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From the 1/21/2022 release of VAERS data:

Found 1,049,249 cases where Vaccine is COVID19 and Patient Did Not Die

Government Disclaimer on use of this data



Case Details (Reverse Sorted by Onset Date)

This is page 107 out of 10,493

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VAERS ID: 1992535 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 3 LA / IM

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

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

Write-up: PATIENT RECEIVED PFIZER BOOSTER LESS THAN 6 MONTHS FROM THE 2ND DOSE-PATIENT HAD THE 2ND DOSE ON 7/19/2021. PATIENT ATTESTED THAT IT HAS BEEN 6 MONTHS BUT SAID SHE MISCALCULATED THE TIME. SHE WAS STABLE AND DID NOT HAVE ANY ADVERSE REACTION. SHE LEFT IN STABLE CONDITION.


VAERS ID: 1992540 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-12-29
Onset:2021-12-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD0807 / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain upper, Fatigue, Feeling of body temperature change, Hypoaesthesia, Pain in extremity, Vomiting
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Tendinopathies and ligament disorders (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: 06/13/2021, phizer, 2nd dose, covid, chest pain, 17 at time of vaccine
Other Medications: Concerta XR 54 mg, Birth Control, Pepsid
Current Illness:
Preexisting Conditions: ADHD
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Vomiting, numbness in feet and legs, pain in feet and legs, tiredness, hot and cold flashes, stomach ache


VAERS ID: 1992547 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: California  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 065F21A / UNK LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Hypoaesthesia, Paraesthesia oral, Pharyngeal hypoaesthesia, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Peripheral neuropathy (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Nabumetone (RELAFEN) 500 mg Oral Tab Benazepril (LOTENSIN) 10 mg Oral Tab Fluticasone-Salmeterol (Wixela Inhub) 500-50 mcg/dose Inhl Disk w/devi Albuterol (PROAIR/PROVENTIL/VENTOLIN) 90 mcg/actuation Inhl HFAA Gabapentin (NEURONTIN) 600 mg
Current Illness: ARTHRITIS OF BILAT KNEES ATHEROSCLEROSIS OF AORTA ATRIAL FIBRILLATION, PAROXYSMAL CERVICAL DISC DEGENERATION DIVERTICULOSIS OF COLON ECZEMA FATTY LIVER HTN (HYPERTENSION) HX OF CARDIAC ARRHYTHMIA RADIOFREQUENCY ABLATION, LEFT ATRIAL COMPLEX HX OF CARDIOVERSION HX OF COLONOSCOPY HX OF RENAL CALCULUS HYPERURICEMIA INTERMITTENT ASTHMA LUMBAR DISC DEGENERATION LUMBAR FACET JOINT ARTHRITIS PREDIABETES PULMONARY NODULE SEVERE OBESITY (BMI $g= 40) SLEEP APNEA SPONDYLITIS OF LUMBAR SPINE
Preexisting Conditions: ARTHRITIS OF BILAT KNEES ATHEROSCLEROSIS OF AORTA ATRIAL FIBRILLATION, PAROXYSMAL CERVICAL DISC DEGENERATION DIVERTICULOSIS OF COLON ECZEMA FATTY LIVER HTN (HYPERTENSION) HX OF CARDIAC ARRHYTHMIA RADIOFREQUENCY ABLATION, LEFT ATRIAL COMPLEX HX OF CARDIOVERSION HX OF COLONOSCOPY HX OF RENAL CALCULUS HYPERURICEMIA INTERMITTENT ASTHMA LUMBAR DISC DEGENERATION LUMBAR FACET JOINT ARTHRITIS PREDIABETES PULMONARY NODULE SEVERE OBESITY (BMI $g= 40) SLEEP APNEA SPONDYLITIS OF LUMBAR SPINE
Allergies: No known allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient brought into Covid Observation area 20 minutes after receiving Moderna booster. Reports tingling sensation to lips and tongue and tight feeling in throat. Patient denies any difficulty breathing. No swelling to face, lips, and tongue noted. Able to swallow to saliva and water without difficulty. No wheezing noted. Patient alert and oriented x 4, speaking in complete sentences. Denies experiencing any of these symptoms after 1st two doses of Moderna. Accompanied by his wife. 10:29 am- VS- Temp 97.7, BP 155/90, HR 53, RR 18, 02 SATs 95%RA 10:32 am- Call placed to on call ED physician, informed of patient symptoms above. Verbal order given for Benadryl 25 mg orally x 1 now. Per Dr., continue to monitor patient for 30 minutes, if symptoms improved, ok to discharge home. If symptoms worsen, patient to go to ED. Verbal order repeated and confirmed. 10:36 am- Benadryl 25 mg orally given as ordered. 10:45 am- VS- BP 148/79, HR 54, RR 20, 02 SATs 95%. Patient reports tingling sensation to lips and tongue remain unchanged, throat tightness lessening. 10:57 am- VS- BP 162/78, HR 55, RR 20, 02 SATs 95% RA Patient reports tightness in throat improving and throat/neck area feels numb on both sides, but he is able to feel touch. Denies any difficulty breathing or swallowing. Reports tingling to lips and tongue improving. Denies any chest pain or weakness or numbness to face or extremities. 11:07 am- VS- Temp 97.6, BP 153/80, HR 55, RR 18, 02 SATs 96%RA. Patient symptoms remain unchanged and no new symptoms reported. 11:22 am- Patient reports improving tingling sensation to lips, tongue and lessening tight feeling in throat. Denies any new or worsening symptoms. Denies any difficulty breathing. Speaking in complete sentences with wife who is at bedside. VS: BP 140/72, HR 68, RR 20, 02 SATs 97%. 11:36 am- Patient reports improved tingling sensation to lips and tongue. Denies any tightness to throat. Also denies any throat swelling or itching. Reports numb feeling to both sides of neck, unchanged, not worse. Denies any difficulty breathing or swallowing. 11:39am- Patient discharged home in stable condition, accompanied by his wife who will drive him home. Advised to call 911 or go to nearest ED if symptoms return or worsen. Patient and wife verbalized understanding.


VAERS ID: 1992558 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-12-29
Onset:2021-12-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH PFIZER FD7218 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Erythema, Facial pain, Headache, Injection site pain, Rash, Skin warm
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Glaucoma (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: seroquel, lisinopril, prenatal, baby asprin
Current Illness: na
Preexisting Conditions: bipolar, RA, high blood pressure, OCD, anxiety,
Allergies: na
Diagnostic Lab Data: na
CDC Split Type:

Write-up: I received my second covid shot on 12/29/2021. I took Ibuprofen before i got the shot and before going to bed. I woke up 12/30/2021 with a sore arm in injection site. I took a dose of Ibuprofen in the morning before work but otherwise felt good. I noticed around 12pm my left cheek was sore, no jam pain just sore. I noticed at 1pm that my face was completely red and has a rash. It is a little hot to the touch and the rash isn''t raised. I also noticed I am starting to have a headache and took some ibuprofen I notified my jobs employee health who recommended I do an anywhere care visit. That doctor suggested I take some anti-histamine and report this reaction.


VAERS ID: 1992561 (history)  
Form: Version 2.0  
Age: 10.0  
Sex: Female  
Location: Mississippi  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL0007 / UNK - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Feeling cold, Feeling hot, Immediate post-injection reaction, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NO MEDICATIONS
Current Illness: NO OTHER ILLNESS IN PAST 60 DAYS
Preexisting Conditions: NO HEALTH CONDITIONS
Allergies: NO KNOWN ALLERGIES
Diagnostic Lab Data: BLOOD PRESSURE 100/68 PULSE 99 TEMPERATURE 96.8
CDC Split Type:

Write-up: IMMEDIATELY FOLLOWING VACCINE ADMINISTRATION, PATIENT REPORTED FEELING HOT THEN COLD AND VOMITED CLEAR FLUID.


VAERS ID: 1992567 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: California  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 331308A / 2 LA / IM

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

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

Write-up: Patient had signed up for 2nd Pfizer COVID-19 vaccine and received a Pfizer dose 1 after J&J vaccine. Patient disclosed after she had received the vaccine and mentioned her provider had told her it was okay to receive a 2nd booster.


VAERS ID: 1992570 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-12-28
Onset:2021-12-30
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ1611 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Axillary pain, 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: Metoprolol 100 mg Telmistarten 80mg Paxil 20mg Folic Acid 1mg D3 1000IU
Current Illness: Cold i.e.; stuffy/runny nose, slight cough
Preexisting Conditions: High blood pressure Anxiety
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Day two after receiving the shot, I woke up with soreness under my left arm. After examining my underarm I realized that it was swollen the size of a softball. Assuming it is the lymph node that is swollen.


VAERS ID: 1992586 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL3198 / 3 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL3198 / 3 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: Sumatriptan, Rosuvastatin, Estrace,
Current Illness: no illnesses
Preexisting Conditions: Hyperlipidemia, migraines
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Husband and wife came in for Pfizer booster. Wife needed flu shot in addition to booster. Pharmacist was distracted and administered both Pfizer boosters to wife/patient.


VAERS ID: 1992588 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Virgin Islands  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013F21A / 3 LA / 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: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: Unknown
Diagnostic Lab Data: None
CDC Split Type:

Write-up: The patient received the booster vaccine 3 months early, booster was to received in March of 2022.


VAERS ID: 1992595 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-12-29
Onset:2021-12-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013H2BA / 3 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Fatigue, 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Pfizer vaccination.
Other Medications: None.
Current Illness: None.
Preexisting Conditions: None.
Allergies: Penicillin.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fatigue, muscle aches and resting heart rate 70. It is usually 40-45. Fever (right ear 101.0 and left ear 101.4). Took Motrin.


VAERS ID: 1992597 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL3197 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Incorrect dose administered, No adverse event
SMQs:, Medication errors (narrow)

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

Write-up: WRONG SHOT GIVEN TO 11 YEAR OLD, INTENDED SHOT WAS FOR PEDIATRIC PFIZER DOSE 0.2ML NOT ADULT PFIZER DOSE 0.3ML. PT DID NOT HAVE ANY REACTION AT TIME GIVE.


VAERS ID: 1992608 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Nebraska  
Vaccinated:2021-11-11
Onset:2021-12-30
   Days after vaccination:49
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032F21A / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Angiopathy, Anxiety, Asthenia, Blood electrolytes normal, Blood thyroid stimulating hormone normal, C-reactive protein increased, Carbon dioxide increased, Catheter placement, Chest X-ray normal, Chronic obstructive pulmonary disease, Computerised tomogram head abnormal, Condition aggravated, Confusional state, Cough, Diarrhoea, Dyspnoea, Dysuria, Electrocardiogram abnormal, Hypercapnia, Influenza A virus test negative, Influenza B virus test, Memory impairment, Mental status changes, Metabolic function test normal, Neurological symptom, Pollakiuria, Procalcitonin, Productive cough, Prohormone brain natriuretic peptide increased, Pyrexia, Rales, Restlessness, Rhonchi, SARS-CoV-2 test negative, Sinus tachycardia, Troponin normal, Urine analysis normal, Wheezing
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Dementia (broad), Pseudomembranous colitis (broad), Akathisia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Depression (excl suicide and self injury) (broad), Hypersensitivity (broad), Noninfectious diarrhoea (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Dehydration (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: aspirin, citalopram, fluticasone - salmeterol, gabapentin, levothyroxine, metoprolol, rosuvastatin, tiotropium
Current Illness:
Preexisting Conditions: COPD
Allergies: amoxicillin
Diagnostic Lab Data: CT Head to rule out cerebrovascular accident CXR TSH Normal CRP elevated troponin negative CMP ordered Procalcitonin negative
CDC Split Type:

Write-up: Patient brought in by rescue squad with severe stroke-like symptoms. Chief complaint of extreme confusion. Temperature 37.8 degrees centigrade. Pleasant 83-year-old male brought to emergency department via ambulance for evaluation of confusion. The patient''s wife states that the patient has had intermittent confusion for the past 2 days but it became acutely worse this morning. Patient''s wife also states that the patient has had a cough for the past 2 days. The patient does complain of shortness of breath. Patient has known history of COPD. The patient and his wife denies any reports of fevers. The patient denies any chest pain. He denies abdominal pain, nausea or vomiting. Patient''s wife states that the patient has had some loose stools. His wife reports that he was using the bathroom frequently last night but does not know if he was having loose stools or if it was due to urinary frequency. The patient does complain of having occasional dysuria as well as urinary frequency. He states that he is in the hospital but cannot tell me the month, the year or why he is in the hospital. Altered mental status, unspecified R41.82 Low-grade temp, 37.8 ?C, nontoxic-appearing. Presented to emergency department with altered mental status, patient was alert to person, stated that he was in the hospital. Patient did have difficulty remembering his wife''s name and remembering his caregiver as well as the names of his children. Patient restless at times. Patient globally weak. No arm drift or leg drift. A stroke work-up was initiated. Patient had a CT head without contrast which was negative for acute fracture or hemorrhage. Showed vasculopathic changes. Patient did have some periods where his mentation seemed to improve but then would become confused again. Covid swab obtained, negative for COVID-19, influenza a and B not detected. Pupils equal round and reactive to light. Patient is normally alert and oriented x4. UA unremarkable. Chest x-ray obtained, do not appreciate any focal infiltrate. CMP shows normal electrolytes. Patient has a mildly bumped CO2 level of 31, upper limit of CO2 is 30. It is possible the patient''s confusion may be related to hypercapnia however it is very minimally bumped up. The patient will need to have further work-up due to his altered mental status as it does not seem to be a clear-cut answer to the cause of it. The patient has been confused for several days according to his wife with worsening today. Patient did request transfer to Facility, his wife was in agreements with transfer to Facility. Spoke with hospital, spoke with Dr. who did accept the patient for transfer. The patient will be transferred by ambulance to the Facility, the Hospital did state that the patient was travel eligible and they would arrange for transport of the patient to their facility. 2. COPD with exacerbation J44.1 Presented to emergency department with altered mental status. Patient was found to be dyspneic with expiratory wheezing bilateral upper lobes, coarse rhonchi and crackles in his bilateral bases. No JVD appreciated. ECG showed sinus tachycardia, no ST segment elevation or acute ischemic changes. proBNP was 1114. Patient does not have any documented history of heart failure. Patient was given a DuoNeb and had improvement with his shortness of breath. Had a loose cough. Patient had recurrence of wheezing and was given an additional albuterol nebulizer treatment in the emergency department. Patient given dexamethasone 6 mg IV. Covid swab negative. Patient has known COPD. 1 view chest x-ray obtained, do not appreciate any focal infiltrate. Suspect the patient may have COPD exacerbation causing his shortness of breath. 3. Elevated brain natriuretic peptide (BNP) level R79.89 Orders: albuterol, 2.5 mg = 3 mL, Soln, NEB, q4hr (interval), PRN shortness of breath or wheezing, Routine, Start date 12/30/21 12:06:00 CST, 12/30/21 12:06:00 CST dexamethasone 10 mg/mL injectable solution, 6 mg = 0.6 mL, Soln, IV Push, Once, NOW, Start date 12/30/21 14:18:00 CST, Physician Stop, Stop date 12/30/21 14:18:00 CST, 12/30/21 14:18:00 CST Ativan, 0.5 mg = 1 tab(s), Tab, Oral, TID, PRN anxiety, Routine, Start date 12/30/21 13:30:00 CST, 12/30/21 13:30:00 CST EKG, 12/30/21 9:27:00 CST, Stop Date 12/30/21 9:27:00 CST, Walk, No, No, Standard Precautions, stroke alert Insert Straight Catheter, 12/30/21 9:30:00 CST Patient Transfer Order, 12/30/21 12:06:00 CST, transfer XR Chest 1 View Portable, 12/30/21 9:29:00 CST, Routine, 12/30/21 9:29:00 CST, cough, SOB, No, Transport Mode: Walk, , No, , No, Rad Type ER Level 4 Informed Dr. with plan of care and agrees with plan of care. Patient Discharge Condition Stable Discharge Disposition Transfer to Facility at 1422


VAERS ID: 1992625 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL3197 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Fatigue, 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), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: Thimerosal--was fine after getting first 2 doses of Pfizer
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient passed-out twice after administration, then vomited. She felt very weak and tired until she vomited then she began to feel better. I talked to the patient about an hour later when she was at home and feeling better.


VAERS ID: 1992631 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5618 / 1 LA / IM
FLU4: INFLUENZA (SEASONAL) (FLULAVAL QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS 47K47 / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Incorrect product formulation administered, No adverse event
SMQs:, Medication errors (narrow)

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

Write-up: Patient was inadvertently given a 5-11 years formulation of Pfizer-BioNTech COVID-19 Vaccine for her 1st dose in her primary series. Patient and family was informed of administration error. Patient had no distress or adverse reaction to dose given.


VAERS ID: 1992642 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-12-29
Onset:2021-12-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH LOT FD0809 / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Maternal exposure during breast feeding
SMQs:, Neonatal exposures via breast milk (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: birth control
Current Illness: no
Preexisting Conditions: no
Allergies: no
Diagnostic Lab Data:
CDC Split Type:

Write-up: I am a breastfeeding mother. My son (11 months) nursing baby vomited at 1:15am (12/30) following my 11:15am (12/29) vaccination. He was uncomfortable crying from hours 1:15-3:30am and threw up. Not like him to do so normally. He vomited again at 9:30am (12/30).


VAERS ID: 1992655 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-04-16
Onset:2021-12-30
   Days after vaccination:258
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0158 / 2 UN / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER2613 / 1 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Dysphonia, Oropharyngeal pain, SARS-CoV-2 test positive
SMQs:, Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: amLODIPine (NORVASC) 5 mg tablet TAKE 1 TABLET Additional information for Item 9: 12/30/21 amLODIPine (NORVASC) 5 mg tablet TAKE 1 TABLET BY MOUTH EVERY DAY o atorvastatin (LIPITOR) 10 MG tablet TAKE 1 TABLET BY MOUTH EVERY DAY AT NIGHT
Current Illness:
Preexisting Conditions: Prediabetic, hypertension
Allergies: No known allergies
Diagnostic Lab Data: 12/30/21 COVID Result IPOC PCR Detected Abnormal
CDC Split Type:

Write-up: 12/30/21 Patient states that for the past 2 days he has been experiencing a sore throat which is not significantly changed since it began. Patient has also been experiencing mild hoarseness associated with this or throat but denies congestion, shortness of breath, difficulty breathing, nasal drainage, cough, ear pain, abdominal pain, nausea, vomiting or diarrhea. Patient denies recent fever, chills and overall states that he feels well other than his sore throat. Patient has been fully vaccinated and received a booster for COVID-19. No other complaints today in clinic. Review of Systems Constitutional: Negative for chills, fatigue and fever. HENT: Positive for sore throat and voice change. Negative for congestion,


VAERS ID: 1992661 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030H21B / UNK OT / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test, Injury associated with device
SMQs:, Medication errors (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: blood work at occupational health 12/30/21
CDC Split Type:

Write-up: After administering a dose of moderna to a patient the needle accidently stuck into the nurses thumb.


VAERS ID: 1992666 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: California  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 069F21A / 3 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Hyperhidrosis, 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), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: n/a
Preexisting Conditions: N/A
Allergies: Amoxicillin, Penicillins class
Diagnostic Lab Data: Per MD N/A
CDC Split Type:

Write-up: Patient received Vaccine- while in observation area, patient complained of dizziness and Passed out. Patient almost immediately woke up-and was diaphoretic and pale. MD stat was called, Patient completed observation on gurney in presence of RN. Vital signs taken and MD assessed patient. Patient was ok to go to home.


VAERS ID: 1992679 (history)  
Form: Version 2.0  
Age: 7.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5618 / 3 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: Received 3rd dose.


VAERS ID: 1992693 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD7218 / 3 RA / IM

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

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

Write-up: Client recieved a 0.3 cc Booster dose of the Pfizer vaccine yet was not eligible due to age. She is 15 years old. Mother and client was informed of the error.


VAERS ID: 1992709 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8027 / 3 LA / IM

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

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

Write-up: No adverse event noted.


VAERS ID: 1992725 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8027 / 7+ LA / 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:
Diagnostic Lab Data:
CDC Split Type:

Write-up: I administered the Pfizer Covid 19 Booster vaccine to this patient four months after her second covid vaccine instead of six months. I verified the vaccination card after I administered this vaccine. Before I gave the shot, I did ask the patient if she had the vaccine 6 months ago and she told my yes. I did not verify on the card that it was 6 months ago before I gave the shot.


VAERS ID: 1992729 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-05-13
Onset:2021-12-30
   Days after vaccination:231
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19
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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: covid


VAERS ID: 1992733 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013H21B / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood pressure increased, Dizziness, Epistaxis, Nausea
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (narrow), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: proventil, vit D3, levothyrox, entresto, promethazine, tizanidine
Current Illness: heart patient
Preexisting Conditions: heart failure, irregular heart rate
Allergies: nkda
Diagnostic Lab Data: EMS checked the Pt''s blood pressure, it was elevated (140s).
CDC Split Type:

Write-up: Pt states she didnt eat much all day, she became nauseous from the smell of food from in store deli and threw up and had substantial bleeding from her nose, Pt was alert when I arrived on scene, no epi pen was needed, Pt states she almost passed out.


VAERS ID: 1992734 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-10-25
Onset:2021-12-30
   Days after vaccination:66
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19
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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: covid


VAERS ID: 1992737 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-12-17
Onset:2021-12-30
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041J21A / 3 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dry skin, Erythema, Pain, Pain in extremity, Pruritus
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (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: Claritin
Current Illness: Mild cold
Preexisting Conditions:
Allergies: Pollen
Diagnostic Lab Data: I have scheduled a doctor''s appointment but the earliest I can get in with the new year is the 11th of January. If this continues to get worse, I will be going to urgent care.
CDC Split Type:

Write-up: Woke up and my hands were both itchy, and my right hand hurt along the top of the palm, where the knuckles are. Itching has persisted in both hands for 12 hours, but has been far worse on right. Also have a round patch of itchy skin on right wrist two inches long by one inch wide (roughly). If I squeeze the fingers of my right hand into a fist, I feel significant pain up my fingers starting at the knuckles on the palm-side of my hand. I have the same reaction on my left hand, but far less. My hands have been dry recently due to frequent washing, so I originally attested the itching, pain and redness to that, but when it didn''t fade like it normally does when I applied lotion, I became a little concerned. I took an allergy pill (Loratadine - Generic) and it reduced the symptoms a bit, but the pain and itching are still very present.


VAERS ID: 1992740 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-12-28
Onset:2021-12-30
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 33030BD / 3 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Lymph node pain, Lymphadenitis, 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: 12 hrs of severe exhaustion resulting in bedrest, Age 44, 4/9/21, Pfizer SARCOV2 VAC Dose #2
Other Medications: Valtrex, Desvenlafaxine, Mucinex, Amoxycillin - Clav
Current Illness: Sinus infection
Preexisting Conditions: Migraines, HSV, Depression, Seasonal Allergies
Allergies: None
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Very large inflammed lymph nodes in armpit with visible swelling and soreness to the touch


VAERS ID: 1992746 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL0007 / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: No adverse event, Underdose
SMQs:, Medication errors (broad)

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

Write-up: NO ADVERSE EVENT. MINOR WAS GIVEN (5-11) FORMULATION INSTEAD OF FORMULATION FOR 12 AND OVER. GIVEN PROPER DOSAGE FOR ORANGE CAP. NOTIFIED PARENT OF MED ERROR. ADVISED NO REPEAT DOSE NECESSARY. MOTHER STATED UNDERSTANDING.


VAERS ID: 1992752 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: New York  
Vaccinated:2021-12-13
Onset:2021-12-30
   Days after vaccination:17
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ8757 / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Blister, Hypersensitivity, Inflammation, Pain
SMQs:, Severe cutaneous adverse reactions (broad), Angioedema (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Calcium 600+D High Potency 600-400 MG-UNIT Oral Tablet , Levothroid 88 MCG Oral Tablet , Lipitor 20 MG Oral Tablet ,Bisoprolol Fumarate 2.5 MG Oral Tablet
Current Illness: HLD, hypothyroidism
Preexisting Conditions: HLD, hypothyroidism
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient had allergic reaction to covid-19 vaccine (Pfizer) since the booster shot (12/13/21). She had 20-30 inflammatory vesicles and bullae at the left arm with rash. She also reported mild pain. I gave her Claritin 10 MG Oral Tablet and Halobetasol Propionate 0.05 % External Ointment today. Waiting for outcome.


VAERS ID: 1992762 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032H21A / 3 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: The pt called from lobby saying their throat felt like pins and needles. They stated they were dizzy and that their tongue felt bigger. A rapid response was called. Vital signs were taken and were stable. 50 mg of Benadryl was given orally. Pt able to speak, breath, and drink water. As the minutes went on, their hands and neck were itchy. They were taken by ED nurses to ED for further evaluation.


VAERS ID: 1992766 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-11-18
Onset:2021-12-30
   Days after vaccination:42
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 213D21A / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, Pneumonia
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

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

Write-up: Came to the ED for abdominal pain. Pt also has pneumonia.


VAERS ID: 1992770 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: New York  
Vaccinated:2021-12-29
Onset:2021-12-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL3197 / 3 LA / IM

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

Write-up: Heart rate jumped after waking in the morning and never settled. 90 to 115, often above 100, though mostly sitting at home computer.


VAERS ID: 1992772 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 33025BD / UNK LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Paraesthesia, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (broad), Guillain-Barre syndrome (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: Minor hives with 1st Pfizer; disclosed after.
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient later disclosed she had hives with last Pfizer shot, and also hand tingling. Observation time switched to 30 minutes. She had hand tingling "like it''s falling asleep" in the right hand about 20 minutes after the vaccine, but it went away. Her left hand was still tingling. 50mg diphenhydramine PO administered. About 20 minutes later, still tingling but less so. Patient did not wish to proceed to urgent care and left observation. No difficulty breathing or facial swelling. Followed-up with patient via phone 2 hours later. She stated immediately after leaving, her face broke out in hives but since resolved. Never any throat or lip swelling or difficulty breathing. Tingling in hand has not resolved. Recommended follow-up if symptoms do not abate.


VAERS ID: 1992778 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-12-29
Onset:2021-12-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 0415214 / 3 LA / 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Smartypants Men''s Multivitamin
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Persistent bloody nose


VAERS ID: 1992781 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Maine  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033H21A / 1 LA / IM

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

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

Write-up: Our immunizing technician accidentally gave the 17 year old patient a moderna vaccine as her first dose without verifying with the pharmacist before giving the shot. Currently Moderna is only approved for adults age 18 years or older.


VAERS ID: 1992800 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL3198 / 1 LA / IM

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

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

Write-up: Patient signed up for COVID vaccine online and was administered Pfizer COVID vaccine first dose. After administration, patient said that he did not want Pfizer brand and wanted Moderna. Patient did not experience any adverse affects from Pfizer as of yet.


VAERS ID: 1992807 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-12-27
Onset:2021-12-30
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 330308D / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: C-reactive protein increased, Chest pain, Echocardiogram normal, Electrocardiogram ST segment abnormal, Myocarditis, Pericarditis, Troponin increased
SMQs:, Systemic lupus erythematosus (broad), Myocardial infarction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations: Numbness in the foot after second dose of Pfizer Vaccine - 5/25/21 - resolved after a few weeks
Other Medications: Zyrtec, aspirin
Current Illness: Headache the day prior to vaccine
Preexisting Conditions: Mild, intermittent asthma, allergic rhinitis
Allergies: Dogs, amoxicillin
Diagnostic Lab Data: 12/30/21 -- ECHO - normal, EKG - ST changes in inferolateral leads, troponin elevation - 3.76, CRP - 1.7
CDC Split Type:

Write-up: Acute myocarditis/pericarditis - chest pain, elevated troponin, ST changes on EKG, slightly elevated CRP


VAERS ID: 1992817 (history)  
Form: Version 2.0  
Age: 8.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5618 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Underdose
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 pulled away and less than half of vaccine was administered.


VAERS ID: 1992827 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: California  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8027 / 2 LA / IM

Administered by: Public       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: Moderna 1st dose


VAERS ID: 1992832 (history)  
Form: Version 2.0  
Age: 9.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL0007 / 1 - / IM

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

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

Write-up: Client received first dose of Pfizer and waited in lobby for 15 minutes after injection. When patient was walking to the car with family, she reported to feeling dizzy and they walked back inside to report it to medical staff. Pt complained of slight dizzyness. Pt was conscious and responsive. Upon exam, the medical staff member reported patient skin normal in color, normal temperature, and breath sounds clear. All vitals stable. Report states patient had breakfast but nothing since. After several minutes of evaluation, patient and family members assisted to vehicle without any difficulty.


VAERS ID: 1992837 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8027 / 2 LA / IM

Administered by: Public       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: 1st dose Moderna.


VAERS ID: 1992839 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5618 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Incorrect dose administered, No adverse event
SMQs:, Medication errors (narrow)

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

Write-up: Client received a pediatric dose of Pfizer Covid Vaccine (age 12) instead of an adult dose. No adverse event occurred.


VAERS ID: 1992841 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1855835 / 3 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Condition aggravated, Epiglottitis, Interchange of vaccine products, Throat irritation
SMQs:, Oropharyngeal infections (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Medication errors (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: Patient had an allergic reaction to her second dose of Moderna back in April 2021
Diagnostic Lab Data: Vitals were all normal
CDC Split Type:

Write-up: Patient complained of itchy, scratchy throat and what felt like a swollen epiglottis about 15 minutes after vaccine. She was administered 50mg of diphenhydramine orally. She stated that symptoms were slowly getting worse, so she was observed in clinic for a while. The clinic felt she was ok to go home about 15-30 minutes after arriving at clinic (about 45 minutes to 1 hour after vaccine). Of note, she opted to get the Janssen vaccine as her booster as she had previously experienced more significant epiglottis swelling after her second Moderna vaccine in April 2021


VAERS ID: 1992844 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 068H21A / 3 LA / IM

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

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

Write-up: patient received a booster covid 19 moderna vaccination on 12/30/21 after her scheduled apt with her PCP. After administration it was brought to the MA''s attention that the immunization was administered after 12 hours of the bottle puncture time but before 24 hours. contacted the CDC who recommended i contact moderna. Moderna informed me there is no recommendations at this time.


VAERS ID: 1992860 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Syncope
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: Spastic dysplasia type 4
Allergies: Allergies to pollen.
Diagnostic Lab Data: Vital signs.
CDC Split Type:

Write-up: Patient passed out and had brief seizure like activity. Patient has Spastic dysplasia Type 4 and was wheelchair bound. Mother on scene with patient as primary caregiver and refused transport to medical facility. Patient alert and oriented within a minute or so and able to protect her own airway. Patient able to drink water on her own. Mother said this was "normal" for patient when she gets injections. Patient smiling and laughing with crew and mother prior to departure. Advised mother to call 911 if patient relapsed.


VAERS ID: 1992866 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-12-29
Onset:2021-12-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 33101BA / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad)

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

Write-up: weezingh, tightness in chest


VAERS ID: 1992959 (history)  
Form: Version 2.0  
Age: 5.0  
Sex: Male  
Location: Alabama  
Vaccinated:2021-12-29
Onset:2021-12-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ8762 / 2 LA / IM

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

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

Write-up: Patient received the Pfizer Covid Vaccine for ages 12 & older as opposed to the Pfizer Covid Vaccine for ages 5-11. He was monitored closely and no adverse reaction was observed.


VAERS ID: 1992962 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Axillary pain, Feeling hot, Headache, Hypoaesthesia, Immediate post-injection reaction, Nausea, Pain in extremity
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Sexual dysfunction (broad)

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

Write-up: Pain in arm started right away and headache, right leg felt numb like it was sleeping for about 10 minutes afterwards. Right armpit sharp pain, no swelling. Nauseous once I got home and took my methimazole, about 20 minutes after shot. Felt hot on and off all day after shot.


VAERS ID: 1992964 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: California  
Vaccinated:2021-12-29
Onset:2021-12-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 070H21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain
SMQs:, 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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Risperidone; Fluoxetine; Low-ogesterol; Januvia; multi-vitamin
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Chest pain


VAERS ID: 1992965 (history)  
Form: Version 2.0  
Age: 10.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

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

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

Write-up: 0.2ML OF ADULT PFIZER GIVEN TO 10 YR OLD.


VAERS ID: 1992967 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 33025BD / 3 LA / IM

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

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

Write-up: Patient came in for the Pfizer (age 12+ purple cap) booster dose of vaccine today. After they left, it was noted the patient was 15 years 7 months old. Pfizer booster doses are currently only recommended down to age 16. Parent contacted and informed of the administration error. No out of the ordinary side effects noted at this time.


VAERS ID: 1992972 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ8762 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Eye movement disorder, Hypotension, Loss of consciousness, Seizure
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (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), Vestibular disorders (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

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

Write-up: Patient got dizzy and light headed. She then went still and had seizure type reaction. eyes rolled back, hands were clenched, mouth was odd, patient passed out. upon awakening, she was very weak with low BP. called 911


VAERS ID: 1992975 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: New York  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 33025BD / 3 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Patient states had similar reaction to previous doses of covid vaccine.
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: Patient states had similar reaction to first two doses of covid vaccine.
Diagnostic Lab Data: unknown
CDC Split Type:

Write-up: Patient given vaccine at 3:46 p.m., while in observation area patient stated his throat felt tight, patient states this happened with his previous two doses of covid vaccine. RRT called immediately at 4:13 p.m. B/P 128/80 P 72 RR 18 O2 sats 98%RA. Patient denies feeling shortness of breath. RRT arrived at 4:15 p.m. and patient left with RRT team to go to ER at 4:16 p.m.


VAERS ID: 1992983 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: California  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: pt received a booster dose 15 days too early. He was only 5.5 mos out.


VAERS ID: 1992990 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 33025BD / 3 LA / IM

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

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

Write-up: Child came in today for their booster dose of Pfizer (12 years+/purple cap) today. After they were vaccinated and left it was noted that the child was only 15 years old and current CDC/FDA recommendations are for booster doses starting at 16 years and older. Parent was contacted and notified of the vaccine administration error. "normal" mild to moderate side effects were reviewed. Procedure for reviewing Covid-19 vaccination appointments was addressed and staff notified to be aware of the age of the child and ensuring that a booster dose is appropriate for their age before vaccinating.


VAERS ID: 1992993 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Idaho  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ1620 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Loss of consciousness, Mydriasis, 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: n/a
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: n/a
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Patient stood up quickly and slowly slumped down wall -- passed out for a brief period (seconds) and came to. Very pale and pupils dilated -- mom reported patient hadn''t had breakfast. Patient was given an orange juice and stayed in seated position. Pupils returned to normal in seconds, color returned to normal in about 10 minutes. Patient reported feeling fine when family departed 30 minutes later.


VAERS ID: 1992997 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 028K21A / 3 LA / IM

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

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

Write-up: Vaccine was given to a 16 year old instead of an 18 year old. No adverse events occurred. Patient is fine.


VAERS ID: 1992998 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: New York  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ8757 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Pallor, Seizure, Vomiting
SMQs:, Acute pancreatitis (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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: stated no
Preexisting Conditions: stated no
Allergies: not told
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt was sitting in our waiting area for the 15 minutes time after receiving the vaccine. Looked over to check on him and heard a noise and it looked like he had a small seizure. He came to within 1 minute. Called 911. Pt wanted to lie down on the floor. Allowed him to. Kept talking to him. He was pale in color and then vomited. EMTs transported him to the hospital for evaluation.


VAERS ID: 1992999 (history)  
Form: Version 2.0  
Age: 7.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Patient given adult dose of Pfizer vaccine instead of age 5-11 years dose at Walgreens pharmacy. No signs, symptoms present at the time of this report. Please contact parent, at patient contact phone number provided for additional details.


VAERS ID: 1993222 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-12-26
Onset:2021-12-30
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 33025BD / 3 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8730 / 2 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6206 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Epinephrine 0.3mg/0.3ml sol A-IJ as needed.
Current Illness:
Preexisting Conditions: Asthma, GERD, Scoliosis
Allergies: Nuts, all
Diagnostic Lab Data: 12/30/21- COVID Result IPOC PCR Detected Abnormal.
CDC Split Type:

Write-up: 12/30/21 Patient is a server at a restaurant. Last week general manager was positive and the restaurant closed for 1 week. He had a test done on December 23 that was negative for Covid. Had one a couple weeks prior to that that was also negative. However on his own he went to Pharmacy and had a rapid test done there on Tuesday the 28th. That test was positive. He had a little bit of a scratchy sore throat otherwise per review of systems below negative. He wanted to be tested again to see if he really has it or not. Feels fine today. Review of Systems Constitutional: Negative for chills and fever. HENT: Negative for rhinorrhea, sore throat and voice change. Respiratory: Negative for cough. 12/30/21 Musculoskeletal: Negative for myalgias. Neurological: Negative for headaches.


VAERS ID: 1993224 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL3197 / 3 RA / IM

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

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

Write-up: The patient is immuncomprised, received additional dose of pfizer before due. Accompained by parents, who insisted she is due for her 3rd additional dose, her vaccination card indicated she received first dose 05/13/21 and second dose 06/03/21 and is eligible to received an additional 3rd dose been immuncomprised. But after vaccine administration, record shows 3rd dose was administered on 11/23/21. The patient was monitored for 15mintues, no adverse reaction or acute ditress noted.


VAERS ID: 1993225 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: California  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045J21A / 3 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: n/a
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: n/a
Diagnostic Lab Data:
CDC Split Type:

Write-up: 16 year old patient was here for 3rd dose booster. Patient and parents signed up patient for Pfizer. Myself, the pharmacist, verified the consent form and saw that patient was here for Pfizer booster which is indicated. Once patient got back to the room with the nurse hired by the company to administer vaccinations, the father requested Moderna. Without pharmacist consultation or approval, the nurse gave a 0.25 mcg Moderna Booster to the 16 year old patient.


VAERS ID: 1993227 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-04-28
Onset:2021-12-30
   Days after vaccination:246
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8736 / 2 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7533 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Cough, Fatigue, Malaise, Myalgia, Pain, Respiratory tract congestion, SARS-CoV-2 test positive, Sick relative
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No current medications per MD note
Current Illness:
Preexisting Conditions: No pertinent past history per MD note
Allergies: No known allergies
Diagnostic Lab Data: 12/30/21 COVID Result IPOC PCR Detected Abnormal
CDC Split Type:

Write-up: 12/30/21 43 yo female presents with congestion for the past 3 days with body aches. She has not been taking any medications for symptoms. She is here with spouse who also has COVID symptoms. She has not had known sick contacts. She is fully vaccinated for covid without booster. Review of Systems Constitutional: Positive for fatigue. Negative for chills and fever. HENT: Positive for congestion. Negative for sore throat. Respiratory: Positive for cough. Negative for shortness of breath. Musculoskeletal: Positive for myalgias. Neurological: Negative for headaches.


VAERS ID: 1993229 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: California  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3594 / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lopressor, simvastatin, and hydrochlrothiazide.
Current Illness: None
Preexisting Conditions: High blood pressure, high cholesterol.
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Metallic taste in mouth


VAERS ID: 1993232 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-12-29
Onset:2021-12-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Dizziness, Headache, Oropharyngeal pain, Pain, Pyrexia, Respiratory tract congestion
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (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:
Current Illness:
Preexisting Conditions: Asthma
Allergies: Codein, Vicodin, penicillins
Diagnostic Lab Data:
CDC Split Type:

Write-up: Congestion. Headache. Body aches. Fever. Chills. Sore throat. Dizziness.


VAERS ID: 1993235 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: California  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ1611 / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: No adverse effect happen. But patient was not eligible for booster, given by mistake.


VAERS ID: 1993236 (history)  
Form: Version 2.0  
Age: 9.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3594 / 1 RA / IM

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

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

Write-up: Patient was given the 12+ purple top Pfizer vaccine instead of the 5-11 y orange top Pfizer dose. Patient waited 30 minutes post vaccination in clinic. No reactions or symptoms during this time.


VAERS ID: 1993239 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: New York  
Vaccinated:2021-12-28
Onset:2021-12-30
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033H21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Axillary pain, Chest pain, Inflammation
SMQs:, 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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none reported to us
Preexisting Conditions: lupus
Allergies: none
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: left underarm and chest area inflammed and painful


VAERS ID: 1993241 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-12-14
Onset:2021-12-30
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032H21A / 3 LA / -

Administered by: Private       Purchased by: ?
Symptoms: Discomfort, Erythema, Injection site induration, Injection site pain, Injection site rash, Injection site swelling, Pruritus, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Extravasation events (injections, infusions and implants) (broad), 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 - other than being diagnosed with hypertension. Hypertension onset February of 2020.
Allergies: known none
Diagnostic Lab Data: N/A - I have not gone to the doctor yet. However, I may have to go to quick care to get something to help with the itching.
CDC Split Type:

Write-up: On December 15, 2021 left arm at the injection site became swollen, hard and painful with a small rash approximately 30cm in diameter. I took ibuprofen for the pain and took benadryl to combat the situation. It cleared up on Tuesday, December 20, 2021. On December 30, 2021 I woke up with blotchy large red welts on my body around waist and under breast and on right inside of arm in the deltoid region. Currently taking benadryl 25mg at the direction of the pharmacist. Covering affected areas with cortizone 10 cream. Really uncomfortable due to the itching. I was diagnosed with Covid 19 back in November 2021 and was asymptomatic. Shot #1 and Shot#2 didn''t bother me.


VAERS ID: 1993250 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-12-28
Onset:2021-12-30
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ8762 / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Condition aggravated, Gait disturbance
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Arthritis (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: Phentermine 37.5 mg PO TABS valsartan 160 mg Tabs
Current Illness: Left knee pain. I received an injection to help with the inflammation about 3 weeks ago.
Preexisting Conditions: Prior knee and hip joint pain.
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Although I have had joint issues in both knees and hips. My right knee and hip had not given me any problems for several years. While working at about 2:00 in the morning both my right hip and knee started to hurt. I had been setting at a desk and no reason for the sudden pain. It continued to get worse through the night and all day today. The pain in the joints is extreme. I can barely walk. I have taken an old meloxicam I had and some Tylenol extra strength. I called and have an appointment with an orthopedic MD next Friday. This is my 3rd shot and I have not experienced any thing like this on the first two. I have had some left knee issues over the last couple of months but did not associate that with the timing of my other vaccines. This came on suddenly and severely with no explanation. I would not have connected this if there was any other reasonable possibility. I searched the internet and found that there had been a few cases. So I thought I should report it.


VAERS ID: 1993253 (history)  
Form: Version 2.0  
Age: 8.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL0007 / 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: Unknown
Preexisting Conditions: Unknown
Allergies: Unknown
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient fainted about 5 mins after receiving the first dose of Pfizer pediatric vaccine.


VAERS ID: 1993254 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-12-29
Onset:2021-12-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 33025BD / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Lymph node pain, 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: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Ipsilateral supraclavicular lymphadenopathy. Very painful


VAERS ID: 1993255 (history)  
Form: Version 2.0  
Age: 9.0  
Sex: Male  
Location: California  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5618 / 2 LA / ID

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

Write-up: Clients mother verbalized that the client c/o feeling anxious prior to vaccination today. Client verbalized to his mother that he felt nauseated and writer visually noted client vomit. Writer immediately assisted client to walk to MD and EMS on site called by nurse. Client visualized to vomit again x''s 2. Clients initial set of vitals, 137/75 with O2 99% on RA and HR 128. MD on site assessed client and recommended client wait an additional 15 minutes. At the end of the 15 minutes, client noted with no further complaint of nausea and vitals noted as 122/68, O2 99% on RA and HR 94. Client discharged by MD.


VAERS ID: 1993257 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: New York  
Vaccinated:2021-12-29
Onset:2021-12-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 028K21A / 3 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Dizziness, Lymph node pain, Lymphadenopathy
SMQs:, Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), 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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Dizziness and weakness Swelling and pain of lymph nodes on the left arm and on the neck


VAERS ID: 1993429 (history)  
Form: Version 2.0  
Age: 6.0  
Sex: Male  
Location: New York  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL0007 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain upper, Asthenia, Blood glucose, Chills, Cold sweat, Eye movement disorder, Fatigue, Feeling cold, Feeling hot, Hyperhidrosis, Pallor, Syncope, Unresponsive to stimuli, Urine analysis
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (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), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: went to pediatrician office after the paramedics said his vitals were good. dr. did urine and blood sugar. all was fine then. he was tired and cold. dr told us to watch for abnormalities and call if anything else happens.
CDC Split Type:

Write-up: within 5-10 minutes, his stomach was hurting and began to sweat profusely, clammy, very hot, got pale, plae skin and lips, eyes rolled back, fainted, weak. paramedics were called. while waiting he began to response to touch and was given something to smell. He was given Gatorade. he then started to shiver. paramedics arrived, tested his vitals. at that time, his vitals were good. they said drop in blood pressure probably caused it.


VAERS ID: 1993431 (history)  
Form: Version 2.0  
Age: 7.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ1611 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Pharmacy gave my son the adult dosage of the Pfizer vaccine and was supposed to get the children vaccine. He has not taking any meds at or around the time of the vaccination.
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: 7 year old child given adult Covid vaccine.


VAERS ID: 1993434 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033A21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Underdose
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: Pt was given 0.25 ml instead of 0.5 ml on her second Moderna shot


VAERS ID: 1993438 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: California  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL3197 / 2 - / IM

Administered by: Other       Purchased by: ?
Symptoms: Chest discomfort, Condition aggravated, Dizziness, Palpitations
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient. Received Pfizer booster COVID vaccine (LOT#:FL3197) on 12/30/21 at 1647. Patient alerted EMT and stated that she felt heart palpitations and tightness in her chest. Patient stated that this happened to her about 3 weeks ago when she took melatonin. Patient stated that she went to the ED and Doctor told her she was experiencing an allergic reaction to the melatonin. The Doctor stated that her chest wall was swelling and was causing her heart palpitations. EMT took patients vital signs at 1706. BP: 124/77 HR: 63, O2: 98%. Patient stated that her heart palpitations and chest tightness comes and goes. RN''s arrived on scene at 1707. EMT retook vital signs at 1711. BP: 122/76, HR:79, O2: 98%. Patient stated that her chest tightness was a 9/10. RN called EMS at 1713. Other RN gave patient Benadryl 50mg/mL at 1715. RN asked patient to stay an extra 30 minutes for observation. EMT retook patients vital signs at 1717. BP: 128/97, HR: 78, O2: 99%. EMS arrived at 1725. EMS assessed patient. Patient signed AMA. EMS left vaccination site at 1730. RN educated patient on worsening adverse symptoms from COVID Pfizer vaccine and when to seek EMS. RN recommended that patient go see PCP about heart palpitations. Patient verbalized understanding of education. Patient stated that palpitations are "getting better" and that her dizziness is now at a 4/10. Patient completed her observation time at 1747. Patient left vaccination site with her mom unassisted and with a steady gait at 1747.


VAERS ID: 1993440 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: California  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL3197 / 3 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dizziness, Hypoaesthesia, Migraine, Muscular weakness, Nausea
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Sexual dysfunction (broad)

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

Write-up: PATIENT EXPERIENCED LIGHTHEADENESS, NAUSEAU, WEAKNESS TO LEFT ARM, NUMBNESS TO LEFT ARM, AND PATIENT STATED "IT IS HER SEVERE MIGRAINE" 15 MIN POST VACCINATION WITH PFIZER COVID DOSE. PATIENT EXPERIENCED SIMILAR EFFECTS 2 DAYS AFTER SHE RECEVIED HER 1ST DOSE OF JANNSSEN VACCINE on June 18, 2021. NOT A NEW ONSET. PATIENT STATED FORGOT MIGRAINE MED AT HOME. 911 WAS CALLED HOWEVER PATIENT REFUSED TO GO TO ED. HUSBAND PICKED UP PATIENT.


VAERS ID: 1993443 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ1611 / 3 LA / SYR

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

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

Write-up: Patient may have inadvertently received a higher dose of vaccination, technician wasn''t sure if she mixed the vial with 1.8 ml of diluent or 0.8 ml of diluent . Patient did receive 0.3 ml of of vaccine.


VAERS ID: 1993582 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ1611 / 3 RA / SYR

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

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

Write-up: Patient may have inadvertently received a higher dose of vaccination, technician wasn''t sure if she mixed the vial with 1.8 ml of diluent or 0.8 ml of diluent. Patient did receive 0.3 ml of vaccine.


VAERS ID: 1993593 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: California  
Vaccinated:2021-12-28
Onset:2021-12-30
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, Dizziness, Fatigue, Headache, Hot flush, Malaise, Nausea, Postictal state, Seizure like phenomena, Tremor, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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:
CDC Split Type:

Write-up: pt c/o not feeling well, fatigue, shaky, dizzy and weak day after vaccine admin, also experienced hot flashes., around 6;30 am pt experienced increasing head ache followed by seizure activity, pt found postictal, and soon after experience nausea and vomiting


VAERS ID: 1993603 (history)  
Form: Version 2.0  
Age: 5.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-12-29
Onset:2021-12-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Pain in extremity, Pyrexia, Rhinorrhoea, Sneezing
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (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: 22q11.21 microduplication, Born with Pierre-Robin Sequence
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient had soreness in legs, low grade fever, & sneezing/runny nose accompanied by a tight barely sounding noise when sneezing.


VAERS ID: 1993606 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 330258D / 2 LA / IM

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

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

Write-up: Patient received vaccine outside of 6 hour storage window following reconstitution. Pfizer was contacted and reported that the vaccine dose was still viable. Patient was contacted and informed of the error. No adverse reactions were reported.


VAERS ID: 1994772 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 330258D / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: No adverse event, Product storage error
SMQs:, Medication errors (narrow)

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

Write-up: Patient received vaccine outside of 6 hour storage window following reconstitution. Pfizer was contacted and reported that the vaccine dose was still viable. Patient was contacted and informed of the error. No adverse reactions were reported.


VAERS ID: 1994774 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032H21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cough, Dyspnoea, Feeling hot, Rash
SMQs:, Anaphylactic reaction (narrow), 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: Atenolol 25 mg, Topamax 50 mg, and Seroquel XR 300 mg
Current Illness:
Preexisting Conditions:
Allergies: Corn, Effexor ER, Morphine, Penicillin, Sulfa, Latex, and Yeast.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient began feeling warm at 5:42 pm 10 minutes after receiving the Moderna vaccine. Knowing she had a history of anaphylaxis to certain food products I began to monitor her closely. Since she has had reactions before we offered Benadryl 50 mg and she took one by mouth at this time. She at this point had also started coughing and started developing a rash on her neck and chest. She was able to talk to and answer questions still at this time. I checked her blood pressure at 5:46 pm which measured 124/78 mm/Hg and pulse was 74 bpm. She continued to decline at this point with the rash getting worse on her neck, increased labored breathing and increased coughing to the point she was unable to answer questions. We had already called 911 at this point and I went ahead and administered an EpiPen dose of 0.3 mg at 5:52 pm. I checked her blood pressure 5 minutes later which measured 123/68 mm/Hg and pulse was 123 bpm. She began to improve with her cough slightly and was able to start answer some questions again. The paramedics arrived at 6:02 pm. After they assessed her she was taken to the hospital for further evaluation and monitoring.


VAERS ID: 1994775 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-12-29
Onset:2021-12-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Condition aggravated, Mastication disorder, Muscle tightness, Neck pain, Pain in jaw, Tinnitus
SMQs:, Dystonia (broad), Hearing impairment (narrow), Osteonecrosis (broad), Arthritis (broad)

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

Write-up: Sudden onset tinnitus in left ear, ~30 hours after covid booster administered. Patient had previously experienced sore jaw (difficulty chewing), tightness and sharp pain in neck. Patient has previously experienced tinnitus from 2007-2011, in both ears due to head trauma, with no recurrence after 2011 (until today).


VAERS ID: 1994754 (history)  
Form: Version 2.0  
Age: 9.0  
Sex: Male  
Location: Hawaii  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 084J21A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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 had no adverse reaction after 15 minute waiting period in the pharmacy. Pharmacy staff will follow up with patients parents in future.


VAERS ID: 1994756 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Simvastatin Ibuprofen PRN Atarax PRN
Current Illness: none active
Preexisting Conditions: hypercholesterolemia
Allergies: none
Diagnostic Lab Data: Treatment only administered, no labs
CDC Split Type:

Write-up: Urticarial skin rash started approximately 2-3 hours after booster dose administered. This did not happen with the first two Pfizer doses she received. There were no new exposures in household or personal care products, no unusual foods ingested.


VAERS ID: 1994768 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / -

Administered by: Private       Purchased by: ?
Symptoms: Chills, Diarrhoea, Pain in extremity, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Fever and chills lasting approximately 2-3 hours that occurred approximately 12 hours after receiving the booster. During that timeframe episode, I also experienced several rounds of diarrhea and one round of simultaneous diarrhea and vomiting. Arm soreness also increased around this time and had been milder earlier in the day.


VAERS ID: 1994771 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Maine  
Vaccinated:2021-12-29
Onset:2021-12-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030H21B / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Contusion, Lymphadenopathy, Mobility decreased, Muscular weakness, Oedema peripheral, Pain
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Angioedema (broad), Peripheral neuropathy (broad), Haemorrhage terms (excl laboratory terms) (narrow), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Accidents and injuries (narrow), 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: Lexapro 15 mg 1x daily
Current Illness: None
Preexisting Conditions: None
Allergies: Sulfa, opiates (none taken)
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Extreme body pain and lymph node swelling. Unable to move. Left armpit (vaccine administered on left arm) so swollen as to be bruised. Body aches and muscle weakness due to pain extreme.


VAERS ID: 1995543 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD7218 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Eye swelling, Mouth swelling, Swelling face, Swollen tongue
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Systemic: Allergic: Swelling of Face / Eyes / Mouth / Tongue-Mild, Additional Details: Patient reported to a technition that she was having some swelling of the tonge. I was administering vaccines to other patients and attended to her as soon as possible. When I got to her she said she had taken a drink of water and the swelling was coming down. She wasn''t having any difficulty breathing. Since the swelling was coming down, i gave her some benadryll and checked back with her in 5-10 min. at that point she had not taken the benadryll and the swelling had subsided completely.


VAERS ID: 1995544 (history)  
Form: Version 2.0  
Age: 10.0  
Sex: Male  
Location: California  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL0007 / 1 LA / IM

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

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

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


VAERS ID: 1995545 (history)  
Form: Version 2.0  
Age: 9.0  
Sex: Male  
Location: Nevada  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5618 / 2 LA / IM

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

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

Write-up: Systemic: Confusion-Severe, Systemic: Dizziness / Lightheadness-Severe, Systemic: Exhaustion / Lethargy-Severe, Systemic: Fainting / Unresponsive-Severe, Additional Details: Patietn was asked to wait for 15 minutes after his 2nd dose , 7 minutes after his father informed us his son was not feeling well ,at that time Patient fainted and fell on his face , 911 contacted immediately , Patient was confused and not aware of his surroundings , however patient was breathing normal , medics arrived few minutes later and took his vitals and advised father he needs to be taken to ER for heart monitoring


VAERS ID: 1995617 (history)  
Form: Version 2.0  
Age: 5.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL0007 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (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: Site: Pain at Injection Site-Mild, Additional Details: Child was very afraid while getting vaccinated. Mother asked if lidocaine spray would be allowed before administration. I agreed and used the spray and tehn sterilized his arm with an alcohol wipe. When the child appeared still enough with his mom holding him still, I inserted the needle, before I was able to depress the plunger at all, the child pulled away quickly and I was then forced to reinject the needle to administer the vaccine.


VAERS ID: 1995621 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 067F21A / 3 LA / IM

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

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

Write-up: Error: Booster Given Too Early-


VAERS ID: 1995624 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-12-29
Onset:2021-12-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Metformin 500mg, Lisinopril 5mg, lovastatin 20mg
Current Illness: None
Preexisting Conditions: Managed type 2 diabetes
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Sometime last evening (around 9.30pm on 12/30) I became aware of a constant ringing in my right ear. Orienting my head in different ways had no effect. Sometimes it''s louder than other times. It still persists this morning as I write this.


VAERS ID: 1995631 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-12-29
Onset:2021-12-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Chills, Pain, Somnolence
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypoglycaemia (broad)

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

Write-up: Chills for 10 hours Body aches Sleepiness


VAERS ID: 1995633 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ1611 / 3 LA / IM

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

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

Write-up: Error: Booster Given Too Early-


VAERS ID: 1995639 (history)  
Form: Version 2.0  
Age: 5.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-12-29
Onset:2021-12-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / -

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

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

Write-up: Vomiting three times, diarrhea, fatigue, upset stomach.


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