got a four inch rash 7 days after the first dose that took several days to disappear. Went to urgent care a week before dose two was due, doctor said my ear drum was swollen but no evidence of infection. Got a primary care physician to get checked out. She noted I was inflamed looking in my mouth/throat. We did blood tests. She suggested Flonase and Allegra and referred me to Allergists for the face swellings. I went and the idea so far was contact dermatitis; they didn''t think it the vaccine and it''s okay to get dose two. Which I did, last Monday morning. However, this newest swelling seems very unlikely to be contact dermatitis because I haven''t used any products, purposely trying to avoid what happened last time. However the date range is one day faster than last time-- where four days later my ear swelled; today is three days and wah la- Swelling again. If I''m on track like last time (Dose 1) I will get a four inch (I hope no larger) rash at day 7 at the site of the injection.


VAERS ID: 1587293 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-18
Onset:2021-08-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Tachycardia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (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: none
Current Illness: none
Preexisting Conditions: none
Allergies: nonJanssene known
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Tachycardia withut chest pain, to a rate 120 bpm. On a previous occasion, BUT just reported to me today, Patient states he had runs of tachycardia up to 170 bpm, at time of first Modern injection. Tachycardia to rate of 170 associated with first and only Moderna injection of COVID vaccine.).


VAERS ID: 1587308 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: South Dakota  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Hyperhidrosis, Immediate post-injection reaction, Loss of consciousness, Nausea, Nervousness, Pallor
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), Guillain-Barre syndrome (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), 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: NONE
Allergies: NONE
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was here with her mother for her first covid 19 vaccine. Patient stated that she got nervous when when got shots and felt a little nauseous during the administration. immediately after the immunization the patient became pale and sweaty. she placed her head on the table in front of her and stated she just needed to rest. She then tried to sit up and seemed to loose consciousness for just a moment. the patient never fell or hit anything. She was weak, pale, and sweaty. We provided water, orange juice, and candy to the patient. We provided an ice pack and towels for comfort. She felt better within 30 minutes and went home.


VAERS ID: 1587313 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021C21A / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Dizziness, Flushing
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), 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: 1:16 After patient received vaccine; started feeling lightheaded and face was flushed. Vitals were taken to assess her symptoms: BP 142/96, heart rate 101, O2 98%, respiration 22, temp 97.2 Patient stated she felt better. Stated she had not eaten today only drank coffee. Was given water to drink and cleared.


VAERS ID: 1587317 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-08-17
Onset:2021-08-19
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Oedema peripheral
SMQs:, Cardiac failure (broad), Angioedema (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: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: unknown
Diagnostic Lab Data: unknown
CDC Split Type:

Write-up: Patient stated that he notice that he had a slight swelling under his armpit on his left arm. There is no redness and it is not sore. He noticed this today 08/19/2021


VAERS ID: 1587320 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-18
Onset:2021-08-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 2 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0142 / 1 RA / IM

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

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

Write-up: Client received a Pfizer 1st dose on 12/31 and J&J on 8/19/21. No A/R reported to date.


VAERS ID: 1587329 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Idaho  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040C21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Feeling hot, Hyperhidrosis, Pain
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: none know or listed by patient
Current Illness: none known or listed by patient
Preexisting Conditions: none known or listed by patient
Allergies: None known or reported by patient
Diagnostic Lab Data: none given
CDC Split Type:

Write-up: Prior to vaccination, patient reported being afraid of needles and afraid of medical procedures. Patient was advised to stay in the store for 15 minutes after vaccination to make sure he didn''t have a reaction. He left the pharmacy area to go to the deli, then returned to the pharmacy area about 5 minutes later and reported feeling very hot and light headed. He appeared very pain and was sweating. He did not report any shortness of breath, no tingling lips, and no tingling/scratchy throat. He was given 25mg diphenhydramine and was advised to stay in the pharmacy for observation. He reported feeling much better and thought he was having anxiety and not a true reaction.


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