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

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



Case Details (Reverse Sorted by Onset Date)

This is page 111 out of 3,524

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VAERS ID: 1386211 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-05-12
Onset:2021-05-22
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0150 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Gait disturbance, Lymphadenopathy, Paraesthesia, Peripheral swelling
SMQs:, Cardiac failure (broad), Angioedema (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Enlarge lymph node on the left neck area underneath the collarbone. Left arm had a tingling sensation. Unable to walk on left foot due to swelling.


VAERS ID: 1386268 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-05-20
Onset:2021-05-22
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Deep vein thrombosis, Dyspnoea, Peripheral swelling, Pulmonary embolism
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad)

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

Write-up: Pt admitted for L lower extremity DVT and bilateral extensive PE''s. No known medical history, family/personal history of clots, no known clotting risk factors. Pt noted swelling in his leg 2 days after getting second covid vaccine and later developed SOB leading to presentation.


VAERS ID: 1386285 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Nebraska  
Vaccinated:2021-05-15
Onset:2021-05-22
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / UNK LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Injection site pain, Neuralgia, Pain, Pruritus, Urticaria, Wound
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (narrow), Accidents and injuries (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Bio identical progesterone, estrogen, vitamin c, d3, fish oil
Current Illness: None
Preexisting Conditions: None
Allergies: Buckwheat
Diagnostic Lab Data: Went to urgent care on June 3 rd to receive diagnosis of shingles. Visual diagnosis from physician
CDC Split Type:

Write-up: Injection site pain that continued for two weeks. Inching and pain 6 inches behind injection site on back of shoulder. Progressed of open sores and throbbing pain. Nerve pain to shoulder and up neck. On left side. Progress3d to several scattered hive like spots in. Idle back, center chest , inner thigh, on side of head


VAERS ID: 1386356 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 1 LA / IM

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

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

Write-up: No adverse reactions occurred. Patient was given the vaccine too early at age 11 years old.


VAERS ID: 1386883 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-05-21
Onset:2021-05-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Headache, Musculoskeletal stiffness, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Fever (104.5), muscle aches, dizziness, stiffness, severe headache


VAERS ID: 1387734 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthma, Dyspnoea, Influenza like illness, Musculoskeletal chest pain, Oropharyngeal pain, Oxygen saturation, Oxygen saturation decreased, Pain, Seizure, Sinus congestion, Throat irritation, Upper respiratory tract congestion
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (narrow), Systemic lupus erythematosus (broad), Convulsions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (broad), Respiratory failure (broad), Hypoglycaemia (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Epilepsy (Was seizure free for two years; diagnosed in 2009 or 2010.)
Allergies:
Diagnostic Lab Data: Test Date: 20210524; Test Name: Oxygen; Result Unstructured Data: Test Result:89; Test Date: 20210524; Test Name: Oxygen; Result Unstructured Data: Test Result:92; Test Date: 20210524; Test Name: Oxygen; Result Unstructured Data: Test Result:98
CDC Split Type: USPFIZER INC2021600490

Write-up: Asthma; Oxygen was 89; Shortness of breath/breathing difficulties; Ribs hurt; Felt like she was coming down with the flu; Head and sinus congestion; Head and sinus congestion; Throat was on fire, it hurt so bad; Throat was on fire, it hurt so bad; Seizure; Kind of achy/achy feeling; This is a spontaneous report from a contactable consumer (patient) via medical information team. A 40-year-old female patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, solution for injection, Batch/Lot Number: EW0186), via an unspecified route of administration, administered in left arm on 22May2021 10:45 (at the age of 40 years old) as 1st dose, single for COVID-19 immunization, at a pharmacy. Medical history included epilepsy from an unknown date and unknown if ongoing (seizure free for two years; diagnosed in 2009 or 2010). Concomitant medications were not reported. On 23May2021, the patient was having breathing difficulties and had to go the emergency room (ER). The patient reported she went to the ER Monday, 24May2021 and was released 11 hours later. She also stated that on Sunday morning on 23May2021, she woke up at 0400 AM and her throat was on fire, it hurt so bad. This was Sunday at 0400, and her husband heard her, and they walked around the house, she had her hands over head, like when running and her ribs hurt. She raised her arms, and tried to take deep breaths, and it was working, to breathe, but it felt like she couldn''t breathe, she couldn''t catch her breath. She stated she went to work and in 1.5 hours came home, she called the pharmacy and said she can''t breathe, then she was told this is not normal. She was told to go to the hospital, and she went and stated that her oxygen was 89 and then it shot up to 92 with standing and raising her arms up over her head, and they did 6 breathing treatments and 3 doses of steroids in her IV and oxygen and she went up to 98. She was sent home with a diagnosis of asthma with albuterol inhaler and nebulizer machine, treatments and said that she all of a sudden has asthma. She then added she had a seizure Sunday morning of 23May2021. She also felt like she was coming down with the flu. On 22May2021, Saturday night, she was kind of achy, then on Sunday, 23May2021, she felt like she was coming down with flu, she had head and sinus congestion, the achy feeling, all that was fine, it was the breathing that scares her. The patient was not hospitalized due to the events. The outcome of the event seizure was unknown and for other events was recovering.


VAERS ID: 1387742 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: FLUOXETIN; HYDROXYZINE
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Anxiety; Autism
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021601597

Write-up: hives all over her body; This is a spontaneous report from a contactable consumer (patient''s mom). A 16-year-old female patient received bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE), dose 1 via an unspecified route of administration, administered in right arm on 22May2021 (Batch/Lot number was not reported) as single for COVID-19 immunisation. Medical history included anxiety and high functioning autism from an unknown date and unknown if ongoing. Concomitant medications included fluoxetine hydrochloride (FLUOXETIN) and hydroxyzine taken for an unspecified indication, start and stop date were not reported. The patient experienced hives all over her body on 22May2021. They look like mosquito bites, but are not, and are on her toes, hands, torso, legs, everywhere. They are little red bumps and itchy. Like dime-sized. Some are dime and some are nickel sized. Hives started about 4, maybe 6 hours after the vaccination. Outcome of the event was not recovered, reported as worsened. Therapeutic measures were taken. She was giving Hydroxyzine and putting on a topical ointment, as Hydroxyzine is an antihistamine, stronger than Benadryl. Event did not require a visit to Emergency Room or Physician Office. Information on lot/batch has been requested.


VAERS ID: 1387757 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-05-18
Onset:2021-05-22
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Blindness, Cold sweat, Malaise
SMQs:, Glaucoma (broad), Optic nerve disorders (broad), Retinal disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021602984

Write-up: can''t see; sick; Clammy; This is a spontaneous report from a contactable consumer (patient). A patient of unspecified age and gender received BNT162B2 (Pfizer-BioNTech COVID-19 vaccine, lot number and expiry date unknown), via an unspecified route of administration on 18May2021 as an unknown dose number, as a single dose for COVID-19 immunization. The patient''s medical history and concomitant medications were not reported. The patient wanted to know if the vaccine can make the eyes go blurry. On 22May2021, Saturday, the patient has been sick and clammy and the patient can''t see, it was a mess. The patient did not know whether he needs to go to the emergency room or not. The outcome of the events was unknown. Information on the lot/batch number has been requested.


VAERS ID: 1387811 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-05-18
Onset:2021-05-22
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 RA / -

Administered by: Unknown       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: LEVOTHYROXINE SODIUM
Current Illness: Thyroid activity decreased (Many years)
Preexisting Conditions: Medical History/Concurrent Conditions: Tinnitus (Might have been noticing it from time to time in last 10 years)
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021650148

Write-up: tinnitus/Ringing in ears; This is a spontaneous report from a contactable consumer (Patient). A 53-years-old male patient received bnt162b2 (BNT162B2), dose 1 via an unspecified route of administration, administered in Arm Right on 18May2021 14:00 (Batch/Lot Number: EW0177) as 1ST DOSE, SINGLE DOSE for covid-19 immunisation. Medical history included ongoing hypothyroidism (from many years) , tinnitus from an unknown date (might have been noticing it from time to time in last 10 years). The patient had no family medical history. The patient did not have history of all previous immunization with the vaccine considered as suspect. The patient did not administered additional vaccines on same date of the vaccination. The patient did not receive any other vaccines within four weeks prior to the vaccination. Concomitant medication(s) included levothyroxine sodium (LEVOTHYROXINE SODIUM) taken for hypothyroidism, start and and ongoing. On Saturday 22May2021, he had ringing on his ears. He wanted to know if that was from the vaccine or not. At the time that it happened, he was pressure washing and he was not sure if the loud noise contributed to his tinnitus. He has a history 10 years ago of tinnitus. The pressure washer was very loud. Then he started to wonder. He had pressured washed before and never had it before. Caller stated that he still had the ringing. It was not as bad as it was at first. The patient stated he did not do anything but try to stay away from loud noises. The outcome of the event was improving. Follow up attempts are needed. Further information has been requested.


VAERS ID: 1388003 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-05-21
Onset:2021-05-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041C21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthma, Chest X-ray, Chest discomfort, Cough, Dyspnoea, Headache, Lymphadenopathy, Oropharyngeal pain, Pain, Pain in extremity, Productive cough, Rhinorrhoea
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: motrin 800mg prn, skyla iud, loratadine 10mg prn
Current Illness:
Preexisting Conditions: asthma
Allergies: seasonal allergies in spring and fall
Diagnostic Lab Data: CHEST XRAY ON 6/5/21 IN ER FOR "ASTHMA RELATED SYMPTOMS", R/O PNEUMONIA, TREATED WITH AN ALBUTEROL-IPRATROPIUM 3ML AEROSOLIZED TREAMENT. HELPED TEMPORARILY FOR ABOUT 4 HOURS AND THEN SYMPTOMS CONTINUED/WORSENED.
CDC Split Type:

Write-up: DELTOID PAIN EVERY MORNING, PAINFUL TO LIFT OR ROTATE LEFT ARM (DELTOID/ROTATOR CUFF REGION), CAN NOT LIFT HEAVY OBJECTS WITH LEFT ARM, INFLAMMATION IN AIRWAY, ASTHMA SYMPTOMS/ASTHMA ATTACKS DAILY, SOB/TROUBLE BREATHING DAILY, EXERTIONAL DYSPNEA, DRY COUGHING IN FIRST WEEK, PRODUCTIVE COUGHING AFTER FIRST WEEK, SWOLLEN LYMPH NODES, SORE THROAT, THICK NASAL MUCOUS, COUGHING AND SOB MADE WORSE WHEN LYING DOWN, CHEST TIGHTNESS/PRESSURE, HEADACHES.


VAERS ID: 1388012 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: New York  
Vaccinated:2021-05-21
Onset:2021-05-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dysphonia, Ear pruritus, Facial discomfort, Hypoaesthesia oral, Oral discomfort, Skin sensitisation, Tongue discomfort, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Goli, allegra , multivitamin
Current Illness: none
Preexisting Conditions: asthma
Allergies: Gluten
Diagnostic Lab Data: I started taking a lot more allergy meds 2 at a time every 5 hours for 3 days.
CDC Split Type:

Write-up: I had my 1st vaccine on may 21st about 2:30. I woke up 5:45am May 22nd I was hoarse and wheezing, my tongue lips and face felt tingly numb and puffy. my ears were hot and itchy also my body felt like my skin was crawling. taking a lot of allergy meds, My mouth is still numb 3 weeks later.


VAERS ID: 1388521 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-05-21
Onset:2021-05-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6199 / 1 - / SYR

Administered by: Public       Purchased by: ?
Symptoms: Bladder catheterisation, Bladder obstruction, Blood test, Blood urine present, Computerised tomogram, Dysuria, Haemorrhage urinary tract, Impaired work ability, Renal haemorrhage, Ultrasound pelvis
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Centrum Silver Garlic Fish Oil Beet Root L-Arginine Zinc Cimetidine
Current Illness:
Preexisting Conditions:
Allergies: Aspirin
Diagnostic Lab Data: CT Scan Blood Screening Ultrasound
CDC Split Type:

Write-up: On May 21st @ 10:25am, I received my 1st dose of the Pfizer Covid vaccine. There were no immediate reactions during the 15 minute "holding period", but the following morning, May 22nd @ ~09:00am, I was urinating blood and blood clots with very little urine evacuating. Proceeded to the Urgent Care facility to which they immediately directed me to the ER. Upon arrival, they had me give a urine sample which was blood red, and put me on a picc line and pushed fluids, then performed a CT and an ultrasound of my pelvic area. During this time, my urge to urinate began to become very painful because my bladder was now fully blocked and I could only pass a small amount of blood clots. They then had to install a large 3 way catheter to relieve the urine and allow the passing of the large blood clots coming from my hemorrhaging left kidney. After being in the ER for ~8.5 hours, they released me with the catheter still installed with a mobile bag. I stayed laid up for 2.5 days until Monday when all of the blood clots had passed and my urine had returned to a normal color. They then removed the catheter and sent me on with medication to continue to take. I have a follow up appointment, but I am still having restrictions when I urinate and now when I try to ejaculate, so I am very concerned that this has permanently injured me. I have had ZERO issues in the past and consider myself a very healthy individual who works very hard to stay healthy. I maintain a weight of 206-210 lbs @ 6''1" through a daily rigorous exercise program, diet, and supplements. I don''t smoke, do drugs, or drink excessively. This event has cost me money for my deductible (because I don''t use it), plus the costs of the copays, medications, and 1 day of missed work. I have all of the paperwork from both the ER visit and Urology visits... Please advise what I can do to recoup my out of pocket costs for a vaccine that the Government has directed the population to receive. You can reach me at this email. Thank you.


VAERS ID: 1388853 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Immediate post-injection reaction, Injection site pain, Myalgia, Pain in extremity, Paraesthesia oral
SMQs:, Rhabdomyolysis/myopathy (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Peft arm pain persistent for 3 days following the injection
Other Medications: Birth control pill.vit d.multi vitamins. Omega 6.
Current Illness:
Preexisting Conditions: Hypothalamic amenorrhea
Allergies: NA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Upper lip tingling immediate after the injection Left and right calf pain Left calf muscle pain persistent Muscle pain throughout the body Dizziness and lightheaded Pain at the injection site


VAERS ID: 1389040 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8733 / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Chills, Influenza like illness, Injection site pain, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Fever/ chills / sore muscles / sore injection site / flu like symptoms / no treatment


VAERS ID: 1389078 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-21
Onset:2021-05-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 RA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Disturbance in attention, Dizziness, Fatigue, Gait disturbance, Headache, Lethargy
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Depression (excl suicide and self injury) (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

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

Write-up: I have been light headed and lethargic for 2 weeks now. Started with headaches and exhaustion. Still tired and unstable. Hard to concentrate and keep my balance.


VAERS ID: 1389081 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-05-21
Onset:2021-05-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 2 RA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Facial pain, Hypoaesthesia, Swelling face
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (broad), Guillain-Barre syndrome (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? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Levoxyl .25mg
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: Tylenol
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: Right side of face cheekbone area swelled (NO fillers!!), went numb to the touch but deeply painful for the next 5/6 days


VAERS ID: 1390026 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dyspnoea, Feeling abnormal, Headache, Impaired driving ability, Panic attack, Presyncope
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: 30 minutes after receiving the first Covid-19 vaccine I was driving home when I felt a shortness of breath and my thinking became very fuzzy. No one was on the street I was driving and I panicked and dialed 911 because I thought I was about to blackout and I wanted someone to come help in case I did. The operator talked me through whatever was happening. It was decided I had had a panic attack and no ambulance was called. Nothing like this had ever happened to me before. I had a headache the rest of the day but no more panic attacks.


VAERS ID: 1390056 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: South Dakota  
Vaccinated:2021-05-17
Onset:2021-05-22
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypersensitivity, Lethargy, Lip swelling, Pain, Pain in extremity, Pyrexia, Swelling face, Vaccine positive rechallenge
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Moderna Dose 1 04/19/2021
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Timeline was exactly the same as that of the first dose. Day one, nothing, day 2 very sore arm, days 3,4,5 nothing. Day 6 reaction. After the first dose I developed high fever, body aches and lethargy on the sixth day and it lasted several days. On the second dose, it followed the same timeline, but on day 6 my lips and cheeks swelled and kept swelling for 7 hours even though I was admitted to the hospital emergency room within the first hour and they gave me 4 drugs by IV to counteract the swelling. The doctors told me I was having an allergic reaction, but I had not eaten anything out of the ordinary and I''ve never had an allergic reaction of any kind. They were reluctant to admit that it was a Covid vaccine reaction, but they couldn''t find any other answer and I knew it was... the timing was too coincidental. Also, the drugs they gave did nothing and it took several days for my facial swelling to diminish.


VAERS ID: 1390175 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014C21A / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anaemia macrocytic, Bacterial disease carrier, Blood magnesium decreased, Blood potassium decreased, Blood pressure systolic, Cellulitis, Condition aggravated, Fatigue, Injection site erythema, Injection site inflammation, Injection site pain, Pallor, Platelet count decreased, Psychomotor hyperactivity, Pyrexia, Tremor, Vomiting, White blood cell count decreased
SMQs:, Acute pancreatitis (broad), Haematopoietic erythropenia (narrow), Haematopoietic leukopenia (narrow), Haematopoietic thrombocytopenia (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Dementia (broad), Akathisia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Depression (excl suicide and self injury) (broad), Hypotonic-hyporesponsive episode (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Hypokalaemia (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? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations: Also felt tired and nauseous after 1st dose of Moderna COVID-19 vaccine
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Per patient: Felt hyper after receiving the vaccine then really tired later. Vaccine was painful when administered whereas the first dose didn''t hurt at all. Felt as if the vaccine was too high in the arm. Took nap after vaccine. When woke up (approx. 7hrs after vaccine), noticed face was very pale. Two hours later, was shaking with high fever (max was 103F). Began throwing up and couldn''t keep anything down. Tried to take Tylenol for fever. Went to hospital approx. 1hr later. Area around the administration site became very red and inflamed. At hospital, she was treated for cellulits with clindamycin. Systolic blood pressure was 170mmHg. Also discovered during visit nasal colonization with MRSA, low magnesium, low potassium, low platelets, low white blood cells, and macrocytic anemia (although these were likely unrelated to vaccine). Hospital stay lasted 5 days.


VAERS ID: 1390923 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-05-13
Onset:2021-05-22
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-06-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / -

Administered by: Other       Purchased by: ?
Symptoms: Bell's palsy
SMQs:, Hearing impairment (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: CANNABIS; DEPO PROVERA
Current Illness:
Preexisting Conditions: Comments: List of non-encoded Patient Relevant History: Patient Other Relevant History 1: None
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021607076

Write-up: experienced Bell''s palsy, her tongue was numb, could not taste on her right side, pain behind ear, sensitivity to loud noises,eye would not close; This is a spontaneous report from a contactable consumer (patient). A 21-year-old non pregnant female patient (who was not pregnant at the time of vaccination), received first dose of bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE, Solution for injection, batch/lot number and expiry dates were not provided), via an unspecified route of administration, administered in left arm on 13May2021 at 13:00 (at the age of 21-year-old) as a single dose for COVID-19 immunisation in school or student health clinic. The patient medical history was reported as none. No known allergies were reported. Concomitant medications received within 2 weeks of COVID vaccination included cannabis (CANNABIS); medroxyprogesterone acetate (DEPO PROVERA) both taken for an unspecified indication, start and stop date were not reported. The patient did not receive other vaccine in four weeks of vaccination. The patient was not diagnosed with COVID, prior vaccination. She has not been tested for COVID, post vaccination. On 22May2021 at 09:00, the patient experienced Bell''s palsy, her tongue was numb, and she could not taste on her right side, pain behind ear, sensitivity to loud noises and eye would not close. Next day (23May2021) her whole right side of face was weak. Third day (24May2021) right side of her face was almost fully paralyzed. Adverse events were resulted in doctor or other healthcare professional office/clinic visit, emergency room/department or urgent care and disability or permanent damage. The patient was treated with steroid and antiviral for the events. The patient reported events seriousness as serious (disability or permanent damage). The patient gave consent to contact her and her healthcare provider regarding events and about this report. The outcome of the event was not recovered. Information on the lot/batch number has been requested.


VAERS ID: 1390929 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Texas  
Vaccinated:0000-00-00
Onset:2021-05-22
Submitted: 0000-00-00
Entered: 2021-06-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Hallucination, Pyrexia, SARS-CoV-2 test, Seizure
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Dementia (broad), Convulsions (narrow), Psychosis and psychotic disorders (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Chronic kidney disease stage 3; Heart failure; Hypertension; Type I diabetes mellitus
Allergies:
Diagnostic Lab Data: Test Date: 20210522; Test Name: Covid-19 NAAT; Result Unstructured Data: Test Result:Negative; Comments: Nasal Swab
CDC Split Type: USPFIZER INC2021607779

Write-up: hallucinations; left sided temporal seizures; fevers; This is a spontaneous report received from a contactable other-HCP. A 66 years old male patient received BNT162B2 (lot number unknown) at single dose for COVID-19 immunisation on unknow date. Relevant medical history included: Type I Diabetes, CKD III (Chronic kidney disease stage 3), Hypertension and Heart failure. Relevant concomitant drug was unknown. Patient reported of fevers since 22May2021 two days after the vaccine. Two weeks later he reported to have hallucinations per son and also left sided temporal seizures, both since 22May2021. The patient was independent and living alone before this episode. Antiepileptic medication was received as treatment. The patient was hospitalized due to the events. The outcome of event was resolving. The patient had Covid-19 NAAT (Nasal swab) test on 22May2021 with negative result. Prior to vaccination, the patient was not diagnosed with COVID-19.; Sender''s Comments: Based on temporal association and profile of the product, the events were considered related to suspect product BNT162B2 (lot number unknown).


VAERS ID: 1391510 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-05-21
Onset:2021-05-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: C-reactive protein increased, COVID-19, Chest X-ray abnormal, Cough, Lung disorder, Pneumonia, Pyrexia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: Obesity (BMI 35), ADHD
Allergies: NKDA
Diagnostic Lab Data: 5/28 chest xray shows worsening patchy airspeace disease in left lung base. Positive COVID test on 5/28, elevated CRP values on 5/28 and 5/29.
CDC Split Type:

Write-up: Patient reports cough and fever since 5/22. Was seen by pediatrician in clinic on 5/25, diagnosed with pneumonia and prescribed azithromycin. Parent reported compliance with medication but reported that patient started to have coughing fits and fever of 104 at home. This prompted ER evaluation and subsequently admitted to hospital for observation. During admission, patient was treated with IV Ceftriaxone x 3 days and PRN Mucinex for pneumonia. No oxygen requirements, so no further intervention was needed per MD.


VAERS ID: 1391722 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-05-21
Onset:2021-05-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Fatigue, Loss of personal independence in daily activities
SMQs:, Dementia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Flu vaccine, nausea, vomiting, fatigue
Other Medications: Lamictal, Wellbutrin SR
Current Illness: None
Preexisting Conditions: Migraines
Allergies: Doxycycline
Diagnostic Lab Data: None
CDC Split Type:

Write-up: The next day I became extremely fatigued and this has lasted since my vaccine. I have such little energy it''s difficult for me to spend time with my children, complete housework, or focus on my work. It is slowly improving.


VAERS ID: 1391907 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-05-01
Onset:2021-05-22
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-06-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Balance disorder, Burning sensation, Dizziness, Feeling abnormal, Feeling drunk, Gait disturbance
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Levothyroxine, liothyronine. Estradiol cream. Progesterone cream. Magnesium citrate, vitamin D, coenzymated B-complex, trace minerals. Flonase.
Current Illness: Vestibular migraine.
Preexisting Conditions: Vestibular migraines.
Allergies: Cipro, sulfa drugs, avocado. Cat dander. Grass pollens.
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Chronic nonstop dizziness, burning head, brain fog, inability to walk any distance without feeling of drugged drunkenness. Off-balance. Onset three weeks after second vaccine, has been steady 24/7 since then.


VAERS ID: 1336111 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-01
Onset:2021-05-21
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: rash


VAERS ID: 1336148 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-05-19
Onset:2021-05-21
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Chills, Diarrhoea, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Pseudomembranous colitis (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Noninfectious diarrhoea (narrow), Hypoglycaemia (broad)

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

Write-up: 24 hours later, shaking chills, diarrhea, chest pain


VAERS ID: 1336249 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-05-01
Onset:2021-05-21
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037A21B / UNK - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038B21A / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Pain in extremity, Tendon pain
SMQs:, Tendinopathies and ligament 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: Tramadol
Current Illness: None
Preexisting Conditions: Allergies,
Allergies: Penicillin she''ll fish and bactrim
Diagnostic Lab Data: Calling to make appointment today with orthopedics to get hands checked out.
CDC Split Type:

Write-up: First shot gave me a tight chest and swollen throat right away day one about 40 minutes after receiving shot. That night I was woken up with burning ligament and tendon pain in my legs. This subsided after two days. Pain in all joints of foot, ankle, knees and elbows have been ongoing but not constant. The day after second shot tendons in thumbs on both hands became painful and popping. This hasn''t went away and is constantly painful.


VAERS ID: 1336254 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: New York  
Vaccinated:2021-05-19
Onset:2021-05-21
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lo Loestrin - birth control Spironolactone
Current Illness: None
Preexisting Conditions: Cold sores
Allergies: None
Diagnostic Lab Data: N/a
CDC Split Type:

Write-up: Red Rash all over chest and neck


VAERS ID: 1336467 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-01
Onset:2021-05-21
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0153 / 2 LA / IM

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

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

Write-up: Pt. c/o feeling light-headed while underobservation approx. 5 minutes after receiving vaccine. Pt. notes she did not eat breakfast. Pt given H2O2 + fig energy bars and started feeling better. VS: BP140/66, 98%-76 repeat BP124/64, 98%, 77. Pt noted she started feeling better and she denies lightheadedness, pt states she is ok to drive. Pt offered note to stay home from work, and she declined. Pt. left approx. 12:05pm. Pt advised to call 911 if she notes shortness of breath, swollen throat, swollen eyes, swollen tongue. Rest & tylenol prn


VAERS ID: 1336475 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Chest discomfort
SMQs:, Anaphylactic reaction (broad)

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

Write-up: pt reported intermittent chest tightness, denies sob, dispnea acheness or swelling at injection site pt staes sh has allergies to sulfa, asprin and qunololos. vital signs 94% on RA, HR 76 pbm pt staed she did not have anything to eat thi morning pt encourage to stay hydrated and encourgae to eat before comming for the second dose after a few min pt felt better


VAERS ID: 1336489 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: PT REPORTED FEELING ANXIUS AND DIZZY, ALSO REPORTS BLURRY VISOIN PT REPORTS FEELING BETTER AFTER ABOUT 5 MIN, HR 80, 96% O2, PT REPORTS SMILAR REACTION TO PREVIOUS VACCIN DID NOT TASKE ANY MEDICATION TODAY PT WAS ENCOURAGE TO LIE FLAT AND TO HYDRATE PT LEFT SITE WITH PARENT AFTER 15 MIN WAS RESOLVED SYMPTOMS


VAERS ID: 1336497 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: 50mg zoloft
Current Illness: None
Preexisting Conditions: None
Allergies: NKA
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Pt describes feeling dizzy/lightheaded immediately after receiving vaccine. Upon arrival is A&0 x4 with no signs of distress. . Pt was Released At 1525 To Self. Ambulate Was Offered but refused, Pt Was escorted to exit by Staff. VS Are As Follows. 1517: BP 125/81, HR 87, RR 12, O2 Sat 97% on RA 1524: BP 123/82, HR 88, RR 12, O2 Sat 97% on RA


VAERS ID: 1336503 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 1 LA / IM

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

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

Write-up: There is suspicion that Pfizer-Biontech Vaccine was diluted with less than 1.8mL of Normal Saline and therefore the doses were more concentrated than 30mcg.


VAERS ID: 1336509 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 1 LA / IM

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

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

Write-up: There is suspicion that Pfizer-Biontech Vaccine was diluted with less than 1.8mL of Normal Saline and therefore the doses were more concentrated than 30mcg.


VAERS ID: 1336512 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022B21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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 event. Patient underage.


VAERS ID: 1336513 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Hypoaesthesia oral, Paraesthesia oral
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad)

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

Write-up: Patient c/o tongue feeling numb and tingling after vaccination. No throat constriction or shortness of breath. Speech clear, no difficulty swallowing. Denied rash or itching. Given Fexofenidine 60 mg by mouth. Advised to go to ER for evaluation but patient refused. Vital Signs stable . O2 sat 98% and 99 %.Patient had vaccination at 2:37 pm. Reaction was reported at 2:55 pm.Patient left clinic at 3:28 pm


VAERS ID: 1336517 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 1 RA / IM

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

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

Write-up: There is suspicion that Pfizer-Biontech Vaccine was diluted with less than 1.8mL of Normal Saline and therefore the doses were more concentrated than 30mcg.


VAERS ID: 1336522 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood glucose normal, Fall, Head injury, 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), Accidents and injuries (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: They stated that they have passed out before
Other Medications: None reported
Current Illness: None reported
Preexisting Conditions: None reported
Allergies: KNDA
Diagnostic Lab Data: Blood glucose was tested and came out to be 105.
CDC Split Type:

Write-up: Patient was in the waiting area for about 10 minutes then turned pale and passed out. They fell out of the chair they were in and hit their head on the floor. They regained consciousness within about 10 seconds. EMT was called and responded to help treat and advise the patient on the next steps.


VAERS ID: 1336524 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Assesed BP 105/78 immediately after event. Assessed BP 20 minutes later sitting and standing 126/84, 134/78 respectively. O2 sat 99 %
CDC Split Type:

Write-up: 5 minutes after vaccination patient had sign and symptoms of Vasovagal reaction. Patient felt dizziness, passed out. Patient was given apple juice, salty snack, bottle of water.


VAERS ID: 1336528 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 1 LA / IM

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

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

Write-up: Post vaccine (10:00am) pt experienced lightheadedness, dizziness and nausea. PT reported that she had not eaten; given juice and granola bar. 5 mins later pt reported nausea, but unable to vomit. PT continued to report dizziness. PT assisted to lay down on mat with legs up on chair. Cold compress to head and clothing loosened. Vitals remained stable, but symptoms would resolve only for a short period and would return. 911 called at 1037. EMT arrived at 1049. Following evaluation, PT transported to hospital for further evaluation and treatment if needed.


VAERS ID: 1336531 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183-H / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dizziness, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad)

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

Write-up: Pt. completed full observation without event and arrived at checkout complaining of dizziness, lightheadedness and tingling sensation. Returned to observation and laid down. Cleared by EMS to exit facility.


VAERS ID: 1336533 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Dizziness, Head discomfort, Musculoskeletal stiffness, Nausea
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Arthritis (broad)

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

Write-up: PT REPORTED HEAD FULLNESS, STIFFSNESS OR NECK, SLIGHT DIZZINESS AND NAUSEA, PT STATED SHE IS IMMUNOCOMPROMISED AS SHE AHAS AN AUTOIMMUNE DISEASE AND CURRENTLY UNDERGOING CHEMO TREATMENTS AND ON CELLECOT. PT DENIES SOB, DYSPNEA. PAIN @INECTION SITE, ITCHINESS OR SWELLING. PT INSTRUCTED TO LAY HEAD FLAT AND ENCOURGE TO DRINK WATER VITAL SIGNS 93% ON RA AND HR 94BPM. AFTER ABOUT 20 MIN PT SATED SH NO LONGER FELT DIZZINESS, NAUSEA, PT STILLREPORTED HEAD FULLNESS AND NECK STIFFSNESS AND PT FINISHED 30 MIN OF OBSERVATION TIME AND LEFT.


VAERS ID: 1336536 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Malaise, Nausea, Throat irritation
SMQs:, Acute pancreatitis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: approx 15 mins post injection client''s mother states client is not feeling well. Eval''d client, c/o mild nausea and "throat feels a little scratchy" denies any other s/s. v/s remained stable throughout, Administered 5mg of Zyrtec to client, observed for another 30 mins, client states "feeling normal as always now" discharged from site, in stable condition.


VAERS ID: 1336560 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Hypoaesthesia, Malaise, Nausea
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)

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

Write-up: Patient consented to and was given the Janssen Covid-19 vaccine on 05/21/2021 at 3:10pm. Approximately 5 minutes post-administration, the patient reported not feeling well and was given assistance to get seated. She reported dizziness, nausea and numbness in her extremities. Emergency personnel were notified and arrived within 5 minutes. She was asked and accepted to be transported to Hospital for further evaluation.


VAERS ID: 1336561 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-05-19
Onset:2021-05-21
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1820095 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache, Pain in extremity, Peripheral swelling
SMQs:, Cardiac failure (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Tendinopathies and ligament disorders (broad)

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

Write-up: Patient described arm to have a large spot of swelling and pain. Said swollen spot had gotten bigger and was painful. Patient also stated that she had a bad headache. Directed patient to stay hydrated, use cool cloth/ice pack on arm, and to take Tylenol or Ibuprofen to help with pain and headache. When she called back and said those weren''t helping we directed her to go to ER if she thought she needed to. She said she would try to hold out and see how she felt later.


VAERS ID: 1336571 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dysphagia, Dyspnoea, Hypoaesthesia oral
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

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: Fluzina Migradorexena
Current Illness: Denies
Preexisting Conditions: Venous Insufficiency and Migraines
Allergies: Denies
Diagnostic Lab Data:
CDC Split Type:

Write-up: 35 y/o female with past medical history of Migraines and Venous Insufficiency who presents with numbness to left side of tongue, shortness of breath and some difficulty breathing post vaccination. Patient received the J&J vaccination (1 dose). Patient states that she did not mention to registration or nursing staff of her medical history of Venous Insufficiency. Patient denies reactions to previous vaccinations. Patient denies chest pain, itch or rash. NP and Paramedics at bedside. Patient provided with Benadryl 25 mg PO x1 and a bottle of water. Patient vitals within normal limits, 112/73 BP, 75 HR, 97% RA, Resp 12. Patient monitored by the NP over 30 minutes with resolution of symptoms. Patient with improvement of difficulty swallowing and difficulty breathing within 10 mins of Benadryl administration, but tongue numbness didn?t improve until 25 mins post medication administration. Patient was able to eat a protein bar without difficulty (patient requested). Patient last set of vitals also within normal limits, 115/77 BP, 65 HR, 98%, Resp 12. Patient advised on concerning symptoms and when to seek ER evaluation. Patient discharged home in stable condition.


VAERS ID: 1336576 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 1 RA / IM

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

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

Write-up: Patient had LOC, fell backwards and hit his head 8 minutes after injection.


VAERS ID: 1336580 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0175 / 1 LA / IM

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

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

Write-up: Syncopal episode lasting 5 seconds. Observed by provider on site. No intervention required.


VAERS ID: 1336679 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-05-20
Onset:2021-05-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, Hyperhidrosis, Retching, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: REPORTED FAINTING BY WITNESSES, NURSE VISUALIZED DIAPHORESIS, DRY HEAVING, PT REPORTED WEAKNESS.


VAERS ID: 1336703 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-05-20
Onset:2021-05-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? 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: LAYING ON THE FLOOR WHEN NURSE ENTERED POD. PATIENT REPORTED DIZZINESS, HEADACHE, NURSE NOTED DIAPHORESIS.


VAERS ID: 1336756 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 1 LA / IM

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

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

Write-up: Patient was seen for a covid-19 vaccine. Patient''s parent filled out the consent form and the demographic form and entered the DOB on both forms. the nurse verified the DOB with the patient/parent and changed the DOB on the consent sheet because that is what she was advised when asking the patient. (Front Staff) then called the Mom, to clarify the date of birth of patient. Mom stated they lied about her daughter?s date of birth and made a parental decision to have her daughter get the vaccine early and changed her birthday, her actual DOB . (Practice Manager) called person from County and was advised not to give the patient the second dose. The second dose can only be given after the patient turns twelve. We were also advised to enter the vaccine into MCIR and fill out a VAERS form. The VAERS form was submitted on 5/21/2021. (Practice Manager) reached out to the Mom, to advise her that patients second Covid-19 appointment will be canceled. She was also advised if the insurance comes back and denies payment of the vaccine; she will be held responsible for the amount that is due. mom asked when patient can get the second dose and I advised her she had to wait until patient turns 12 years old. She asked if the patient would have to restart the vaccine. I advised her I cannot answer that because she does not fall into the guidelines and would have to reach out to the county and I provided her with the number to reach County Covid-19. At this time there are no adverse reactions to report.


VAERS ID: 1336788 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Louisiana  
Vaccinated:2021-05-14
Onset:2021-05-21
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8731 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain upper, Acute kidney injury, Anuria, Blood creatine phosphokinase increased, Blood creatinine increased, Chromaturia, Ischaemic hepatitis, Nausea, Pain, Pyrexia, Rhabdomyolysis, Sleep disorder, Urine output decreased, Vomiting
SMQs:, Rhabdomyolysis/myopathy (narrow), Acute renal failure (narrow), Hepatitis, non-infectious (narrow), Acute pancreatitis (broad), Neuroleptic malignant syndrome (narrow), Myocardial infarction (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Chronic kidney disease (broad), Tumour lysis syndrome (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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: vitamin d 50000 iu weekly, metaglip 5/500 am, novolog, lisinopril 20mg daily, trileptal 300mg BID, benztropine
Current Illness:
Preexisting Conditions: schizophrenia, hyperlipidemia, hypertension, diabetes mellitus
Allergies: penicillin
Diagnostic Lab Data: scr 2.3 baseline 1.18;
CDC Split Type:

Write-up: This is a 44 M with NIDDM, HTN, HLD, Schizophrenia here with c/o fever and generalized body aches for about 7-8 days. Says was having body aches for about 8 days, had COVID 19 vaccine first dose on 5/14/21. Since then, had worsening body aches and also started having fever(not sure how much). Urine color changed to brown in the past week. No change in appetite or nausea or vomiting prior to admit as per him. No new medications and does not consume recreational drugs. Not an alcoholic, no recent trauma, does not work out and was not exposed to extreme heat or cold recently. In ER, patient was found to having AKI, shock liver, CK level which is too high to be calculated, had 1 episode of high-grade fever. He was therefore started on IV fluids and admitted for further management of rhabdomyolysis. Overnight had no urine output and having poor urine output since this a.m.. Had 1 episode of nausea and vomiting this morning. No more fever since on the floor. Complaining of epigastric pain that woke him up from sleep this afternoon.


VAERS ID: 1336793 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-17
Onset:2021-05-21
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Menstruation irregular
SMQs:, Fertility disorders (broad)

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

Write-up: I started bleeding vaginally 8 days earlier than my period usually would start. I am usually like clockwork, but I began my period 8 days early.


VAERS ID: 1336794 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022C21A / 2 LA / IM

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

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

Write-up: Pt. reported nausea after waiting. 30 minutes observation period. Seen by Medic . No intervention. Left on stable condition at 15:12 p.m. Recorded by RN.


VAERS ID: 1336803 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 023C21A / 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? 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: none
CDC Split Type:

Write-up: Patient previously received a does of Moderna vaccine while under the age of 18, and per current recommendation was given the 2nd dose while still under 18. no complaints or complications were noted.


VAERS ID: 1336806 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821286 / 1 LA / IM

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

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

Write-up: patient fainted, fell off chair and hit head on wall we had him lie down on floor, took his blood pressure and put ice pack on bump on his head he eventually sat up and felt better


VAERS ID: 1336808 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA MODERNA / 1 RA / SYR

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

Write-up: Gave Moderna vaccine instead of recommended Pfizer vaccine.


VAERS ID: 1336819 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / IM

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

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

Write-up: Patient felt dizzy, flushed, and nauseous following vaccination. She vomited several times. She did not feel like she was going to pass out so she remained seated until she stopped vomiting and felt better. She did not want to call ambulance and she stayed about 40 minutes until she felt better and husband drove her home.


VAERS ID: 1336948 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8736 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Dizziness, Head discomfort, Pallor
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad)

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

Write-up: dizzy, pale, fullness in ears. Increased monitoring. VSS and symptoms resolved


VAERS ID: 1337014 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1920095 / 1 LA / IM

Administered by: Military       Purchased by: ?
Symptoms: Dizziness, Visual impairment
SMQs:, Anticholinergic syndrome (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Spironolactone
Current Illness: None
Preexisting Conditions: Lightheaded and dizziness with exertive activities when she is playing sports.
Allergies: None
Diagnostic Lab Data: Physician assessed patient and EMS arrived and further assessed the patient, performed vital signs, and provided the patient a bottle of water.
CDC Split Type:

Write-up: After receiving the vaccine the pt walked over to the Recovery area and Pt verbalized becoming lightheaded, dizzy, and having spotty vision. Pt says she has a history of lightheaded and dizziness , so she knows to lay down when that occurs and that''s what she did.


VAERS ID: 1337015 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-20
Onset:2021-05-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: PenicilinE, NSAID
Diagnostic Lab Data:
CDC Split Type:

Write-up: Swollen tongue, lips and rash


VAERS ID: 1337033 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024C21A / 2 LA / -

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

Write-up: PT RECD FIRST DOSE OF MODERNA 4/23/21 AS A MINOR. PT CAME BACK TODAY FOR SECOND DOSE. PARENT WAS EDUCATED AND INFOR PROVIDED REGARDING MODERNA FOR MINORS. CONSENT SIGNED. PT RECD SECOND DOSE TO LEFT ARM.


VAERS ID: 1337065 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039A21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: n/a
CDC Split Type:

Write-up: 17 y/o inadvertently given first dose Moderna vaccine at 17 years 9 months of age. No adverse reactions followed. Client informed first dose was given inadvertently off-label due to age.


VAERS ID: 1337066 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 1 RA / -

Administered by: Other       Purchased by: ?
Symptoms: Psychomotor disadaptation syndrome
SMQs:

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

Write-up: WITNESSED FALL S/P FIRST DOES PFIZER, ALOC X1 SEC, PARAMEDICS CAME, SX RESOLVED, REFUSED TRANSPORT, HOME WITH MOTHER.


VAERS ID: 1337077 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Deafness, Dizziness, Hyperhidrosis, Pallor, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Hearing impairment (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Suddenly felt dizzy and loss of hearing, sweaty and arms and legs felt tingly. He turned pale. We laid him down and placed ice pack on his forehead and neck. BP initially was 84/50 repeat in 10 min was 105/54. He felt better after 10 min. Felt back to normal at 30 min when he was released to his mother


VAERS ID: 1337080 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Oropharyngeal discomfort, Paraesthesia oral, Rash erythematous, Rash papular
SMQs:, Anaphylactic reaction (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), 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? 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: Linear isolated raised erythematous areas on left arm. Benadryl given at 3:13p. Pt complains of right side of tongue and throat feeling full. Refused EMT, another Benadryl given at 4:05p. No visible swelling upon assessment.


VAERS ID: 1337119 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA EW0178 / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dyspnoea, Throat tightness, Tremor, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: history of prolonged QTc, severe anxiety and depressive disorder as well as bipolar disorder (newly diagnosed)
Allergies: Fexaril (anaphylaxis); carrots, grean beans, bananas, and seasonal allergies.
Diagnostic Lab Data: unknown
CDC Split Type:

Write-up: Pt presented to the clinic to receive the Pfizer vaccine, administered at approximately 11am. Pt was moved to observation area for 30 mins. Ten minutes after administration, the patient reported developing difficulty breathing, throat tightening, and wheezing in the lower left lung. One dose of Epi administered at ~11:13am and EMS called. Vitals taken at 11:17am with BP 120/72 bpm, O2 Sat 98%, & lungs clear, however, pt developed full body shaking. Pt AA0 x3. EMS arrived onsite at 11:25am and taken to ED.


VAERS ID: 1337120 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033B21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: none
Preexisting Conditions: Asthma
Allergies: Amoxicillin, Latex, Codeine
Diagnostic Lab Data: Unknown if any will be done at the hospital.
CDC Split Type:

Write-up: Patient received her second dose of Moderna COVID 19 vaccine, she was fine immediately after receiving the dose. I asked her to sit in the pharmacy area for observation post administration. Approximately 10 minutes later the patient turned pale and appeared to faint, she fell off the chair and hit her head on the floor. First aid was administered and the patient quickly woke up. 911 was called and the patient left the store under her own power with EMS.


VAERS ID: 1337123 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Code assist called- Pt complaining of dizziness- blurry vision- Took pt''s BP and it was 168/120-2nd BP 65/28- RN''s and MD''s assisted the code and 911 was called.


VAERS ID: 1337144 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0189 / 1 LA / IM

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

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 Reported
Current Illness: None Reported
Preexisting Conditions: None Reported
Allergies: None Reported
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Pt reported having trouble swallowing 12 minutes after injection, escorted to med ops 1, no evidence of allergic reaction, no rash, no trouble breathing. Vitals monitored as follows: LYING 5:59 - HR 85, Resp 12, BP 135/81, Sp02 100 Standing 6:06 - HR 64, Resp 12, BP 142/82, Sp02 100


VAERS ID: 1337194 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-05-19
Onset:2021-05-21
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002C21A / UNK LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Muscular weakness
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad)

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

Write-up: The patient called and stated that upon ambulating this morning, his left leg "feels like it''s going to give out on me when I stand on it." The patient claims that he has had no changes in his daily regimen, no new medications, and is not taking any medications that he can reasonably attribute to this possible side effect. I advised the patient to complete the CDC V-Safe form provided with his vaccine, and to contact his primary healthcare provider as soon as possible to seek guidance for assessment and treatment. Additionally, we will contact the CDC for further guidance and appropriate parties will reach out to the patient as more information becomes available.


VAERS ID: 1337277 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Hawaii  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017C21A / 2 RA / IM

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

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

Write-up: patient thought she received 1st dose of moderna vaccine and was confirmed during patient discussion prior to administration. Pt received 2nd dose of Moderna vaccine on 5/21/21 to right deltoid. After administration, it was found that patient received 1st dose of pfizer and should have received pfizer as second dose. Pt did not report any adverse reactions upon vaccine administration of second dose.


VAERS ID: 1337285 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 LA / IM

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

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

Write-up: Patient received the Janssen COVID vaccine then shortly after administration patient stated that their vision started to go blurry and the next thing their sight went dark, patient was seen falling out of chair head first after passing out.


VAERS ID: 1337288 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: New York  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Hyperhidrosis, Pallor, Peripheral coldness, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), 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: none
CDC Split Type:

Write-up: Patient experienced as 15- 20 second syncopy spell when he sat up frpm a sitting position after receiving the covid vaccine initial vitals 102/60 pulse 40 after regaining conciousness BP was 111/60 pulse at 60 patient prior to fainting appeared diapharatic, pale and cool to the touch there were no signs of llegeric reaction including flushing of the face lack of hives or angiodema no wheezibg, no strider or labored breathing patient complained of dizzness upopn standind equal to 30 mins.. EMS was notrified when arrived patient was up and alert without dicculties EMS recommended patient be released to his gaurdian BP at release 112/57 pulse 62 father advised to call physician if any concerns arise or go to nearest hospital in an emergent situation


VAERS ID: 1337290 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / UNK LA / IM

Administered by: School       Purchased by: ?
Symptoms: Feeling hot, Hypoaesthesia, Injection site haemorrhage, Injection site hypoaesthesia, Injection site pain, Peripheral coldness, Skin warm, Throat irritation, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (broad), Haemorrhage terms (excl laboratory terms) (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Sensitivity to tomato products, scented soaps and shampoos; allergic to guinea pigs; allergic to Spring
Diagnostic Lab Data:
CDC Split Type:

Write-up: Immediately began bleeding, which ran down arm from injection site. Approximately 4 minutes later, back of entire arm that received injection was numb from underarm to pinky and ring finger; warm hives on front of both arms down to wrists; warm, rosy cheeks and cold hands/fingers; tickle in back of throat. Benadryl given at clinic. 2.5 hours later, numbness in arm reduced to upper arm only; hives on arms have reduced; tickle in throat gone. Continues to have pain at site of injection.


VAERS ID: 1337314 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8737 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cold sweat, Confusional state, Feeling hot, Headache, 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), Dementia (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Within a few minutes of receiving the vaccine, the patient turned pale and clammy. He became confused and lost consciousness for several seconds, his head fell back and he made gurgling noises. When he regained consciousness, he couldn''t remember our conversation. He said he was hot and his head hurt for a few minutes, he remained pale and sweaty for several minutes. After 10-15 minutes he said he felt fine.


VAERS ID: 1337317 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN EW0185 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Feeling hot, Glossitis, Pruritus
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Vestibular disorders (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: She started itching, got hot, said her tongue felt funny. I sat with her asked her if was ok breAThing short of breath, she said no. I ASKED IF SHE WANTED A BENADRYL AND SHE SAID NO. MY TECH WAS AN EMT AND CAME OUT WHILE I WENT TO GET BLOOD PRESSURE CUFF, WE WATCHED HER AND SHE STARTED GETTING ITCHIER BUT BLOOD PRESSURE WAS FINE. WE CALLED EMS . SHE WAS RESPONSIVE, DIZZY, AND ALERT WHEN SHE LEFT WITH EMS.


VAERS ID: 1337323 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Visual impairment
SMQs:, Anticholinergic syndrome (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Hypoglycaemia (broad)

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

Write-up: five minutes after 13 year old patient''s first dose of Pfizer COVID shot, I was alerted that pt reported that her vision was "going black." when I arrived at our designated waiting area, she was sitting down with her father. parent stated that pt has never had any type of reaction to a vaccine previously, but stated that she had severe anxiety about this vaccine. pt was moved to the floor and raised her legs onto the chair. parent declined my offer to call 911 or rescue squad. her pulse was normal. parent and patient waited a total of 30 minutes before leaving the store. pt felt back to normal before leaving the store.


VAERS ID: 1337325 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: None
Allergies: NKDA
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Client reported feeling, "lightheaded" approximately 10 minutes following the vaccine administration. Patient was immediately placed in the anti-gravity chair, and given food and water. The patient denied history of fainting but reported similar experiences with previous vaccines. The lightheadedness was relieved following the consumption of food, water, and placing in the patient in a semi-Fowler''s position.


VAERS ID: 1337339 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047C21A / 1 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Asthenia, Dizziness, Headache, Heart rate increased, Palpitations, Refusal of treatment by patient
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Dehydration (broad)

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

Write-up: Pt. received 1st dose approximately at 08:53 a.m. Pt. stated that she could feel her heart beating fast and complaint of feeling light. Pt. denied shortness of breath and chest pain. Pt''s heart rate increased to 140-160m. Oxygen @3L via nasal cannula given by LVN. Oxygen saturation 100%, Respiration 20. HR started to improve and decreased to 84, BP taken manually 142/78. Pt. stated she was feeling better just weak. 09:19, pt''s vital signs were monitored for 45 min. Pt. refused to see one of the providers at clinic. Stated she feels better. C/o of headache, 5/10. Pt. discharged in good spirits when discharged to son who took her home. Was advised to go to ER if symptoms of shortness of breath, chest pain, dizziness, lightheaded, or heart palpitations occur and to follow up with provider.


VAERS ID: 1337346 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 RA / IM

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

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

Write-up: minutes after receiving vaccine the seated patient complained of dizziness and nausea. pt was also in cold sweats and proceeded to vomit


VAERS ID: 1337363 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 042B212A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cold sweat, Nausea
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypoglycaemia (broad)

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

Write-up: Patient got nauseous and clammy post vaccination. He was nervous and worked up prior to. We put his feet up and gave him some water. He felt better in 15 minutes and went back to work.


VAERS ID: 1337368 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 1 LA / IM

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

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

Write-up: AFTER GETTING SHOT, PATIENT PASSED OUT. I CHECKED BLOOD PRESSURE AND 73/42 AND PULSE WAS 51. CALLED 911. PUT PATIENTS LEG UP AND PUT SOME ICE ON BACK OF HER NECK AND UNDER ARM. PATIENT GAINED CONSCIOUS. FELLING OK. PARAMEDICS ARRIVED AND TOOK HER TO HOSPITAL. PATIENT WAS ABLE TO TALK AND ANSWER CORRECTLY.


VAERS ID: 1337419 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-05-20
Onset:2021-05-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 RA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Back pain, Neck pain, Pain in extremity, Rash macular
SMQs:, Retroperitoneal fibrosis (broad), Hypersensitivity (narrow), Arthritis (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: Daily mulivitamin
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: NONE
Diagnostic Lab Data:
CDC Split Type:

Write-up: Within 8 hours of receiving the vaccine, it felt like my arms, legs, and back were being beaten. I have pain in my neck. I have bright red splotches on my inner thighs.


VAERS ID: 1337423 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-05-20
Onset:2021-05-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 1 LA / IM

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

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

Write-up: father reported that patient''s DOB was 5/17/09 and was 12 years old on VAR questionnaire. When processing rx after administration, a duplicate patient record came up with a different DOB of 5/27/09 which would make pt 11. Upon calling parents, we verified that pt''s DOB was 5/27/09 and he wouldn''t be twelve for another 7 days after first dose administration.


VAERS ID: 1337430 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Bradycardia, Hypotension, Pallor, Respiratory rate increased, Seizure
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (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 (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: NA
Current Illness: NA
Preexisting Conditions: None reported to pharmacy
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Within 30 secs to 1 minute following vaccination patient started to seize. He came out of the seizure quickly (approx 20-30 sec). EMS was called and on site in minutes. Patient was breathing on his own but breathing was rapid. He lost color in his face/lips. When EMS arrived they noted that he was hypotensive and bradycardic. He began to regain color while EMS was on site. They opted to take him in for further evaluation. No history of seizures.


VAERS ID: 1337440 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 2 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Abdominal pain upper, Syncope, Tonic clonic movements
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: BP 100/65 Pulse 101
CDC Split Type:

Write-up: Patient fainted approximately 5 minutes after receiving his second Pfizer vaccine. He was observed to have tonic-clonic jerking but this was not seizure nor does the patient have a history of seizures. His mother reported fainting previously during stressful situations. Ice pack was given and BP was taken at 11:20 and was 100/65 and pulse was 101. When EMS arrived, patient''s BP was 134/80 and pulse was 83. Patient reported stomach pains post-fainting. EMS cleared patient to leave and he signed off that he did not want to go to the hospital.


VAERS ID: 1337450 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-04-20
Onset:2021-05-21
   Days after vaccination:31
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 1 LA / SYR

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

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

Write-up: swollen lymph nodes under arm pit; severe migraines


VAERS ID: 1337483 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-05-19
Onset:2021-05-21
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 1 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Cellcept, Guanfacine, Adderall XR, Lexapro Albuterol (but hasn''t used for several years)
Current Illness: None
Preexisting Conditions: nephrotic syndrome, attention deficit hyperactivity disorder, anxiety, asthma
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Nosebleedx2 - pressure with a tissue in his nose, nosebleed stopped in less than 15 minutes headache - tylenol, Aleve, improved


VAERS ID: 1337499 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-20
Onset:2021-05-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183/PUBLIC / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Dysphagia, Odynophagia, Pain in extremity
SMQs:, Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Pt seen ER Dr this moring 5/21, Vaccine reaction, initial encounter, dysphagia and pain with swallowing, received Pfizer first covid vaccine yesterday, some pain in arm after vaccination, no initial issues noted, went to bed, woke up in night complaints of painful and difficulty swallowing water, no shortness or breathe or difficulty breathing, no rash, mom gave bendayl at home this morning, able to swallow food and water now, no issues with prior vaccines, pt does have seasonal allergies, pt. discharged home with mom, continue over the counter allergy med like claritin or zyrtec for next few days, follow up with PCP for recheck prior to decision about 2nd vaccine.


VAERS ID: 1337511 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: New York  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: History of syncope following phlebotomy
Preexisting Conditions: none
Allergies: ? Food Allergies
Diagnostic Lab Data: Pulse oximetry normal
CDC Split Type:

Write-up: Syncopal episode with Loss of Consciousness for several seconds . Radial pulse was weak Heart rate was 48 / min and BP 85/60 . Heart rate and BP improved 112/80 Struck back of head during fall


VAERS ID: 1337538 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033C21A / 1 LA / IM

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

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

Write-up: Pt was in mass vaccination clinic. Review of form was not assessed by clerical personnel and sent to nurse to be vaccinated. Mother was present with child. Pt stature and body type appeared to be adult like. He is approximately 6 ft tall and weighed about 200 lbs. Event was discovered after vaccine was administered and information was entered .


VAERS ID: 1337547 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-05-20
Onset:2021-05-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808986 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood glucose normal, Loss of consciousness, Posture abnormal, Retching, 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), Dystonia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

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

Write-up: Pt was very anxious. She received vaccine and was sitting in the waiting area post vaccine. Her head fell backwards and husband saw this-he pushed her head forward and yelled for help. When I got to the pt she was unconcious and unresponsive. I tried to revive pt and she initially did not respond. We called 911. I lifted her head and she started to gurgle and seemed like she was going to throw up. She then came to. When EMT arrived they checked vitals and blood sugar. All was fine. Pt refused any other help. I spoke with pt today and she is fine


VAERS ID: 1337551 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-03-18
Onset:2021-05-21
   Days after vaccination:64
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805025 / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Haemoptysis
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Infective pneumonia (broad)

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

Write-up: Patient woke up coughing blood tinged, mucus this morning. Denied fever, vomiting, and diarrhea. Patient was sent to the emergency department.


VAERS ID: 1337580 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8736 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Pt has had an episode of syncope related to every injection per mother and pt. Has occured w/ flu shots, hep b vaccine, etc.
Other Medications: vyvanse
Current Illness: ADHD
Preexisting Conditions: n/a
Allergies: lavender
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Pt had an episode of syncope, pt''s mother supported the pt''s head, ammonia tablet was used to rouse pt and pt was assisted to the floor. Vitals were monitored, legs elevated, cold compress provided to the pt and placed on her neck. Pt rested and awoke 2-3 minutes later.


VAERS ID: 1337606 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Hyperhidrosis, Pallor, Peripheral coldness, Syncope, Vision blurred
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Glaucoma (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (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: Unisom
Current Illness: None
Preexisting Conditions: None reported
Allergies: No known drug allergies
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Syncope - patient experienced lightheadedness, sweating, paleness, blurred vision and cold extremities. I reassure patient that he will be okay and this is the body''s response to pain/anxiety. I also provided patient with water and make sure he was seated so he does not fall. His vision return to normal after 5 minutes or so and he started recovering within 15 minutes.


VAERS ID: 1337635 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: North Dakota  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 RA / IM

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

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

Write-up: Nurse gave serum that had expired its 6hr since puncture time. Time and Date were on the dose. Education has been provided to nurse to pay attention to detail. Patient will be called and scheduled to come in for another dose.


VAERS ID: 1337647 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: California  
Vaccinated:2021-04-23
Onset:2021-05-21
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006C21A / 1 LA / IM

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

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

Write-up: PATIENT WAS A MINOR WHEN HE RECIEVED HIS 1ST DOSE OF VACCINE ON 4/23/2021: HE RECIEVED MODERNA INSTEAD OF PFIZER. TODAY HERE FOR 2NDDOSE. I AM THE PHYSICIAN DOING CLINICAL REVIEW, REPORTING THE INCIDENT. PATIENT HAD NO ADVERSE REACTIONS TO HIS FIRST DOSE.


VAERS ID: 1337692 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: New York  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 1 LA / IM

Administered by: School       Purchased by: ?
Symptoms: Headache
SMQs:

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

Write-up: Developed severe headache 15 min after returning to class following vaccination . Approximately 30-40 min post vaccination FAther came to school and will transport his daughter to an Urgent care center for evaluation


VAERS ID: 1337693 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8735 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? 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: N/A
Diagnostic Lab Data:
CDC Split Type:

Write-up: vasovagal syncope


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