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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 105 out of 3,524

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VAERS ID: 1341322 (history)  
Form: Version 2.0  
Age: 16.0  
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 EW0186 / 1 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cough, Dysphagia, Dyspnoea, Feeling abnormal, Pharyngeal swelling, Pruritus, Throat irritation
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Anticholinergic syndrome (broad), Dementia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None that we are aware of at this time.
Current Illness: none that we are aware of
Preexisting Conditions: None that we are aware of
Allergies: Dairy and latex.
Diagnostic Lab Data: None at this time
CDC Split Type:

Write-up: Patient received the vaccine at 4:00p. Her mother called us over at 4:05 as Shaelynn was feeling "weird". She began to itch and cough, apparently trying to throw up, felt her throat was itching and swollen. She stated she couldn''t swallow and was having a hard time breathing (although she was breathing). We administered an Epi Pen 0.3mg (only one) and called 911. Patient was transported to the hospital by ambulance.


VAERS ID: 1341332 (history)  
Form: Version 2.0  
Age: 16.0  
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 / -

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

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

Write-up: PT SLUMPED OVER IN CHAIR UNCONCIOUS, PALE, DID NOT EAT PRIOR TO VACCINATION. PT WOKE UP, SX RESOLVED, DRINK AND SNACK PROVIDED. REFUSED TRANSPORT.


VAERS ID: 1341344 (history)  
Form: Version 2.0  
Age: 14.0  
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 EW0168 / 1 RA / -

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

Write-up: PT STARTED SLOUCHING DOWN IN CHAIR, ASSISTED PT TO COT. BP 115/71, HR 81. PT STATES HE FEELS FINE NOW, PROVIDED WATER, SX RESOLVED, NO TRANSPORT.


VAERS ID: 1341375 (history)  
Form: Version 2.0  
Age: 25.0  
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 043A21A / 1 LA / -

Administered by: Other       Purchased by: ?
Symptoms: Feeling cold, Pallor, 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? 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: SYNCOPE, PALE, COLD, UNRESPONSIVE X 30 SECS, ASSISTED TO FLOOR, WOKE UP, PARAMEDICS ON SITE, BP 141/72, HR 91, PROVIDED WATER, SX RESOLVED, NO TRANSPORT.


VAERS ID: 1341378 (history)  
Form: Version 2.0  
Age: 17.0  
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 EW0179 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Anxiety, Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypoglycaemia (broad)

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

Write-up: Patient observed at 1647 stating she was nauseous and anxious. Patient given emesis bag and then vomited. Assisted patient in wheelchair and taken to observation private area with guardian. Obtained a full set of vitals at 1650 as follows: O2 sat 98% RA, HR 71, RR 32, and BP 110/80. Encouraged patient to slow breathe in and out of bag. Another set of vitals obtained at 1700 as follows: O2 sat 98% RA, HR 89, RR 20, BP 110/75. Pt stated she was starting to feel better. Observed patient for another 10 minutes at 1710 vitals as follows: O2 sat 98% RA, HR 83, RR 26, BP 111/79. Assisted patient to a sitting then standing position. Patient''s mom stated she thinks everything is okay..and she would monitor her at home. Explained to her to seek EMS if symptoms progress. Patient''s mother Verbalized good understanding. Left site at 1718.


VAERS ID: 1341384 (history)  
Form: Version 2.0  
Age: 15.0  
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 EW0191 / UNK RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Hyperhidrosis, Nausea, Pallor, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (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: Fainted
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient fainted within a minute of receiving vaccine. Pale, diaphoretic, nauseated. No treatment. Recovered without incident.


VAERS ID: 1341408 (history)  
Form: Version 2.0  
Age: 13.0  
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 (MODERNA)) / MODERNA 023C21A / 1 LA / IM

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

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

Write-up: Patient received the moderna brand covid-19 vaccination by mistake (supposed to receive pfizer due to age restrictions). No treatment necessary. Patient and legal guardian aware wrong vaccine was given and will report any adverse reactions if necessary. Will follow up with patient in regard to next steps in completion of vaccination.


VAERS ID: 1341420 (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 EW0179 / 1 - / IM

Administered by: Work       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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NA
Current Illness: NA
Preexisting Conditions: NA
Allergies: NA
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: The client was accompanied by his mother. Staff vaccinated the client. When filling out the consent form, the client started looking pale and was about to pass out. Staff caught the client before falling off the chair. They laid him down and put a cool pack on his neck. Called 911 to scene at 1731. EMT arrived at the scene at 1740. The client passed out for a minute but was still breathing. Vitals BP, 124/66, HR 56, Pulse Ox, 98%. Vaccinated lot num Pfizer EW0179 exp. 08/2021. EMT Transported client at 06:05pm


VAERS ID: 1341585 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 1 AR / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Epistaxis, Fall, Head injury, Syncope, Unresponsive to stimuli, Urticaria
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Angioedema (narrow), Haemorrhage terms (excl laboratory terms) (narrow), 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), Accidents and injuries (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Fainting / Unresponsive-Severe, Additional Details: upon exiting vaccination room pt fell forward. it is unknown if she fainted or tripped, mom was standing behind her and was unsure as well. pt bumped head and had a welt on her upper right eyebrow, also her nose began to bleed. ice pack was given/applied to head/eye, paper towel given to stop nose bleed. also water/starburst given. 911 was called. dispatchers came and quetsioned if she felt dizzy when she left room to which pt responded no, ambulance took pt.


VAERS ID: 1341600 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: New Hampshire  
Vaccinated:2021-05-20
Onset:2021-05-22
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / SYR

Administered by: School       Purchased by: ?
Symptoms: Heart rate increased
SMQs:, Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dehydration (broad)

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

Write-up: Increased resting heart rate 165 bpm


VAERS ID: 1341606 (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: 2021-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7533 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Confusional state, Dizziness, Fall, Hypotension, Lip injury, Loss of consciousness, Syncope, Unresponsive to stimuli
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), Dementia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (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), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
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-Severe, Systemic: Hypotension-Mild, Additional Details: Patient went to observation area after receiving Pfizer Covid-19 Vaccine. Patient became lightheaded and faint and fell to floor. Patient was unconscious for aproximately 30 sec. After being repositioned, patient did regain consciousness; however was a little confused as to what had happened. Patient did injure his lip during fall. Vitals were all within normal limits with a slightly low blood pressure reading. 911 was called immediately. Stated had not eaten today/slept night before either.


VAERS ID: 1341613 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-21
Onset:2021-05-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anxiety, Cough, Dyspnoea, Nervousness
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (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: anxiety, nervousness, shortness of breath-Severe, Additional Details: patient presented to pharmacy next day following janssen covid vaccine. presented with shortness of breath, anxiety, nervousness, cough. patient states symptoms started around 2AM. Ambulance was called. EMT took patient to hospital


VAERS ID: 1341624 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 LA / IM

Administered by: Pharmacy       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? Yes
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: Dizziness / Lightheadness-Severe, Systemic: Seizure-Mild, Additional Details: patient suddenly fell down, had a slight seizure last around 5 sec and regains concious. He feels fine but pharmacy still called 911 and was escort to receive emergery/urgent services.


VAERS ID: 1341669 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0171 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dysphagia, Dysphonia, Glossitis, Swollen tongue
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Anticholinergic syndrome (broad), Parkinson-like events (broad), Oropharyngeal allergic conditions (narrow), 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), 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? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Aspirin 81mg Apixaban 5mg Fluoxetine 10mg Omeprazole 20mg Lisinopril 5mg Famotidine 40mg Cholecalciferol Adult Multivitamin
Current Illness: N/A
Preexisting Conditions: Hypertension Anticardiolipin Antibody Positive MTHFR Gene Mutation Heterozygous Factor V Leiden Protein S Deficiency Depression
Allergies: No known allergies
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Patient received 1st dose Pfizer COVID19 vaccine @ 10:30 AM Around 7PM of the same day she developed irritation on the right side of her tongue followed one hour later by swelling of the right side of the tongue with change in voice and difficulty swallowing. Presented to the Emergency Department shortly after and symptoms resolved rapidly with administration of Tranexamic acid @ 0001 on 5/23/21. On the morning of 5/23/21 she had no further symptoms and there was no recurrent tongue edema.


VAERS ID: 1341671 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-05-21
Onset:2021-05-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Echocardiogram abnormal, Electrocardiogram abnormal, Pericardial effusion, Pericarditis, Troponin normal
SMQs:, Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: minocycline, escitalopram, buproprion, dextroamphetamine-amphetamine, multivitamin
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: ekg with PR depression, echo with trace pericardial effusion, negative trop
CDC Split Type:

Write-up: pericarditis


VAERS ID: 1341675 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

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

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

Write-up: Patient was inadvertently given the Johnson & Johnson vaccine instead of Pfizer. It was our 1st day giving this-- RN not used to paying attention to the 18 year old cut-off. After this occurred 18 & up was written on the J&J cooler and on the board behind the vaccination table. We also added signage of the exact DOB.


VAERS ID: 1341690 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-05-21
Onset:2021-05-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Exposure during pregnancy, Headache, Nausea, Pain, Pain in extremity, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Loradatine, Magnesium, Nature Made Prenatal, Unsiom, Tylenol
Current Illness: None
Preexisting Conditions: None
Allergies: Diary
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Pregnancy due on July 27th no previous miscarriage, adverse effects are: fever, body ache, headache, nausea, starting at 9 am the following day and lasting all day. Took a Tylenol at 9pm the first night for sore arm, one at 4am the next morning for extremely sore arm and body aches, two the following morning at 11am for sore arm, body aches, headache, and nausea, then one at 7pm for headache and body aches. One more at 11pm to sleep then fine when waking up at 9am. Took multiple naps totaling 4-5 hrs Sat.


VAERS ID: 1341709 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-05-21
Onset:2021-05-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Chills, Dizziness, Headache, Pain, Pyrexia, Sleep disorder, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Levothyroxine, fetzima, carvedilol, potassium, hydroxychloroquin, vit D, omega 3, biotin
Current Illness: 3 Swollen lymph nodes in left collarbone/neck
Preexisting Conditions: Depression, anxiety, PTSD, hypothyroidism, hbp
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: vomiting (30 mins only about 11 hrs after injection). Chills fever dizzy headache body aches and can''t sleep (still happening 35 hrs after symptoms started - 45 hrs after injection)


VAERS ID: 1341717 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-05-19
Onset:2021-05-22
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Electrocardiogram abnormal, Myocarditis, Troponin increased
SMQs:, Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: hsTNT: 2800 ECG with STE in II,III, aVF and V4-V6
CDC Split Type:

Write-up: One day following second dose of vaccine, patient developed chest pain. Was admitted to the hospital with concerning ECG features and high troponin elevation. No wall motion abnormalities, so less concern for STEMI. Likely diffuse myopercarditis. Full workup still pending


VAERS ID: 1341770 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 RA / IM

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

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

Write-up: Lost consciousness. Evaluated by EMS-Cleared


VAERS ID: 1341822 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Circulatory collapse, Confusional state, Feeling abnormal, Headache, Heart rate increased, Immediate post-injection reaction, Neck pain, Oral pain, Pallor, Seizure
SMQs:, Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (narrow), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Dementia (broad), Convulsions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (narrow), Arthritis (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Anxiety
Allergies: Latex
Diagnostic Lab Data: EMS took vitals. As they reported to me, all were normal with the exception of an elevated pulse.
CDC Split Type:

Write-up: About 30 seconds after the vaccine was administered the patient collapsed in her chair and began to seize. Prior to the collapse she had asked to sit for a moment and said that she was feeling strange. I stabilized her in the chair until the seizure finished, it lasted about 30 seconds. I then helped her to the floor and had her sit against the wall. She was pale and confused but conscious. She complained of head and neck pain, as well as oral pain. She denied seizures in the past, but states that she may have previously had "seizure-like activity". I asked my technician, to call 911. Once emergency services was on the way I kept her in the immunization room with the door propped open and got her an apple juice. Then I stayed with her until EMS arrived. EMS determined that she was stable and stayed with her until family arrived to take her home


VAERS ID: 1341844 (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: 2021-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Pulse 64 Respirations 18 SPO2 96% BP 100/66 Exam normal
CDC Split Type:

Write-up: Dizziness, lightheadedness, nearly fainted Given crackers, water and juice


VAERS ID: 1341867 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 2 LA / IM

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

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

Write-up: PATIENT GOT A SECOND DOSE OF JOHNSON AND JOHNSON COVID 19 VACCINE WHEN ITS ONLY SUPPOSED TO BE ONE DOSE. IT WAS EXPLAINED TO THE PATIENT THAT THIS VACCINE IS SINGLE DOSE ONLY BUT HE DID NOT SAY IT WAS HIS SECOND DOSE ALREADY. WE FOUND OUT WHILE BILLING THE SECOND DOSE.


VAERS ID: 1341937 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 1 LA / IM

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

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

Write-up: Passed out about 5 minutes after receiving the shot. Was sitting in a chair and collapsed to the ground. She regained consciousness within 30 seconds and was sitting in a chair again 5 minutes later


VAERS ID: 1342014 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-14
Onset:2021-05-22
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Cardiac arrest
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Cardiomyopathy (broad), Respiratory failure (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: None
Current Illness: Angina
Preexisting Conditions: Angina HLD
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Cardiac arrest


VAERS ID: 1342029 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805031 / N/A LA / IM

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

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

Write-up: 1. 40 y/o male with no past medical hx c/o lightheadedness and dizziness 8 mins after receiving the Johnson and Johnson vaccine. He reported that he came directly to site after a 12 hrs flight and he last ate earlier this morning. He was assessed and monitored by NP, EMT, and paramedic. BP - 103/68, HR- 62, resp 14, O2 sat 95% on RA, had mild anxiety. He was given H2O and granola bar, allowed to lie down, instructed on relaxation measures. He was kept at site until he reported that he felt better, calm and had no complaints. He was given the Vaccination information sheet, reinforced instructions on ADRs SEs to call 911 and go to the ED and that symptoms may occur up to 3 wks after receiving the vaccine. He verbalized understanding and willingness to comply. He noted that he will be returning to on 6/8/2021. He left site in no acute distress, awake alert and oriented to person place time and situation, calm.


VAERS ID: 1342041 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805031 / N/A RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Nausea, Vomiting
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: 11:30 nausea and vomiting. 11:35 symptoms resolved. BP 111/68, HR 83, sats 99, Resp 18. 11:57 left ambulating for home accompanied by family.


VAERS ID: 1342101 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: New Mexico  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Cold sweat, Feeling of body temperature change, Pallor
SMQs:, Guillain-Barre 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:
Current Illness: none
Preexisting Conditions:
Allergies: amoxicillin, penicillin, shellfish
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient said he felt very hot, then cold and clammy, felt weak, turned very pale in the face. He was given liquid benedryl and some water. He felt better in just a few minutes (about 10 minutes). He said he was fine later that evening and the next day.


VAERS ID: 1342124 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-05-21
Onset:2021-05-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Axillary pain, Dizziness, Headache, Migraine, Myalgia, Nausea, Odynophagia, Oropharyngeal pain, Peripheral swelling, Skin warm, Sleep disorder, Tonsillar disorder
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Acute pancreatitis (broad), Angioedema (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Cymbalta 60mg, Lexapro 5mg, Norethindrone 0.7mg, Nasacort, Vitamin D3 2000 IU, Magnesium 250mg.
Current Illness:
Preexisting Conditions: Depression, anxiety, migraines, insomnia.
Allergies: Nuts, pet dander, dust.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pfizer-BioNTech COVID-19 Vaccine EUA I woke up at about 4:30 AM and couldn?t fall back asleep, I kept feeling sleepy until I would get jolted back awake over and over. My joints were hurting, I had somewhat severe nausea, my head started throbbing. At about 6:40 AM my migraine started, my arm felt hot to the touch, and I got dizzy so I took some acetaminophen. At 10:00 PM I noticed the area under my left armpit was a little swollen and really sore, my throat and right tonsil was also sore and it hurt to swallow. The next day (today) I have another migraine, my throat and left armpit are still sore, and my muscles hurt. I?m getting better though.


VAERS ID: 1342134 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dyskinesia, Headache, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dyskinesia (narrow), Noninfectious encephalopathy/delirium (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: We are unable reach patient.
CDC Split Type:

Write-up: Patient fainted 5 minutes after the vaccination. He regained his conscious but complained severe headache. Patient also had some jerky motion after fainting. Paramedics was called. Patient''s vital signs were normal. He was taken to facility for further follow-up.


VAERS ID: 1342208 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-21
Onset:2021-05-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / UNK LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Migraine
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: birth control pill
Current Illness: none
Preexisting Conditions: none, but mother w hx of migraine HA
Allergies: none known
Diagnostic Lab Data: telephone visit 5/23/21
CDC Split Type:

Write-up: 18h post vaccination, teen began w acute MIGRAINE


VAERS ID: 1342211 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-05-21
Onset:2021-05-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 2 LA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Headache, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Fever 102.6, chills. headache


VAERS ID: 1342212 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 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:
Allergies: nkda
Diagnostic Lab Data:
CDC Split Type:

Write-up: he fainted


VAERS ID: 1342224 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-05-19
Onset:2021-05-22
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Heart rate decreased, Hyperhidrosis, Loss of consciousness, Nausea
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), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Amoxicillin
Diagnostic Lab Data: All the results came back fine and there was no known reason as to why I passed out. The only variable was that I received the vaccine
CDC Split Type:

Write-up: Passed out randomly while out with my wife. Felt nauseous, became sweaty, heart rate dropped


VAERS ID: 1342279 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-05-20
Onset:2021-05-22
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Injection site vesicles
SMQs:

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

Write-up: There is a bulge that has appeared below the injection site that sticks out and seems full of fluid. It appeared as soon as his arm stopped feeling sore and has been there for 2 days as of now.


VAERS ID: 1342295 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Delaware  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022C21A / 2 LA / IM

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

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

Write-up: Patient was given first dose in error (because under the age of 18yo). CDC recommendations are to get the second dose per usual. Parents were informed after first dose and wanted her to have the second dose. Father accompanied her for the second dose.


VAERS ID: 1342301 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-05-20
Onset:2021-05-22
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / UNK - / IM

Administered by: Public       Purchased by: ?
Symptoms: Erythema, Skin warm, Swelling, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Hives developed on both arms on Saturday, Diphenhydramine 25 mg given by PO, Reduced swelling/redness, but hives did not completely disappear. On Sunday 5/23 hives became much more prominent in the afternoon. Spreading on arms, covered 25% of the surface of her back, and legs. Hives are raised, red and warm to the touch.


VAERS ID: 1342304 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Had episodes passing out in the past
Other Medications: none
Current Illness: NONE
Preexisting Conditions: Had history of vasovagal syncope. Has been cleared by cardiologist for sports and other activities. No history of syncope with shots.
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient has history of passing out. 2-3 min after Pfizer shot patient started to feel hot and was pale. A volunteer doctor assisted to sit down on floor. Has syncope episode after seated on ground. Use ammonia capsule . Pulse was intact throughout. Airway as cleared of gum in mouth. Loss of consciousness for 15 sec. Then alert able to call mother who was in the parking lot. 911 EMS called and arrived. Cool compress applied. Ems arrived. Patient felt better. Vital by Ems Glu 80 BP 120/80. Patient was able to drink water. MD instructed mother to clear with PCP or Cardiologist to clear before getting 2nd shot. Mother declined EMS transport. MD walked patient to car.


VAERS ID: 1342308 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-21
Onset:2021-05-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Chills, Headache, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (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? 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: Fever to 103.4F, chills, headache


VAERS ID: 1387929 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypotension, Nausea, Pallor, Vision blurred
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

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

Write-up: Patient became pale, nauseous, blurred vision and lowered blood pressure. Ambulance called and patient was ok and sent home with parents. Next morning at 1030 Am patient was called and was fine.


VAERS ID: 1342382 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-01
Onset:2021-05-22
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Any flue shot causes arm swelling the day of injection and is better within the day
Other Medications: Birth control
Current Illness: No
Preexisting Conditions: No
Allergies: Codeine
Diagnostic Lab Data: None yet
CDC Split Type:

Write-up: About five days post shot began developing folliculitis. Type of folliculitis is unknown. Started on the belly/chest area and has begun spreading elsewhere. 7 days post shot symptoms of ?vaccine arm occurred; beginning as an itch and then swelling and becoming hot. Otherwise no other side effects.


VAERS ID: 1342392 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-05-19
Onset:2021-05-22
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Blood creatinine normal, Blood potassium normal, Blood sodium normal, Conjunctival haemorrhage, Full blood count, Haemoglobin normal, Lipase, Metabolic function test, Nausea, Petechiae, Platelet count normal, Urine analysis normal, Vomiting, White blood cell count increased
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Conjunctival disorders (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Doxycycline
Current Illness: None known
Preexisting Conditions: None significant
Allergies: Amoxicillin
Diagnostic Lab Data: CBC, CMP, urinalysis, lipase obtained 5/22/2021 at 1907. WBC 12.4, hemoglobin 14.0, platelets 245. CMP sodium 138, potassium 4.0, creatinine 0.9 with normal urinalysis.
CDC Split Type:

Write-up: Petechiael rash, nausea/vomiting and subconjunctival hemorrhage


VAERS ID: 1342393 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-05-21
Onset:2021-05-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036C21A / 1 RA / SYR

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

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

Write-up: Two nose bleeds in two days. The first one lasted 10 minutes and there was a large coagulated chunk after 30 seconds. The second lasted one minute and was started by me merely lightly scratching the inside of my nose. I could count the number of nosebleeds I?ve had my whole life prior to getting vaccinated on one hand.


VAERS ID: 1342403 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-05-21
Onset:2021-05-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Arthralgia, Chills, Fatigue, Headache
SMQs:, Arthritis (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: Only daily vitamins
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Chills, joint aches, headache, fatigue


VAERS ID: 1342427 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-05-02
Onset:2021-05-22
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test, Chest pain, Computerised tomogram, Dizziness, Electrocardiogram, Fall, Hypoaesthesia, Joint lock, Mobility decreased, Transient ischaemic attack
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), Embolic and thrombotic events, arterial (narrow), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: 5/23/2021 - blood work & catscan & ekg
CDC Split Type:

Write-up: 5/22/2021 - evening time, right side of body went numb, knee locked up, collapsed on floor, chest pain, could not move whole body for 30 seconds then couldnt move right side for another 10 minutes, last 10 minutes called 911, dizziness conscious whole time 5/23/2021 - Hospital said had TIA mini stroke, prescribed blood thinner, have to follow up with Dr


VAERS ID: 1342441 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-21
Onset:2021-05-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Dizziness, Headache, Myalgia, Peripheral swelling, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Side effects after getting the second shot: Fever 103.1, muscle pain, headache, chills, dizziness, swollen arm


VAERS ID: 1342443 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007C21A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033B21A / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Back pain, Injection site erythema, Injection site pain, Injection site pruritus, Injection site swelling, Injection site warmth, Muscular weakness, Pain
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Atorvastatin 80mg Flecainide Acetate 200 mg/day Lisinopril 10mg Metoprolol Tartrate 25mg Sertraline HCL 50mg Generic one a day vitamin 1 low dose asprin
Current Illness: Hay fever
Preexisting Conditions: Asthma A-Fib (heart) Edema High blood pressure Muscle/joint pain Depression
Allergies: Allergic to "cycaline" type antibiotics Soy nickel some plastics/latex
Diagnostic Lab Data: Have no insurance
CDC Split Type:

Write-up: Starting on Sat 5/22/21 @ 8pm began to get pain all over body. By midnight I was in SEVERE pain (9). I could not sit, stand or laydown without pain. I took 3 Tylenol 500 mg tablets and 1 benedryl. At 6am I took two more Tylenol 500 mg tablets. I paced the floor trying to endure the pain, finally subsided @ 5am and I was finally able to lay down and get some sleep. Currently, my left arm is red, hot, sore, itchy and swollen at the injection site (this happened with first shot also). I feel weakness in both arms and some pain in my lower back.


VAERS ID: 1342449 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041C21A / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Headache, Injection site reaction, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), 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? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Seizures
Allergies: Shellfish
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever, headaches, chills, reaction at the spot of injection.


VAERS ID: 1342452 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 1 LA / IM

Administered by: Military       Purchased by: ?
Symptoms: Abdominal pain, Abdominal pain upper, Appendicitis, Decreased appetite, Full blood count, Pain, Ultrasound scan, Urine analysis, Vomiting
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: CBC, UA, ultrasound.
CDC Split Type:

Write-up: left vaccine site at 12:30, went to dinner at a local restaurant with family, no appetite, had some french fries, went home and c/o stomach ache. Pain in lower right side 1/2 inch above her hip bone. constant dull pain, not piercing. Hurt when coughing. no appetite the next day, vomited twice overnight. went to ER at 2100 on Sunday (the next day) and was admitted. CBC, UA, ultrasound , diagnosed with appendicitis. admitted and scheduled for surgery.


VAERS ID: 1342588 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-05-21
Onset:2021-05-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038C21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cold sweat, Decreased appetite, Fatigue, Headache, Injection site reaction, Lethargy, Muscle spasms, Myalgia, Rash erythematous, Rash pruritic
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Dystonia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Itchy red rash around injection site, headache, cold sweats, muscle cramping & aches overnight, overall lethargy & exhaustion, and loss of appetite.


VAERS ID: 1342602 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Alopecia, Diarrhoea, Fatigue, Headache, Nausea, Pain in extremity, Swelling, Swelling face
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Crestor, propanalol, vit c, vit d, vit b
Current Illness: None
Preexisting Conditions: High cholesterol, migraines
Allergies: Bee, ketoconozale, guafician
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Facial and neck swelling, started 30 min after vaccine and lasted 1 hour, took Benadryl Extremity swelling, started 1 hour post shot and lasted 6-8 hours Less important sided effects- fatigue, arm soreness, nausea, diarrhea, headache- lasting 24-48 hours Hair is falling out in clumps


VAERS ID: 1342922 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: New York  
Vaccinated:2021-05-21
Onset:2021-05-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 1 LA / IM

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

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

Write-up: Site: Redness at Injection Site-Medium, Site: Swelling at Injection Site-Medium


VAERS ID: 1342927 (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: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Syncope, Tremor
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Systemic: Dizziness / Lightheadness-Severe, Systemic: Fainting / Unresponsive-Severe, Systemic: Shakiness-Medium


VAERS ID: 1342930 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Contusion, Fatigue, Headache, Nausea, Pain, Pain in extremity, Rash, Sinus disorder
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Multivitamin Zyrtec Dymista Omega 3
Current Illness: No
Preexisting Conditions: Reynaud?s disease
Allergies: Seasonal allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Sore arm Rash on arm Bruising on palm of hand Severe headache Nausea Fatigue Body aches Sinus issues


VAERS ID: 1342934 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1820095 / UNK LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal discomfort, Chills, Decreased appetite, Dyspnoea, Headache, Nasopharyngitis, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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 at time of but needed acetaminophen after for side affects.
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: headache, upset stomach, fever, chills, (usually right after the fever broke), loss of desire to eat, shorness of breath, started 1 hr after shot, at this time when entering this, still have fever and loss of desire to eat, and chills . I fell like I had a mild cold with no nasal discharge.


VAERS ID: 1342944 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-05-21
Onset:2021-05-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Malaise, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), 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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever, malaise. Given advil. Fever improved. Malaise persists today.


VAERS ID: 1342945 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-05-20
Onset:2021-05-22
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Angiogram, Anticoagulant therapy, Chest pain, Electrocardiogram normal, Pulmonary embolism, Troponin increased
SMQs:, Myocardial infarction (narrow), Embolic and thrombotic events, venous (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Atenolol
Current Illness:
Preexisting Conditions: HTN
Allergies:
Diagnostic Lab Data: Troponin elevated (0.24 -- $g 1.75 -- $g still climbing) 5/23/2021 - 5/24/2021 - Workup ongoing , Pt chest pain free after Heparin bolus and infusion
CDC Split Type:

Write-up: Development of substernal chest pain with elevated troponin 3 days after vaccination. Normal EKG. CT angio w/o evidence of PE.


VAERS ID: 1342950 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Incomplete course of vaccination, Injury associated with device
SMQs:, Medication errors (narrow)

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

Write-up: Site: Redness at Injection Site-Mild, Additional Details: child would not sit still and was scratched with needle. new needle obtained attemtped again but child would not behave and RPh deemed it a safety issue and refused further attempts


VAERS ID: 1342951 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dyspnoea, Impaired work ability, Injection site warmth, Skin burning sensation, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Peripheral neuropathy (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: My entire upper body began breaking out in a hives like rash. My skin began to burn and my breathing became difficult. It was a true allergic reaction, my injection site was hot to the touch for hours. My skin did turn a little purple once in the hospital and I?ve missed two days of work looking like three due to this reaction to the vaccine.


VAERS ID: 1342952 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-05-21
Onset:2021-05-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039B21A / 2 RA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Fatigue, Headache, Nausea, 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lexapro, zyrtec, omeprazole, nasacort
Current Illness: Sinus infection 2 weeks prior
Preexisting Conditions: IBS
Allergies: Celebrex
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Headache, low grade fever, bit of nausea, fatigue for 36 hours.


VAERS ID: 1342993 (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: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Chills, Confusional state, Dizziness, Flushing, Hyperhidrosis, Syncope, Unresponsive to stimuli
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), 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), 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Systemic: Chills-Mild, Systemic: Confusion-Medium, Systemic: Dizziness / Lightheadness-Medium, Systemic: Fainting / Unresponsive-Medium, Systemic: Flushed / Sweating-Medium, Systemic: Weakness-Medium, Additional Details: pt passed out after about 10 minutes while in observation area. dad was next to her and she did not fall. emt were called to check her out and after 1/2 hr pt seemed to be ok


VAERS ID: 1342995 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 2 LA / IM

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

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

Write-up: Error: Booster Given Too Early


VAERS ID: 1343004 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-11
Onset:2021-05-22
   Days after vaccination:72
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6207 / 2 RA / IM

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

Write-up: PATIENT ARRIVED AT MASS VACCINTION EVENT AND WAS GIVEN PFIZER AS A FIRST DOSE. MONTHS LATER, DURING A ROUTINE POSITIVE TEST INVESTIGATION IT WAS DISCOVERED PATIENT HAD RECEIVED FIRST DOSE MODERNA 14 DAYS PRIOR TO PFIZER VACCINATION. CONSENT PAPERWORK WAS PULLED FROM PFIZER EVENT AND PATIENT DOES NOT DISCLOSE PRIOR VACCINATION OF MODERNA.


VAERS ID: 1343011 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypotension, Impaired healing, Paraesthesia, Visual impairment
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Glaucoma (broad), Optic nerve disorders (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? 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: Hypotension-Medium, Systemic: Tingling (specify: facial area, extemities)-Mild, Systemic: Visual Changes/Disturbances-Mild, Additional Details: Stated she could not see clearly or hear well-


VAERS ID: 1343012 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006C21A / UNK LA / -

Administered by: Public       Purchased by: ?
Symptoms: Chills, Headache, Nausea, Oropharyngeal pain, Vomiting
SMQs:, Acute pancreatitis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), 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: Meloxicam finofibrate floxitine
Current Illness: No
Preexisting Conditions: No
Allergies: Not
Diagnostic Lab Data:
CDC Split Type:

Write-up: Sore throat, nausea,, vomiting, chills, headache


VAERS ID: 1343014 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-05-21
Onset:2021-05-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (UNKNOWN)) / UNKNOWN MANUFACTURER - / 2 AR / IM

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

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

Write-up: swelling of axillary lymph nodes


VAERS ID: 1343016 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-05-21
Onset:2021-05-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest X-ray, Chest pain, Dizziness, Electrocardiogram
SMQs:, Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none to my knowledge
Current Illness: none to my knowledge
Preexisting Conditions: none
Allergies: penicillin
Diagnostic Lab Data: 5/24/20: cxr, ekg. pt declined emergency room
CDC Split Type:

Write-up: chest pain, dizziness started next day


VAERS ID: 1343029 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Incorrect dose administered, Needle 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:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Dose was wasted due to bent needle. Patient received vaccine


VAERS ID: 1343038 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-05-15
Onset:2021-05-22
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 005C21A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Headache, Injection site pain, Injection site reaction, Rash erythematous, Rash papular, Rash pruritic
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: red rash at the injection site- raised, itchy, burning- started about a week after injection along with constant headache.


VAERS ID: 1343044 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-05-21
Onset:2021-05-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWD177 / 2 LA / IM

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

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

Write-up: Patient received 2nd dose of COVID-19 vaccination, Pfizer instead of Moderna. 1st dose of COVID-19 vaccine was Moderna @ a Publix . Patient complained of body ache and body soreness the next day. patient stated "he woke up to body ache and body soreness the next day."


VAERS ID: 1343078 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022C21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), 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? No
Previous Vaccinations:
Other Medications: none
Current Illness:
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: fever of 102.1 onset 12 hours after second dose. he took Tylenol


VAERS ID: 1343087 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-05-20
Onset:2021-05-22
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Facial spasm
SMQs:, Dystonia (broad)

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

Write-up: Facial tic, started on 5/22 and has persisted.


VAERS ID: 1343088 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-04-03
Onset:2021-05-22
   Days after vaccination:49
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8734 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Herpes zoster
SMQs:, Opportunistic infections (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: Activella, Xarelto, Azothioprine, Lexapro, Vitamin D3
Current Illness:
Preexisting Conditions: Crohn''s Disease
Allergies: Penicillin, Flagyl, Regalyn
Diagnostic Lab Data:
CDC Split Type:

Write-up: I felt bumps on the back of my left thigh. When I looked in the mirror, I recognized the characteristic early rash of shingles. I had shingles 15 years ago on my torso. Because I''d had the COVID vaccine less than 2 months earlier, I thought it may have cause the infection to reactivate.


VAERS ID: 1343090 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

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

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

Write-up: Experienced fatigue, fever, body aches, headache, nausea for 26 hours.


VAERS ID: 1343095 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Auditory disorder, Dizziness, Hyperhidrosis, Pallor, Peripheral coldness, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Hearing impairment (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: mother said that pt had a febril seizure at 18 month old when pt received a vaccine
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: hiatal hernia, esophageal stricture
Allergies: no known allergies
Diagnostic Lab Data: none
CDC Split Type:

Write-up: sycope, pt started experiencing fainting symptoms such as sweating, paleness, hearing disturbances, weakness, dizziness, coldness of extremities after about 3 minutes of the vaccine, symptoms resolves in about 20 minutes.


VAERS ID: 1343124 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 2 AR / IM

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

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

Write-up: Patient received first dose Moderna 4/24/21, second dose Pfizer 5/22/2021. Troubleshooting: Scribe and vaccinator did not look at card to see what was given prior; he did not present card until after vaccine; first vaccine at different location so no clear record. Counseled by staff that he had received two doses of mRNA vaccine and there was no need for a third dose. Possible language barrier, but pt checked Moderna in the computer and was served by provider.


VAERS ID: 1343132 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040B21A / 2 RA / IM

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

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

Write-up: Patient received 1st dose of Moderna Covid 19 vaccine on 5/8/2021. Patient came to clinic and received second dose of Moderna Covid 19 vaccine on 5/22/2021-14 days early. Patient was instructed not to repeat the dose of vaccine.


VAERS ID: 1343166 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-05-21
Onset:2021-05-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Fatigue, Lymphadenopathy
SMQs:, 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 1. Swollen lymph node in left armpirt (side of injection) 2. Fatigue 3. Chills


VAERS ID: 1343184 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Abnormal dreams, Body temperature increased, Ear injury, Insomnia, Loss of consciousness, Seizure
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: Covid approx. 30 days prior. 101 Fever, tiredness, headaches, body aches.
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Passed out in observation room approx. 5 minutes after the dose, had a mild seizure and tore up my left ear on the carpet. History of passing out in hospital settings, possible vasovagal syncope, no history of seizures. recovered on hallway bed with granola bars and sprite. Approx. 9:30 pm temperature jumped within a couple of hours to around 101, after going to bed was half-awake-half-asleep until 7 am with vivid dreams/internal dialog.


VAERS ID: 1343187 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Condition aggravated, Immediate post-injection reaction, Nausea, Nervousness, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Hypoglycaemia (broad)

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

Write-up: PATIENT PRESENTED TO THE VACCINATION EVENT WITH NAUSESA AND VOMITTING AND A CERTGAIN DEGREE OF NERVOUSNESS. AFTER RECEIVING THE VACCINE, SHE WAS DIRECTED TO THE WAIT AREA FOR OBSERVATION. FIFTEEN MINUTES LATER I WAS CALLED TO THE WAIT AREA WHERE THE PATIENT COMPLAINED OF MORE NAUSEA. SHE SAT FOR THE ENTIRE TIME AND WENT WITH FAMILY MEMBERS TO GET SOMETHING TO EAT. I INSTRUCTED THE PATIENT TO CONSUME A SPRITE TO HELP SETTLE HER STOMACH AND TO EAT A LIGHT SNACK. AFTERWARDS, THE PATIENT AND HER FAMILY LEFT THE PREMISES.


VAERS ID: 1343188 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chills, Fatigue, Headache, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: 1st dose 4/16/2021 Pfizer Lot #ew0150, 59 years old, chills, fever,fatigue. Not as bad as 2nd dose.
Other Medications: Losartan, fluoxetine, Xenia, rosuvastatin, 81 mg aspirin, cranberry pill, 50+ women?s vitamin.
Current Illness: None
Preexisting Conditions: High blood pressure, high cholesterol, anxiety all well taken care of with medications I am currently taking.
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Chills, fever, headache, body aches, fatigue


VAERS ID: 1343198 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-05-20
Onset:2021-05-22
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017C21A / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Lymphadenopathy, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), 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? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Morphine, seasonal
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: Individual reports a "baseball" size swollen lymph node in left armpit. Also reported a fever that resolved after tylenol.


VAERS ID: 1343200 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / SYR

Administered by: Other       Purchased by: ?
Symptoms: Chills, Fatigue, Migraine, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Metoprolol, Wellbutrin, Omeprazole, Motegrity, Xifaxan
Current Illness: SIBO (small intestinal bacterial overgrowth)
Preexisting Conditions: IBS, inappropriate sinus tachycardia
Allergies: Nickel
Diagnostic Lab Data:
CDC Split Type:

Write-up: 05/22/2021 9:00pm - muscle aches, fatigue 10:30pm - migraine, chills 11:00pm - fever (100.6) 05/23/2021 1:00am - fever (101.5) 11:00am - sustained fever, migraine, fatigue 8:00pm symptoms begin to subside


VAERS ID: 1343205 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-05-21
Onset:2021-05-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 042B21A / 2 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Chills, Fatigue, Headache, Nausea, Pain, Pruritus, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: 5/22/21 Body aches, chills, fatigue, nausea, vomiting, headache 5/23/21 Puritis , treated with Benadryl 5/24/21 Puritis, treated with Benadryl


VAERS ID: 1343212 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-04-24
Onset:2021-05-22
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -

Administered by: Private       Purchased by: ?
Symptoms: Deep vein thrombosis
SMQs:, Embolic and thrombotic events, venous (narrow), Thrombophlebitis (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: Vraylar Tesosterone Cypionate
Current Illness: none
Preexisting Conditions: Transgender man, on testosterone for 9 years without history of DVT; drove truck for 3 years with out history of DVT
Allergies: Nickel and Sertraline
Diagnostic Lab Data: 5/23/21 was seen in ER and diagnosed with acute deep vein thrombosis of left peroneal vein
CDC Split Type:

Write-up: He got a COVID vaccine (location unknown to me) and called a few weeks after vaccine to report symptoms of blood clot was diagnosed this past weekend at emergency room.


VAERS ID: 1343220 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-05-21
Onset:2021-05-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / -

Administered by: Private       Purchased by: ?
Symptoms: Pain in extremity, Rash, Skin burning sensation
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin D 3
Current Illness: Strep - treated with clindamycin, last dose 5/5/21
Preexisting Conditions: hearing loss, hyperlipidemia, hypertension, fatty liver, seasonal allergies
Allergies: Amoxicillin
Diagnostic Lab Data: None
CDC Split Type:

Write-up: I just saw a 12 year old in the office who has an odd rash that started the day after she got her first COVID vaccine (Pfizer). She started with the two on her right ankle the day following the vaccine, then the two on her left ankle started the next day, followed by one more on her distal left arm over each of the next three days. She says the burn slightly when she touches them but no itching, not otherwise painful. They look to me like burns or something similar. I wonder if they are self-inflicted but she denies causing them or anything new recently aside from the vaccine. She has been using neosporin occasionally since they were noted, no other treatments. Other vaccine reaction noted: fatigue and slightly sore arm. She just completed a course of clinda for strep on 5/5. Otherwise just takes vitamin D daily. No recent open water swimming, etc.


VAERS ID: 1343223 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-05-18
Onset:2021-05-22
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022B21A / 1 - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Anastrozole; cholecalciferol; cyanocobalamin; hydrochlorothiazide; latanoprost; losartan; meloxicam; omeprazole; timolol
Current Illness:
Preexisting Conditions: Chronic systolic heart failure; insomnia; aortic dilatation; HTN; GERD; Macrocytic anemia; malignant neoplasm of upper-outer quadrant of left breast in female; osteoarthritis of knee; glaucoma; osteopenia; subclinical hyperthyroidism; prediabetes
Allergies: No known allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt received one dose of the Moderna vaccine, then tested positive for COVID-19 on 5/22/2021 and was ill enough to be admitted for inpatient treatment. She is still currently in our inpatient Gen med unit.


VAERS ID: 1343232 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-05-21
Onset:2021-05-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006C22A / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Cough, Headache, Injected limb mobility decreased, Injection site erythema, Injection site pain, Injection site pruritus, Injection site swelling, Injection site warmth, Pain, Pain in extremity, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Losartan HCTZ; Zyrtec; Vitamin D; Vitamin K; probiotic
Current Illness: None
Preexisting Conditions: Hypertension
Allergies: Penicillin Mango, papaya, passion fruit
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Fever ranging from 102.1 on the day after receiving the injection to current temp of 99.8 on day three. Severe headache, chest tightness; constant dry cough; severe body aches; severe pain in arm of injection site, unable to lift arm on day following injection and although the pain has lessened, the injection site is still extremely red, swollen, sore and hot to touch and itchy.


VAERS ID: 1343235 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007C21A AND 033 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Myalgia, Pyrexia, Rash erythematous, Rash pruritic
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: First Dose 7 days later rash in the site of injection (treated with a shot of dexamethasone). Second dose 8 hours after the second dose the rash appears (red, itchy), also fever and muscular pain.


VAERS ID: 1343249 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8736 / 1 LA / IM

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

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

Write-up: ~15-30 mins post vaccine dose, patient developed seizure and transferred to outside hospital emergency room via ambulance. Unknown if patient admitted.


VAERS ID: 1343252 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003C21A / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Decreased appetite, Dysmenorrhoea, Headache, Muscular weakness, Nausea, Oral mucosal eruption, Pain, Throat tightness
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Peripheral neuropathy (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Throat felt tight when I swallowed. Chills, severe headache, body aches, muscle weakness, menstral cramps (without menses), nausea, loss of appetite. Rash on roof of mouth.


VAERS ID: 1343274 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Headache, Hyperhidrosis, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Fever, muscle aches, sweat, chills, head ache


VAERS ID: 1343293 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 2 RA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Bone pain, Chills, Feeling hot, Headache, Nausea, Pain, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Osteonecrosis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Started with a headache and nausia then went to vomiting on and off the next 12 hours. Had a fever that spiked to 102 with chills and body aches. Took tylenol but didn''t reduce symptoms. Rested and drank lots of water. Began having bone aches where the inside of my bones feel hot, but the skin feels cold on top. The bone aches began Sunday morning and have continued. They get more intense the more I walk. The headache severity has reduced, still have a lingering headache in the back of my head. My fever today is at 100 and still have chills.


VAERS ID: 1343300 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Foaming at mouth, Hyperhidrosis, Loss of consciousness, 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), Convulsions (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (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: Unknown
Preexisting Conditions: Unknown
Allergies: NKDA
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: Patient received MODERNA COVID-19 vaccine, waited about 15 min afterwards with no reaction and was seen leaving pharmacy area. About 30 minutes afterwards, patient was found laying on floor in the aisle by a customer who then notified front store employee. When employee approached patient, he was awake and alert, but was described as having white foam coming out of mouth and sweating. He said he was ok but just needed to lay down and rest for a bit. Then he got up and went to restroom and reportedly vomited. 911 was called and response team ended up walking with him out of store.


VAERS ID: 1343303 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-05-20
Onset:2021-05-22
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 2 RA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Acne, Erythema
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Mirena iud, centrum silver multi, 1k MG C, 50mg zinc, 1k D, 1 capsule cinnamon and 1 capsule echnacia.
Current Illness: None
Preexisting Conditions: None
Allergies: None know. Am affected by seasonal allergies.
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Development of cluster of small whiteheads and redness on both cheeks. Doesn''t itch or hurt, isn''t warm to the touch. Started evening of 5/22/21, by 5/23/21 in the evening they covered most of the cheeks. I put coconut oil on and took 1 Benadryl in in the evening and morning of 5/24/21 there is a reduction of the amount but redness is prevalent.


VAERS ID: 1343321 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-21
Onset:2021-05-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Headache, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), 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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Chills, Headache, low fever, body aches


VAERS ID: 1343323 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013C21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Fatigue, Headache, Immediate post-injection reaction, Nausea, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Moderate fatigue and headache after first Moderna vaccine for 48 hours; severe arm pain and redness for 60 hours following vacci
Other Medications: none
Current Illness: none
Preexisting Conditions: asthma
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever 102 F for approximately 24 hours beginning ~15 hours post injection; severe headache and nausea for approximately 36 hours; fatigue and joint aches for 44 hours+


VAERS ID: 1343326 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Loss of consciousness, Nausea
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), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

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: Fluoxetine 10mg QD
Current Illness: N/A
Preexisting Conditions: Asthma, depression, anxiety.
Allergies: No known drug allergies.
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: One of the physician observers wrote: From what I understand she had her shot and switched places with her sister and was standing and then just went down. I don?t believe she hit her head we didn?t see a lump. She came too right away and got nauseated and light-headed again sitting up so we took her to lay down on the stretcher. She was doing ok but laying down when I left. The nurse that administered the immunization wrote: She got vaccinated, tolerated it well. Told her sister she barely felt it and expressed relief. Sat for a minute while in handed her mom paperwork ( vaccination card). Then got up, stood with mom and brother. Was standing one minute and went down without warning, standing next to brother and mom. I had just finished vaccinating the sister, I was putting a bandaid on her when it happened so couldn''t have been more than a couple of minutes. Dr. observed this patient after they passed out at the vaccination clinic and subsequently released her home with the family.


VAERS ID: 1343346 (history)  
Form: Version 2.0  
Age: 93.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-03-31
Onset:2021-05-22
   Days after vaccination:52
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017B21A / 2 - / SC

Administered by: Other       Purchased by: ?
Symptoms: Deep vein thrombosis
SMQs:, Embolic and thrombotic events, venous (narrow), Thrombophlebitis (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? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Senna, tramadol, lasix, metoprolol, MVI, venlafaxine, ferrous sulfate
Current Illness: none, stable
Preexisting Conditions: dementia, atrial fib, anemia, compression fx chronic
Allergies: lisinopril
Diagnostic Lab Data: Would be in hospital files
CDC Split Type:

Write-up: Admitted to local hospital and found to have DVT lower extremity.


VAERS ID: 1343357 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-05-20
Onset:2021-05-22
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / UNK - / IM

Administered by: Other       Purchased by: ?
Symptoms: Blood creatine phosphokinase MB increased, Brain natriuretic peptide increased, C-reactive protein increased, Echocardiogram abnormal, Ejection fraction decreased, Fibrin D dimer, Headache, Pyrexia, Troponin I increased
SMQs:, Cardiac failure (narrow), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Pulmonary hypertension (broad), Cardiomyopathy (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: Upper respiratory tract infection 5/6/2021
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Troponin-I 10.04, CK-MB 76.6, BNP 135, CRP 11.31, d-dimer 435 (5/23, 1506) Echo: "Mildly decreased left ventricular function globally with an approx. EF of 45% ." (5/23, 1545)
CDC Split Type:

Write-up: Fever and headache 24 hours after vaccine. Continued fever and chest pain 48 hours after vaccine.


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