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From the 6/11/2021 release of VAERS data:

Found 352,386 cases where Vaccine is COVID19 and Patient Did Not Die



Case Details (Reverse Sorted by Onset Date)

This is page 104 out of 3,524

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VAERS ID: 1390736 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-05-23
Onset:2021-05-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Analgesic drug level, Apnoeic attack, C-reactive protein, Electrocardiogram abnormal, Endotracheal intubation, Full blood count, Hyperventilation, Laboratory test, Metabolic function test, SARS-CoV-2 test positive, Sinus tachycardia, Tachycardia, Toxicologic test, Troponin normal
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Acute central respiratory depression (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (narrow), Infective pneumonia (broad), Dehydration (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: CBC, CMP, troponin, CRP, urine tox, acetaminophen and salicylate level
CDC Split Type:

Write-up: Patient presented hyperventilating, tachycardic and eventually became apneic and required intubation; had COVID in the past; was COVID IgG positive; troponin normal; ECG sinus tachycardia; all other labs normal on 5/22 and 5/23


VAERS ID: 1391727 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-05-20
Onset:2021-05-23
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-06-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034C21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood creatine phosphokinase normal, Chest pain, Electrocardiogram T wave inversion, Electrocardiogram abnormal, Leukocytosis, Myocarditis, Pain in extremity, Troponin increased
SMQs:, Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Other ischaemic heart disease (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypokalaemia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Amphetamine-dextroamphetamine ER 25 mg, fluoxetine 40 mg, and levonorgestrel-ethinyl estradiol 0.15-0.03 mg (Inrovale)
Current Illness:
Preexisting Conditions: Hx of SVT s/p ablation and depression
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: 18 yo female presented to ED with midsternal chest and left arm pain 3 days post 2nd dose of Moderna vaccine. Upon arrival to hospital patient was hemodynamically stable (BP 120/80, HR 70, O2 sats 100% on RA). Troponins drawn and noted to be uptrending (1.17 then 4.66 after 3 hours). Patient had mild leukocytosis (12) and EKG showed T-wave inversion at V1 and V2. CK was normal. Patient treated for myopericarditis and discharged home after 1 day.


VAERS ID: 1333341 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-05-13
Onset:2021-05-22
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site cellulitis, Injection site rash, Injection site warmth
SMQs:, Hypersensitivity (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received shot and believed that technique on vaccination was inappropriate causing patient to develop SSTI (cellulitis). Patient saw red rash that was very warm to touch on arm at injection site. Patient went to urgent care and given oral antibiotics (Keflex) for infection on arm.


VAERS ID: 1340561 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: New York  
Vaccinated:2021-05-21
Onset:2021-05-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 AR / IM

Administered by: Private       Purchased by: ?
Symptoms: Cerebrovascular accident, Computerised tomogram, Laboratory test
SMQs:, Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Eliquis, HAART, divalproex, Sertraline
Current Illness: HIV, crohn''s disease, HTN, CVA (multiple), DVT
Preexisting Conditions: HIV, crohn''s disease, HTN, CVA (multiple), DVT
Allergies: Azithromycin, Haldol, Lisinopril
Diagnostic Lab Data: Laboratory work up and CT scan showing no bleeding.
CDC Split Type:

Write-up: Pt presenting with symptoms consistent with acute stroke within 24hr after receiving vaccine. Pt has hx of prior strokes before.


VAERS ID: 1340668 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 1 LA / IM

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

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

Write-up: Patient was feeling dizzy. Patient was put on the floor with there feet up in the and then the patient was feeling better so the patient was on the chair when we went out to get him. Patient was given water and a snack. We took the patients vitals at 8:40 am heart rate 61, resp 18, Blood pressure 84/46 and o2 99%, 8:56 heart rate 66, resp 17, Blood pressure 94/58, o2 98%, and again at 9:07 am heart rate 67, resp 18, Blood pressure 91/52 o2 100 %. Mother stated that he has low heart rate. Patient was feeling better so we released the home with his mother at 9:16 am.


VAERS ID: 1340694 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 LA / -

Administered by: Other       Purchased by: ?
Symptoms: Presyncope
SMQs:, Anticholinergic syndrome (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Vaso Vagel reaction


VAERS ID: 1340718 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: D.C.  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6208 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Throat irritation, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (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: possibly penicillin when he was young
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Within minutes of getting his vaccine, he felt his throat tighten with mild itching of his throat. He was assessed with normal vital signs, no wheeze, no emesis, no rash. He felt better quickly without intervention. He was observed for 45 minutes and we practiced some calming visualization strategies.


VAERS ID: 1340733 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness:
Preexisting Conditions: Hx: of vasovagal episodes
Allergies: Amoxicillin
Diagnostic Lab Data: Vital signs 10:28 am - B/P 125/77, HR 64, Spo2 99% - supine 10:33am - B/P 129/80, HR 70, Spo2 100% - sitting up
CDC Split Type:

Write-up: Pt felt faint while sitting in her chair after receiving vaccine, she lowered herself to the floor and elevated her legs. No LOC. Vital signs obtained and WNL as recorded. Rested in supine position and sipped fluids. She felt better and was able to sit up, then stand and ambulate freely without difficulty. Left for home with mom after 30 minutes of observation.


VAERS ID: 1340735 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808986 / UNK - / IM

Administered by: Other       Purchased by: ?
Symptoms: Bradycardia, Dizziness
SMQs:, Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (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: None
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Dizziness, bradycardia


VAERS ID: 1340738 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-21
Onset:2021-05-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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 had asked to get moderna vaccine. A drawn up Janssen vaccination was provided to nurse to administer by myself. The error was figured out and the patient contact was attempted to update them.


VAERS ID: 1340740 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-05-21
Onset:2021-05-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007B21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Supraventricular tachycardia
SMQs:, Supraventricular tachyarrhythmias (narrow)

Life Threatening? Yes
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: pSVT
Allergies: Bee venom, propofol anesthetic
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Experienced SVT at 4:45 AM the day after 2nd vaccination (heart rate =219 bpm. SpO2=99%). Took25 mg metoprolol tartrate. Rythm broke at 5:20 AM, when heart rate returned to 98 bpm, SpO2=98%.


VAERS ID: 1340748 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Nausea
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Nausea Patient brought in to medical screening for evaluation by medics. Left on stable condition at 09:59. Vital signs at 9:47 BP 81/54 at 09:55 HR : 64 BP: 100/59


VAERS ID: 1340750 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821286 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fear of injection, Nausea, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Patient took a hydroxyzine, per her mother.
Current Illness: No known other illnesses
Preexisting Conditions: Anxiety
Allergies: No known allergies
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: The patient fainted a minute after receiving the vaccine, woke up a minute later, and felt very nausiated 5 minutes after waking up. The patient expressed a lot of fear prior to the vaccine, due to a fear of syringes. Her guardian was around to help make sure that she did not suffer any injuries during syncope.


VAERS ID: 1340753 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-05-21
Onset:2021-05-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, Back pain, Chills, Eye pain, Headache, Hot flush, Myalgia, Restlessness
SMQs:, Rhabdomyolysis/myopathy (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Akathisia (broad), Noninfectious encephalopathy/delirium (broad), Glaucoma (broad), Eosinophilic pneumonia (broad), Arthritis (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: Accutane 40mg bid, vyvanse 40mg sid
Current Illness: No
Preexisting Conditions: No
Allergies: No
Diagnostic Lab Data: N/a
CDC Split Type:

Write-up: Muscle and joint pain, hot flashes and cold chills, restlessness, headache and pressure behind the eyes, lower back pain


VAERS ID: 1340765 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Military       Purchased by: ?
Symptoms: Presyncope
SMQs:, Anticholinergic syndrome (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Vaso Vagrl


VAERS ID: 1340778 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821286 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Amnesia, Head injury, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Noninfectious encephalopathy/delirium (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Patient fainted after leaving booth . It appears she may have whacked her head on the concrete floor. No blood. She was back to consciousness but didn''t remember what happened. Ambulance came, took her away in stretcher.


VAERS ID: 1340795 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Fall, Seizure
SMQs:, Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Vestibular disorders (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

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

Write-up: Pt. fell to floor from chair, dizziness, possible seizure activity 12 Lead, started IV, 0 meds. Vital signs: 89/40 Pulse:60 89/41 Pulse :55 89/42 Pulse:56 Recorded by RN. Pt. transported to hospital via ambulance at 11:32 A.M. with mother.


VAERS ID: 1340796 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 1 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Dizziness, Dysphagia, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient reported throat tightness and dizziness exactly 19 minutes after the vaccine was given. Patient could still speak. She was advised for sip of water to see how she does and reported difficulty of swallowing. She verbalized experiencing the same thing when she received her flu vaccine about 10 years ago. Immediately sent to ER via wheelchair. Patient continued to be verbal until the arrival to ER.


VAERS ID: 1340803 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-04-30
Onset:2021-05-22
   Days after vaccination:22
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Amenorrhoea, Menstruation irregular, Pregnancy test negative
SMQs:, Fertility disorders (broad)

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

Write-up: Menstrual cycle is 7 days late post vaccine. Tested negative for pregnancy. Cycle is Normal at 26-27 days and currently on day 33 with no period.


VAERS ID: 1340809 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 1 LA / IM

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

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

Write-up: Pt. Reported numbness, "tingling", brought to med. screening for evaluation. Felt better upon lying down, drinking water . left in stable condition @10:07 Vital signs at 10:00 Pulse: 64 PO2:99% BP: 108/70 Recorded by RN Evaluated


VAERS ID: 1340836 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Confusional state, Dizziness, Hyperhidrosis, Loss of consciousness, Pallor, Palpitations
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), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

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

Write-up: Patient had vaccine and entered waiting area for monitoring period. Started feeling dizzy and started to sit on ground but passed out while transferring to ground. Patient came to confused, pale, sweating and then proceeded to pass out 2-3 additional times. EMS was called as a precaution since patient reported feeling confused, weak, heart palpitations. Patient was advised to remain on the ground while waiting for EMS and was given an ice pack, water, juice and crackers.


VAERS ID: 1340851 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033B21A / 1 RA / IM

Administered by: Unknown       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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Flu vaccine when he was 16 years old, lightheadedness, nausea
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient felt lightheaded and nauseated about 10 minutes after receiving vac


VAERS ID: 1340853 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: D.C.  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6208 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Fall, Feeling hot, 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), Accidents and injuries (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

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

Write-up: After 3 minutes of observation in a chair, he got up to move to the observation area in clinic and then fainted. He fell backward against a closed door and slid down. He quickly regained consciousness and his vitals were stable. within 10 minutes he was no longer dizzy or hot. He was able to sit up right without issues. Per dad, this is the same reaction he had to the flu vaccine in fall of 2020.


VAERS ID: 1340871 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Dysphagia, Immediate post-injection reaction
SMQs:, Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Hypersensitivity (narrow)

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

Write-up: Patient felt like she could not swallow , she was able to drink water without difficulty. We took the patients vitals at 12:35 pm heart rate 96, resp 20, o2 99, blood pressure 120/84, again at 12:45 pm heart rate 92, resp 20, o2 98 and blood pressure 123/73. Asked how the patient was feeling. The patient was feeling better so we released her home with mom at 12:46 pm.


VAERS ID: 1340880 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Presyncope, Retching, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Patient had vasovagal reaction and dry heaving. Fainting resolved within 30 to 60 seconds


VAERS ID: 1340883 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 1 - / -

Administered by: Other       Purchased by: ?
Symptoms: Pharyngeal swelling, Sensation of foreign body
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Patient feeling her throat is swollen with a lump vs sat 98% HR 81 bp 131/70 patient felt better immediately after IM Benadryl was OBS for 45 mins and requesting discharge home was with mother


VAERS ID: 1340897 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Nausea
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Nausea Seen by EMS, Pt. left in stable condition at 12:06


VAERS ID: 1340909 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / UNK - / IM

Administered by: Other       Purchased by: ?
Symptoms: Gastrooesophageal reflux disease, Sensation of foreign body, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific dysfunction (narrow), Hypersensitivity (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:
Preexisting Conditions:
Allergies: pollen
Diagnostic Lab Data:
CDC Split Type:

Write-up: Feeling of tightness in the throat and like a lump and acid reflux not getting better IM Benadryl felt better immediately OBS vs 99% HR 116 BP 115/73


VAERS ID: 1340918 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW-0167EX / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Syncopal episode


VAERS ID: 1340929 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), 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: no
Preexisting Conditions: no
Allergies: Penicillin
Diagnostic Lab Data: BP 10:30 = 120/80; HR 58 BP 10:40 = 120/78 BP 11:20 = 116/80 HR 60
CDC Split Type:

Write-up: patient slumped, syncopal episode for less than 2 seconds. Awakened stating "I feel light headed". Site staff reported event to NP right way, at 10:30am, BP 120/80 pulse of 58, Patient''s mother came to patient''s side, repeat BP 120/78, pulse 58; , repeat again at 11:20 116/80, pulse 60. Mother declines EMS. Patient in good spirits, A&ox4, and left site with mother normal gait and affect.


VAERS ID: 1340940 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0813 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal discomfort, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

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

Write-up: Patient experienced an upset stomach after getting her first dose of the pfizer vaccine. She ended up throwing up but felt better afterwards.


VAERS ID: 1340955 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Flushing, Hyperhidrosis
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (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-Medium, Systemic: Flushed / Sweating-Medium


VAERS ID: 1340956 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood pressure measurement, Dysstasia, Hypotension, Pallor, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

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

Write-up: Patient got her 1st dose of Pfizer vaccine, was told by provider and mother to sit down for 15 minutes. After awhile patient ''s mom came back to pharmacy and alert us patient is fainting. I came to patient and she could barely stood up. patient looked pale. We assisted patient to come to pharmacy sitting area. I measured patient ''s bp. BP reading was 60/43 and 70HR. Patient ''s mom informed us she has not been drinking or eating breakfast, so they went to grab some snacks while waiting and that was when patient fainted. A by stander called 911 when patient first fainted. EMS came and brought patient to ER for further check up.


VAERS ID: 1340966 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anaphylactic reaction, Dyskinesia, Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Anaphylactic/anaphylactoid shock conditions (narrow), Dyskinesia (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: TREE NUT ALLERGIES
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Post vaccination patient lost consciousness, had involuntary muscle movements. mother was worried same reaction patient had during anaphylactic reaction to tree nut allergy and insisted to use the epipen patient had on hands and rph administered epipen and contacted paramedics


VAERS ID: 1340967 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Confusional state, Dizziness, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Confusion-Mild, Systemic: Dizziness / Lightheadness-Mild, Systemic: Fainting / Unresponsive-Mild


VAERS ID: 1340970 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8735 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Heart rate increased, Nausea, Skin warm, Tachycardia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Systemic: Dizziness / Lightheadness-Mild, Systemic: Nausea-Mild, Systemic: Tachycardia-Mild, Systemic: Vomiting-Mild, Additional Details: about 15 min after shot, she said felt warm and felt heart rate increases, when i took bp 135/90, hr 78, she said only last a few minutes


VAERS ID: 1340984 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8735 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Nausea, Nervousness, Vomiting
SMQs:, Acute pancreatitis (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Systemic: Dizziness / Lightheadness-Mild, Systemic: Nausea-Mild, Systemic: Vomiting-Mild, Additional Details: she was nervous, after shot felt nausea, lightheaded, and vomited up some water.


VAERS ID: 1340985 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Rash on neck and chest


VAERS ID: 1340993 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: New York  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Syncope, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Fainting / Unresponsive-Mild


VAERS ID: 1340997 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-05-21
Onset:2021-05-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 044B21A / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dyskinesia, Headache, Muscle spasms, Neuralgia
SMQs:, Peripheral neuropathy (narrow), Neuroleptic malignant syndrome (broad), Dyskinesia (narrow), Dystonia (broad), Noninfectious encephalopathy/delirium (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: Spina Bifida Occulta
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient reported headache, muscle spasms in right arm, jerking muscles, and nerve pain in the right arm. Primary care provider prescribed Cyclobenzaprine 10mg three times per day as needed for muscle spasms and Tramadol 50mg every 6 hours if needed for pain.


VAERS ID: 1340999 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Presyncope
SMQs:, Anticholinergic syndrome (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Patient had a vasovagal episode. He responded quickly after water and juice


VAERS ID: 1341000 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821286 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Feeling hot
SMQs:

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

Write-up: Patient felt very warm after receiving Janssen vaccine. Patient was given an ice pack and a bottle of water. Patient quickly began to feel better. Pharmacist checked in with patient every few minutes. Patient sat in pharmacy area for a total of 30 minutes and felt totally back to normal when he left.


VAERS ID: 1341005 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-05-21
Onset:2021-05-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8133 / 1 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Chills, Fatigue, 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: n/a
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: n/a
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: fever of 102.5, nausea, body aches, chills, fatigue


VAERS ID: 1341009 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Loss of consciousness, Malaise
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), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

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

Write-up: Vaccine was administered. The mom made a comment that her daughter has a tendency to pass out after vaccines after administering the vaccine to the patient. We kept the patient in the counseling room seated for observation to be on the safe side. Within 5 minutes, the patient got light headed and stated she didn''t fell well. She passed out. We laid her down for about 10-15 minutes and gave her some candy since she stated she hadn''t eaten all day. Pt regained consciousness and was fine after.


VAERS ID: 1341011 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808609 / 1 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Fall, Hyperhidrosis, Pallor, Skin burning sensation, Unresponsive to stimuli
SMQs:, Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Patient - received the Johnson & Johnson vaccination (Lot # 1808609) on 05/22/2021 at 1131 in the left arm. Upon walking to observation patient fell, it was observed that he hit the back of his head by nurse at nursing station #4, nurse immediately cradled patient?s head and turned patient on his side for safety. Patient was assessed for open wounds, hematoma and bleeding. Negative findings. EMS called by RN Patient assessed RN. Patient is a 21-year-old with no past medical history per patient?s grandfather. Patient is laying on the floor, with eyes wide open, not verbally responsive, and unable to follow commands. Patient was pale and diaphoretic. Patient is awake, but not oriented to time and place. Patient also does not recall having breakfast, but his grandfather stated that he did have eggs earlier this morning. Vital signs as follow: Time 1134: BP 147/78, pulse 43, 98% room air, temp 97.1 Time 1138: BP 147/82, pulse 47, 98% room air, patient started to become response asking questions. Patient denies any lightheadedness or dizziness, he only felt a burning sensation on the back of his head. Patient?s grandfather at his side. Patient?s wallet, vaccination card and glasses given to patient?s grandfather. Time 1142: BP 125/79, pulse 64, 98% room air Privacy screen in place for confidentiality from other patients. Awaiting EMS. Incident aware 1144 EMS arrived. 1146 Patient placed in wheelchair and left the building with EMS. Patient was awake and alert upon leaving the building.


VAERS ID: 1341015 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Product preparation issue
SMQs:, Medication errors (broad)

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

Write-up: Pharmacist found expired doses of covid-19 vaccine from previous day in immunization room; shots were removed and placed in a vial in red ink "EXPIRED-DO NOT USE". vial was placed with used vials of vaccine and diluent for disposal. Immunizing technician took this vial and gave two (2) patients shots of this expired vaccine.


VAERS ID: 1341025 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Extra dose administered, Syringe issue
SMQs:, Medication errors (narrow)

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

Write-up: I was administering the dose and the syringe did not allow me to finish the dose. It was a retractable needle and it would not allow me to finish administering or retract. So the patient received a partial dose and then was given another full dose.


VAERS ID: 1341034 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood pressure measurement, Dizziness, Heart rate decreased, Tremor, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: no
Allergies: penicillin
Diagnostic Lab Data: blood pressure
CDC Split Type:

Write-up: after administering vaccine patient started to vomit and drop in his pulse, dizzy and bit shakier. after observation called 911 and paramedic came and after checking everything falls within normal limits and patient went home.


VAERS ID: 1341045 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: fainted before, but Mom was sure it was a long time before and patient wouldn''t have any issue
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was fine after vaccine administration, but while sitting down patient passed out while sitting next to her mother. Patient was laid on the floor and regained consciousness while on the floor. Eventually with other help, got patient into wheel chair. Mom didn''t want EMS called and just let patient sit for awhile until our store director in charge left with patient in wheel chair and Mom to make sure patient was alright.


VAERS ID: 1341060 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / UNK - / IM

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

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

Write-up: Patient told her mom she was not feeling well right after the vaccine. Mom told her she would go buy her an icepack to bring home to help her. The patient got up to follow her mom and fainted in the aisle. Her sister came and got the pharmacist and by the time I got to her she was already coming to. We did call an ambulance but by the time they paramedics arrived the patient was ok to leave on her own with her mom.


VAERS ID: 1341064 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood glucose decreased, Blood pressure normal, Heart rate normal, Oxygen saturation normal, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (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: none
Current Illness: none
Preexisting Conditions:
Allergies: none
Diagnostic Lab Data: BP- normal HR- normal Oxygen Levels- normal Blood sugar- 72 according to the Paramedics that came to the store to help the patient. I do not have the exact levels for the others only blood sugar.
CDC Split Type:

Write-up: Patient received her first dose of Covid-19 vaccines and were instructed to sit for 15 minutes. Shortly later she went to purchase something at the front cashier of the store and started to faint. Her mother was behind her to catch her so she didn''t hit her head but they both fell to the floor. A customer in line called Paramedics. Patient''s mom claimed she only sat for 5-10 minutes because she thought she would be fine. Paramedics arrived a few minutes later and checked the patient''s vitals. BP, oxygen levels and HR were normal according to the paramedic but blood sugar level was 72 which was low. The Paramedics told patient to sit, have a snack and stay for at least 15 more minutes and then call a ride to take them home because they walked. Patient agreed because was feeling better. 15 minutes later I checked on patient to make sure she was feeling ok and she said she was feeling better and that they were getting their ride to go home.


VAERS ID: 1341066 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: New York  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO183 / UNK - / IM

Administered by: Other       Purchased by: ?
Symptoms: Fall, Hyperhidrosis, Pallor
SMQs:, Neuroleptic malignant syndrome (broad), Accidents and injuries (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: client received vaccine, ambulated to obs room, 3-4 minutes noted to slump down in chair, caught by paramedic-transferred to strtcher, pale, diaphoretic, BP78/40, HR84, o2 sat 100.


VAERS ID: 1341067 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW05150 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dizziness, Fall, Head injury, Seizure, Skin abrasion
SMQs:, Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Vestibular disorders (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

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

Write-up: Patient began to feel light headed and asked her mom for water. Patient then fell to the side and hit her head as she fell to the floor, then had a seizure lasting 30 sec. patient was Alert and oriented x4 when we got to her. Patient stated she felt like she was falling asleep and dreaming then remembers everyone standing over her. Patient has small bump on upper left of head. Patient was taken to medical center for treatment and observation.


VAERS ID: 1341075 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0202 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Product preparation issue
SMQs:, Medication errors (broad)

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

Write-up: The vaccine batch was diluted with saline from a single-dose vial that had been previously punctured. Typical protocol is single use. Saline was properly sterilized and correct dose was given to the patient but the vial to dilute was punctured twice.


VAERS ID: 1341078 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: New York  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO183 / UNK - / IM

Administered by: Other       Purchased by: ?
Symptoms: Eye movement disorder, Fall, Hyperhidrosis, Vision blurred
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Accidents and injuries (narrow), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Ocular motility disorders (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: no
Current Illness: no
Preexisting Conditions: no
Allergies: no
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Client vaccinated, said it was good then slumped in chair, eyes rolled back. Responded to verbal commands, opened eyes ,pupils dilated, diaphoretic, took a minute for her eyes to come into focus. Paramedic to cubicle, client transported to treatment area. Observed by paramedic for 45 minutes, departed for home with Mom and brother.


VAERS ID: 1341083 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown - mom said she has an anxiety disorder and asthma
Current Illness: None known
Preexisting Conditions: Asthma
Allergies: None known
Diagnostic Lab Data: Unknown at this time
CDC Split Type:

Write-up: 15 minutes after receiving the COVID-19 vaccine from Pfizer, the patient became short of breath and dizzy. The EMS was called and she was transported to the ER


VAERS ID: 1341086 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Seizure, Vomiting
SMQs:, Acute pancreatitis (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

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

Write-up: AFTER RECIEVING VACCINE FIRST DOES PT HAD A SEIZURE AND VOMMITED. DOES HAVE HISTORY OF SEIZURES.


VAERS ID: 1341090 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-05-20
Onset:2021-05-22
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / -

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

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

Write-up: Intense headache, large swollen lymph node in left arm, smaller swollen lymph node in right arm


VAERS ID: 1341093 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033B21A / 1 LA / IM

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

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

Write-up: Approximately 10 minutes post-vaccine, patient fainted (while sitting in chair for observation) and fell to the floor. Bystanders stop to help, and I grabbed my IMZ cart to go on scene; one bystander called 911 for EMS. Patient was breathing, conscious, and had a pulse; she was coherent and able to talk. She denied hitting her head or losing consciousness. Her mother, who was with her at the time, said the patient "shook" a little after she fell. Patient stated she had not eaten all day and thought that may have contributed to her fainting. We provided patient with water, and she was able to sit up on floor and lean against the wall. EMS arrived on scene to take over. The reported her blood sugar and blood pressure were within normal limits. This may have been a vasovagal reaction. Patient was standing after EMS evaluated her, and they approved for her to leave. The patient and her mother left the pharmacy. I told them to call the pharmacy if they have any questions or concerns and to report the event to patient''s MD.


VAERS ID: 1341094 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0169 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dizziness, Loss of consciousness, Presyncope
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), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

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

Write-up: Light headed, passing out. Vasovagal response to needle stick.


VAERS ID: 1341102 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: history of fainting after vaccinations ( answered "no" to history of fainting on vaccine admin. record sheet)
Other Medications: NONE LISTED
Current Illness: NONE LISTED
Preexisting Conditions: NONE LISTED
Allergies: NONE LISTED
Diagnostic Lab Data:
CDC Split Type:

Write-up: Immediately after the receiving dose #1 of Pfizer COVID-19 immunization the patient fainted. Patient remained seated until she came back to after 2 mins. Patient''s mother was in the room, and stated this happens every-time she gets a shot. VAR stated no history of fainting or reaction after any vaccinations. Patient remained seated for 15 minutes while being monitored. After she stated she felt normal and left in her mothers care. No medication was administered.


VAERS ID: 1341108 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 1 LA / IM

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

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

Write-up: AFTER RECIEVING FIRST COVID VACCINE PATIENT FAINTED. PT HAS A HISTORY OF FAINTING AFTER VACCIATIONS


VAERS ID: 1341111 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood pressure decreased, Dizziness, Loss of consciousness, Syncope
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), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad), Dehydration (broad)

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

Write-up: Patient fainted and felt dizzy roughly after 10 minutes upon receiving the vaccine. She immediately gain consciousness but could not recall that she fainted and just said she "blacked out". The pharmacy staff took her blood pressure, and said it was low but after monitoring for 10 minutes, it went back to normal. She felt no more dizziness, was able to stand up, walk normally and went home shortly after.


VAERS ID: 1341118 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Nebraska  
Vaccinated:2021-04-01
Onset:2021-05-22
   Days after vaccination:51
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808980 / 1 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, Asthenia, Chills, Headache, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (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? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: chills, IMMEDIATELY! Headache, low energy, pain in muscles n joints


VAERS ID: 1341121 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 1 RA / IM

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

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

Write-up: RPh administered dose#1 of Pfizer vaccine to patient. Patient was walking toward front of the store after ~15 minute observation. She felt faint and fell to floor. She regained consciousness within a minute or so and stated she was not injured from fall. Blood pressure was normal. Paramedics were called to verify patient was OK. She was given the all clear and left with her mother.


VAERS ID: 1341122 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Oklahoma  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Disorientation, Hyperhidrosis, Nausea, Pallor, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Dehydration (broad)

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

Write-up: Syncope- pale, nauseous, initially disoriented when regained consciousness, sweating. Patient was taken to ED. Escorted out by EMS.


VAERS ID: 1341124 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / UNK - / IM

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

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

Write-up: Syncopal Episode from standing, hit head on ground


VAERS ID: 1341132 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-05-21
Onset:2021-05-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 023C21A / 1 LA / IM

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

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

Write-up: N/A


VAERS ID: 1341137 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0169 / 1 RA / IM

Administered by: Work       Purchased by: ?
Symptoms: Balance disorder, Dizziness, Fatigue, Headache, Hyperhidrosis, Vision blurred
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

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

Write-up: Shortly after receiving vaccination patient experienced blurred vision, lightheaded ness, loss of balance, headache and tiredness, profusely sweating Called 911, provided water and a safe sitting position


VAERS ID: 1341139 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cold sweat, Dizziness, Hyperhidrosis, Loss of consciousness, Tinnitus
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), Hearing impairment (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Gardasi -9 - same type of syncopal reaction
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: dizziness, lightheaded, black out, cold/clammy skin, profuse sweating, ringing in the ears 911 was called and responded to by both fire and medical paramedics vitals were taken and patient was observed for an additional 20 minutes before leaving when he had returned to a stable condition


VAERS ID: 1341145 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fall, Hyperhidrosis, Pain, Pain in extremity, Pallor, Panic attack
SMQs:, Neuroleptic malignant syndrome (broad), Accidents and injuries (narrow), Hypotonic-hyporesponsive episode (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

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

Write-up: GAVE AN 18 YEAR OLD MALE HIS 1ST PFIZER COVID-19 VACCINE AND HAD HIM SIT DOWN FOR 15 MINUTES. ALMOST 5 MINUTES AFTER THE VACCINATION, THE PATIENT WAS SLOUCHED IN HIS CHAIR, SWEATING, LOOKING PALE, AND COMPLAINING THAT HIS BODY WAS HURTING ALL OVER. I RAN OVER TO THE PATIENT AND ASKED IF HE WAS HAVING TROUBLE BREATHING, TO WHICH HE DENIED. I BEGAN TO ASK HIM WHERE EXACTLY DOES IT HURT TO WHICH HE MENTIONED HIS LEGS AND BODY. SINCE HIS BREATHING WAS FINE, I SUSPECTED IT WAS JUST A PANIC ATTACK BUT NONETHELESS I PROVIDED HIM AN ICE PACK AND WATER. WE ALSO MOVED HIM TO A MORE PRIVATE AREA TO ELEVATE HIS LEGS. I OFFERED TO CALL 911, BUT HE DENIED. WE KEPT HIM FOR 30 MORE MINUTES WATCHING OVER HIM TO SEE HOW HE PROGRESSED. HE FELT MUCH BETTER TOWARDS THE END. THE PATIENT ADMITTED HE WAS HAVING A PANIC ATTACK. MY TECHNICIAN OFFERED TO CALL A FAMILY MEMBER TO COME GET HIM, BUT HE DENIED AND SAID HE WAS OKAY TO DRIVE HIMSELF HOME.


VAERS ID: 1341148 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: vitamin B injection, fish oil capsules
Current Illness:
Preexisting Conditions: patient reports scarring on heart
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: patient received the J&J vaccine at 9 am and was monitored for 15 minutes. She is a store associate. Patient returned to work. At 1:30 patient was moving a lot of items from the pallet shipper. Patient felt dizzy and reported that she may need to faint. Patient was monitored by the pharmacist. She was counseled to drink water. We took blood pressure at 129/85 and 133/80. Patient was alert and oriented. Patient was sent home to rest. Follow up counsel on 05/26/2021


VAERS ID: 1341157 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 RA / IM

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

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

Write-up: Patient fainted about 10 minutes after vaccine administered. Came to within a couple of minutes and vitals were stable upon examination by EMT''s within about 15 minutes.


VAERS ID: 1341161 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Adverse reaction, Injection site pruritus, Injection site reaction
SMQs:

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

Write-up: Female patient with 12 years of age had a cutaneous reaction in both arms after fifteen minutes of observation. Presented itching in the punctured area.


VAERS ID: 1341164 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: New York  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Nausea, Pallor
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad)

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

Write-up: Patient was light-headed, pale, nauseous, and dizzy a few minutes after receiving vaccine.


VAERS ID: 1341165 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 1 LA / IM

Administered by: School       Purchased by: ?
Symptoms: Dizziness, Headache, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), 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: Patient''s blood pressure after regaining consciousness was 122/69 HR 66; five minutes later numbers were 118/82 HR 77
CDC Split Type:

Write-up: Minutes after the vaccination patient felt dizzy and fainted and came back to consciousness shortly after. Patient felt much better just had a slight headache after regaining consciousness. Patient was given water and feet were lifted to help with circulation. Patient after additional 30 minutes of observation felt a lot better and was alert with no symptoms reported.


VAERS ID: 1341170 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 1 LA / IM

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

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

Write-up: Patient fainted 3 minutes after receiving the first covid vaccine.


VAERS ID: 1341178 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 041A21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dysphagia, Interchange of vaccine products
SMQs:, Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), 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? Yes
Hospitalized? No
Previous Vaccinations: Patient previously had a Moderna (dose #1) vaccine on 1/15/21. Patient had difficulty swallowing, tingling on tongue, and got t
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: -Had a previous allergy to Moderna vaccine dose #1 - throat got hard, difficult to swallow, got the jitters, and tingling of tongue. -Guaifenesin - patient had a red blotchy rash after taking Mucuinex chest congestion
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient previously had a Moderna (dose #1) vaccine on 1/15/21. Patient had difficulty swallowing, tingling on tongue, and got the jitters about 10-15 mins post dose. She was recommended by her PCP to try the Johnson and Johnson vaccine because of this allergy. We had discussion with an ID specialist and pharmacy manager to go ahead and give the vaccine after weight the risks/benefits. A pharmacist was there to monitor the patient and about 15 minutes post dose, patient had difficulty swallowing and noted that this was a very similar onset to when she received the Moderna vaccine. A code blue was called, patient was sent up on stretcher to the ER. Patient received steroids (methylprednisolone) , famotidine, and Benadryl while in the ER. Currently being monitored in the ER.


VAERS ID: 1341185 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Gaze palsy, Seizure, Urinary incontinence
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Ocular motility disorders (narrow), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

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

Write-up: Situation: 14yo male came in for first dose Pfizer vaccine. Within 5 mins after receiving vaccine, patient had a seizure for approximately 1 minute. During seizure, patient was incontinent of urine. RN was able to get to patient''s side before he fell. Background: Patient did not alert vaccinator or RNs that he had a history of seizure. Mom informed staff after the event that he had a febrile seizure when he was a young child. She did not disclose what age he was at the time of the previous seizure. Assessment: RN observed patient in an active seizure for 1 minute in which his body contracted out and his eyes rolled back. She was at his side to prevent him from falling. He was placed on a gurney and moved to room 6 for closer observation for 30 mins. Pfizer vaccine administered on 5/22/21 at 12:52PM 1255 vitals ? 121/64(83), 97.3F 1257 vitals ? 122/75(90) 1311 vitals ? 116/76, HR 68, 100% O2 1318 vitals ? 112/75, HR 68, 100% O2 1325 vitals ? 111/61, HR 68, 99% O2 Recommendation: MD on call, was called and notified of the event. Her recommendation was for the patient to go to the ED for evaluation and labs. RN called the ED to notify them of the patients intended arrival. The mom agreed to take the patient to ED for further evaluation. The patient was taken out via wheelchair.


VAERS ID: 1341187 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808986 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Patient said that he only uses an inhaler for mild asthma.
Current Illness: Patient stated he is healthy in general and hasn''t been sick.
Preexisting Conditions: Patient states that he has mild asthma and has the inhaler with him at the time. besides asthma he said he is in good health. Patient has had rash reactions to penicillin as a child, no anaphylaxis reactions. Patient is not allergic to any vaccines, other medications, foods or any ingredients in the covid vaccines.
Allergies: Penicillin-he had rash
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received the vaccine in the left arm and was fine. Patient sat and talk to family members and about 10 minutes he felt light headed and wanted to lie down. His breathing was normal, no allergic or anaphylaxis reactions or symptoms, 3 times patient declined the need of 911 call. Patient declined any medical service, as does not need it. Patient rested on the chair with his leg up and then patient wanted to rest on the floor with his leg elevated for a few minutes. Pharmacist called the manager to be present, again we offered water, drink or any foods patient would like. He said that he was fine and that he just needed to sit and rest for a few minutes. After about 10 minutes, he was fine, stood up and walked away without further light head symptom.


VAERS ID: 1341192 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Dizziness, Headache, Hyperhidrosis, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Vestibular disorders (broad), Hypersensitivity (broad), Hypoglycaemia (broad)

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

Write-up: pt began to have headache, chills, light headedness, and sweating approx 12 minutes after administration of vaccine. complained of throat feeling slightly constricted with feeling of gag reflex approximately 20 minutes after administration of vaccine. pt did not show signs or feel like lips or tongue were swelling but 50 mg liquid benedryl was given orally as a precaution. pt remained stable in described condition until was taken home by parent 50 minutes after initial vaccination time. pt contacted 2 hours later and reported no change in condition (neither better or worse)


VAERS ID: 1341193 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0171 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Agitation, Anxiety, Aphasia, Cold sweat, Dizziness, Dysstasia, Feeling abnormal, Feeling hot, Loss of consciousness, Nausea, Pallor, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

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

Write-up: Patient received her 1st dose of the Pfizer Covid vaccine around 11:20am, and started feeling bad within about 5-7 minutes of administration. Her grandmother came to the counter to alert me that she wasn''t feeling well, patient was lightheaded and just "felt bad". She did say she was nauseous, but was very agitated and had trouble verbalizing what was wrong. She was very hot and clammy, her mother reported that she looked very pale. I went to get a cuff to take her blood pressure, but by the time I got it on her arm, she was slumping significantly in the chair, so we decided to move her back to the clinic room to lay her down and elevate her feet. Her mother and I each took an arm to move her. I thought she may have briefly lost consciousness, her legs were not holding any of her weight, but her head was down, so I couldn''t tell if she was alert. We moved her a few more feet into the room and her mother moved to set her down in a chair, she was talking and alert. At this time, her bladder evacuated and she vomited, her mom moved her the rest of the way to the chair. I immediately went back to the room with them and dialed 911 at 11:34am. She was more alert at this time, did not report any difficulty breathing or any swelling or itching of the mouth or throat. She was very anxious/agitated, but she did say that she felt a little better after vomiting. EMS arrived at 11:52, I believe she vomited again before they got here, she did take a few sips of water. EMS left at 12:06pm, the patient and her mother left at 12:07, she was walking on her own, with support from mom.


VAERS ID: 1341197 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Nausea, Pallor, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: PATIENT FAINTED WHILE SITTING DOWN, MOM CAUGHT HER AND HELPED HER STAY IN THE SEAT. PATIENT LOOKED PAIL AND WAS FEELING NAUSEATED. MEDIC ARRIVED AND TOOK VITALS AND OBSEEREVED. PATIENT WENT HOME WITH MOTHER


VAERS ID: 1341198 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anxiety, Dizziness, Fear of injection, Hypoaesthesia, Peripheral coldness, Pulse absent, Tinnitus
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Guillain-Barre syndrome (broad), Hearing impairment (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: The patient received the COVID-19/Janssen vaccine at 12:33pm. Approximately, 5 minutes after receiving it, the stated that he was feeling dizzy and had ringing in his ears. I had him lie down with his knees elevated. He stated that he felt better in the supine position. I attempted to take his blood pressure, but was unable to get a reading after two tries. After a few minutes, he stated that he no longer had any ringing in his ears, but felt some numbness in his arms. His fingers were cold and I had a difficult time finding his pulse. While he was resting, he stated that he had anxiety to needles and "white coat" syndrome. He felt that he was okay to sit up, so he did without any adverse reactions. He drank some water and stated that feeling was returning to his arm. I asked if he had eaten anything this morning and was told, just a cup of coffee. We speculated that low blood sugar could have possibly compounded the situation. At approximately 12:55pm, he felt well enough to leave. I had him contact his mother who was in the store to accompany him out at around 1:00pm.


VAERS ID: 1341205 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 041A21A / 1 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest discomfort, Cough, Pruritus, Throat irritation
SMQs:, Anaphylactic reaction (narrow), 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: Bactrim - anaphylaxis Penicllins - anaphylaxis Allegra Compazine Flonase Montelukast Prednisone Prilosec Vicodin Prochlorperazine
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient has history of a history of idiopathic anaphylaxis and has allergies to many medications. Patient had premedicated herself with Symbicort, Montelukast, diphenhydramine 50 prior to coming in. But 5 minutes after receiving the Covid vaccination she developed throat itching itching all over her skin/lungs, and chest tightness with intermittent coughing. Code Blue was called, and patient was taken to the ER. Patient received epinephrine, famotidine, benadryl and methylprednisone. Patient was monitored in the ER and eventually discharged home.


VAERS ID: 1341208 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-05-21
Onset:2021-05-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Blood lactic acid, Chest X-ray, Electrocardiogram, Full blood count, Hepatic function abnormal, Lactic acidosis, Metabolic function test, Pyrexia, Troponin increased, Urine analysis
SMQs:, Liver related investigations, signs and symptoms (narrow), Lactic acidosis (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: amlodipine, atorvastatin, glucophage
Current Illness: None
Preexisting Conditions: hypertension, hyperlipidemia, diabetes, thrombocytopenia, prostate cancer
Allergies: NKA
Diagnostic Lab Data: Troponin, lactate, CBC, BMP, hepatic function, CXR, UA, ECG
CDC Split Type:

Write-up: Lactic acidosis, elevated troponin, fever, one day after


VAERS ID: 1341220 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808986 / 1 RA / IM

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

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

Write-up: Approximately 5 minutes after receiving vaccination patient fell out of chair onto floor and was breathing but unresponsive to pharmacist. Patient opened eyes and was fully alert with in a couple of minutes of passing out. Patient waited for another 30 minutes, had someone come pick him up, and stated he felt fine.


VAERS ID: 1341223 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Loss of consciousness, Malaise
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), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: No Known
Diagnostic Lab Data: 05/22/21- Unknown at this time, patient went to the hospital for further testing
CDC Split Type:

Write-up: The patient received the vaccine and about a minute or two after administration stated she didn''t feel good and was going to pass out. Her husband set beside her as I went to get water as the patient had not ate or drank anything yet. The patient proceeded to pass out and 911 was called. The Fire Dept arrived and performed vitals and transported the patient to the ER for further testing.


VAERS ID: 1341229 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 LA / 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? 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 age less than minimum age for vaccine (no adverse events occurred as a result of receiving vaccine)


VAERS ID: 1341236 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 025A21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blindness transient, Dizziness, Feeling cold, Hyperhidrosis, Paraesthesia, Sudden hearing loss
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Embolic and thrombotic events, arterial (narrow), Guillain-Barre syndrome (broad), Glaucoma (broad), Optic nerve disorders (broad), Retinal disorders (broad), Hearing impairment (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: none
Current Illness: None
Preexisting Conditions: None
Allergies: Penicillin
Diagnostic Lab Data: Paramedics checked patients vitals including PulseOx, blood pressure and heartrate. By the time paramedics arrived the patient stated that his vision had come back and he could hear again. He was also not sweating at this time.
CDC Split Type:

Write-up: Patient reported feeling dizziness, his vision went black and he lost hearing within 5 minutes of receiving the vaccine. He was sweating and felt cold and tingling. Patient states the tingling started in his feet and worked its way up his entire body. Paramedics were called.


VAERS ID: 1341238 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / IM

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

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

Write-up: 13 minutes after administration of vaccine patient said she felt a little dizzy. I attended her with blood pressure cuff and her blood pressure reading at the time was 87/50. 9-1-1 was called and EMS was immediately sent. The patient seemed tired, but was arousable and maintained consciousness until EMS arrived. She was then taken to the EMS truck for further evaluation and likely sent on to the hospital


VAERS ID: 1341243 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / UNK LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood pressure decreased, Malaise, Orthostatic hypotension, Sitting disability, Vision blurred
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Glaucoma (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

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

Write-up: Less than a minute after administration patient started to feel not well. Patient displayed symptoms of possible syncope. Eyes were unfocused and unable to sit up straight. Epipen was administered immediately. EMS was called. Patient''s blood pressurewas taken multiple times and was low at each reading . Patient''s blood pressure would also drop upon standing up. After about half an hour of not resolving EMS took patient to hospital for further evaluation.


VAERS ID: 1341251 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Dexilant 60 mg
Current Illness: acid reflux
Preexisting Conditions: esophageal achalasia
Allergies: penacyln
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Husband told me he was going to pass out within a few minutes of receiving the shot, I called for the pharmacy tech to come help me before he fell off of the chair. They called for EMS to come and check him out, his bp was 118 over 78. He is home now feeling tired . We can follow up with his doctor if her is not feeling better.


VAERS ID: 1341267 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood glucose normal, Cyanosis, Injection site rash, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: n/a
Allergies: none
Diagnostic Lab Data: Blood pressure 92/52 pulse 86 oxygentatin of blood 100% blood sugar 62 all done be paramedics
CDC Split Type:

Write-up: patient was given shot and fainted and started rash at site lips turned blue also shot was given at 10:23am and at 10:26am adverse event started epipen was given at 10:26am paramedics called and patient was taken to hospital for followup


VAERS ID: 1341270 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: New York  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 1 LA / IM

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

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

Write-up: Pt fainted shortly after the vaccine, regained consciousness immediately. Patient was given an ice pack and water. There was no harm to patient.


VAERS ID: 1341280 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Loss of consciousness, Vision blurred
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), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

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

Write-up: During her observational 15 minutes, patient was having dizziness and blurred vision. Patient had a loss of consciousness for 30 seconds. After regaining, patient was alert and oriented. Patient was given water and asked to sit for 15 minutes.


VAERS ID: 1341289 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: blood pressure 117/42, pulse 60
CDC Split Type:

Write-up: The patient broke out into a sweat and became lightheaded and dizzy just a couple of minutes after receiving the vaccine. We evaluated her pulse, blood pressure, and respirations which were all normal. She laid down with her feet raised for about 10 minutes before the paramedics arrived and she left with them for further evaluation.


VAERS ID: 1341293 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 LA / IM

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

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

Write-up: Patient''s friend reported to pharmacy patient passed out as they walked out the store about 15 minutes after the shot, and someone already called 911. Pharmacist walked out to check on patient, paramedics were already there checking on her. Paramedics said patient is ok, and they will release her. Patient came back to the pharmacy about 10-15min later to tell us she is ok.


VAERS ID: 1341304 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: New York  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK LA / -

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

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

Write-up: Blurry vision, lightheadedness, headache


VAERS ID: 1341320 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Fainting or feeling dizzy according to info provided on VAR
Other Medications: Oral contraceptives
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: Penicillin and Sulfa
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: Patient received vaccine and responded "oh that was easy", got up from the chair, and walked away from the clinic area then fell to the floor. RPH on duty did not see the first fall. Patient was responsive, talking, and laughing (at times) during the event. RPH on duty asked patient if she was okay while she was still lying on the floor. The patient responded by saying I''m okay. The patient then stood up and proceeded to walk toward the pharmacy lobby but then fell to the floor a second time. The RPH on duty called 911, passed the call over to the pharmacy tech to complete the call, then placed a cold cloth (paper towel ) across the patient''s forehead. Emergency Medical Technicians arrived on the scene within minutes. Patient maintained consciousness and was responsive throughout the event. Patient was evaluated by EMT personnel and eventually left the store via wheelchair accompanied by EMT personnel and parent.


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