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

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



Case Details (Reverse Sorted by Onset Date)

This is page 117 out of 6,867

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VAERS ID: 1582133 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: New Hampshire  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Flushing, Hyperhidrosis, Visual impairment
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypersensitivity (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Dizziness / Lightheadness-Medium, Systemic: Flushed / Sweating-Medium, Systemic: Visual Changes/Disturbances-Medium, Additional Details: emergency services was dispatched, but not taken to hospital


VAERS ID: 1582134 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Immediate post-injection reaction, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Hypersensitivity (narrow)

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

Write-up: Systemic: Tingling (specify: facial area, extemities)-Mild, Additional Details: patient said she had tingling in her fingers and arm immediatly after injection


VAERS ID: 1582138 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 088D21A / 1 RA / IM

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

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

Write-up: Error: Wrong Dose of Vaccine - Too High-


VAERS ID: 1582141 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 088D21A / 1 LA / IM

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

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

Write-up: Systemic: Fainting / Unresponsive-Medium, Systemic: Hypotension-Medium, Additional Details: Patient mentioned that she does not like vaccines. I gave the shot and had patient sit there to be monitored. Her mother was there as well. Patient experienced light-headedness. As she was going forward to put her head between her legs, she fell all the way forward, hit her head on ground and received a wound to the left eye brow area. Called 911 and patient was taken to the hospital by ambulance.


VAERS ID: 1582142 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: New York  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821286 / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Apnoea, Asthenia, Injection site pain, Loss of consciousness, Malaise, Nausea, Syncope, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Respiratory failure (narrow), Hypoglycaemia (broad)

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

Write-up: Systemic: Fainting / Unresponsive-Severe, Systemic: Nausea-Medium, Systemic: Weakness-Severe, Additional Details: Post vaccine: 2 min after the vaccine pt reports that she is not feeling well. Pt transferred to the exam table safely. Pt lost consciousness, became apneic, and carotid pulse not palpable. Two chest compressions were given and pt gained her consciousness. 911 activated. Pt returned to normal state and denies any s/s. Pt reports that she was scared of the needle and that she had mild pain in her injection site and she panicked. She reports that she has had multiple similar events in the past.


VAERS ID: 1582143 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Louisiana  
Vaccinated:2021-08-16
Onset:2021-08-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Fatigue, Hyperhidrosis, Myalgia, Skin sensitisation, Tremor
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

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

Write-up: started with muscle aches and fatigue. Later after going to bed severe chills and uncontrollably shaking for two hours. After that alternating severe sweating and chills all night. Skin sensitivity during this whole time.


VAERS ID: 1582148 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: New York  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 LA / IM

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

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

Write-up: Systemic: Confusion-Medium, Systemic: Fainting / Unresponsive-Medium, Additional Details: pt was with dad he said she just went blank and passed out off the chair she never stopped breathing but lost consciousness we kept her comfortable until paramedics came


VAERS ID: 1582151 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 RA / IM

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

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

Write-up: Systemic: Dizziness / Lightheadness-Medium, Systemic: Fainting / Unresponsive-Mild, Additional Details: Patient was instructed to sit down after the vaccine in our waiting room. The patient got up without her knowledge and walked away. The nurse went to check on the patient, and found he looked pale. The nurse, helped the patient to the ground and got me, the NP. The patient was helped to a laying position with legs bent. patient instructed to lie in this position for a few minutes and provided gatorade juice. Patient assisted to sitting, drank juice and recovered.


VAERS ID: 1582153 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 2 AR / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Confusional state, Dizziness, Flushing, Generalised tonic-clonic seizure, Hyperhidrosis, Malaise, Seizure, Syncope, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Convulsions (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Confusion-Mild, Systemic: Dizziness / Lightheadness-Medium, Systemic: Fainting / Unresponsive-Medium, Systemic: Flushed / Sweating-Medium, Systemic: Seizure-Medium, Additional Details: Patient after 2nd dose of pfizer covid did not feel well minute it was injected. After 5 min he fainted, what seemed like a seizure. He slid off his chair which is mother was right next to him. She says he had not taken his AM seizure dose and it looked like it was a grand mal seizure. He regained consciousness within a couple of minutes and stayed seated but said he felt out of oxygen, dizzy, and sweating. EMT called. They evaluated him. Then he was better. EMT left. He left out walking better


VAERS ID: 1582154 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017E21A / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Formication, Headache, Hyperhidrosis, Pain, Syncope, Vertigo, Visceral pain
SMQs:, Torsade de pointes/QT prolongation (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Vestibular disorders (narrow), 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: Plaquenil
Current Illness: None
Preexisting Conditions: Rheumatoid Arthritis
Allergies: Sulfa
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fainting (2x), extreme dizziness/ vertigo, extensive onset of sweating, sensation of 100?s of bugs crawling on neck, excruciating headache and internal pain like a steamroller had run over me. Came on very fast and without warning.


VAERS ID: 1582158 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Kansas  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 1 LA / IM

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

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

Write-up: Systemic: Dizziness / Lightheadness-Mild, Systemic: Fainting / Unresponsive-Mild, Systemic: Flushed / Sweating-Mild, Systemic: Headache-Mild, Additional Details: Patient became unresponsive for a short period of time following vaccination. Patient stated this has happened before following shots/blood draws. They equated it to an axiety issue with needles. Patient recovered from their symptoms while at the pharmacy. EMS was called, however before they were sent to the store the patient had begun to recover and declined transport.


VAERS ID: 1582160 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: New Hampshire  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 1 LA / IM

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

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

Write-up: Site: Pain at Injection Site-Mild, Systemic: Fainting / Unresponsive-Medium, Systemic: Flushed / Sweating-Medium, Additional Details: as patient was leaving the store after approx 15 minutes post vaccine she stepped outside and fell down with dizziness, emts called, she didnt need to go with them. she is recovered.


VAERS ID: 1582304 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-08-16
Onset:2021-08-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC31B1 / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: COVID. Pfiser
Other Medications: Losartan 100mg
Current Illness: None
Preexisting Conditions: High blood pressure
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever chills headache


VAERS ID: 1582318 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 1 RA / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. T022566 / 2 RA / IM
HEPA: HEP A (VAQTA) / MERCK & CO. INC. T033304 / 1 LA / IM
HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. T029523 / 1 LA / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR T1D482M / 2 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. T007235 / 2 LA / SC
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U6951AA / 1 RA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C5770AA / 1 RA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. T032321 / UNK RA / SC

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: Unknown.
Current Illness: Unknown.
Preexisting Conditions: Unknown.
Allergies: Unknown.
Diagnostic Lab Data: No labs collected.
CDC Split Type:

Write-up: After administering the vaccines the client stated he was feeling dizzy, he was assisted to lying position on the ground, pillow behind head, bilateral lower extremities elevated, cold pack to forehead and nape of neck, pulse and blood pressure checked. After 30 minutes client was assisted to sitting position in a chair and monitored for an additional 20 minutes. Client states he felt better.


VAERS ID: 1582336 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-08-16
Onset:2021-08-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Chills, Fatigue, Headache, Injection site swelling, Lymphadenopathy, Myalgia, Nausea, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (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:
Current Illness:
Preexisting Conditions: IBD and associated RA
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Symptoms listed in order of severity: 101-102 degree fever (began about 12 hrs after shot), chills, muscle and joint pains, tiredness, swollen lymph nodes, headache, injection site swelling, nausea *most symptoms besides tiredness and injection site swelling are gone as of morning 8/18 (lasted a little over a day) *took Tylenol which helped some and slept most of day *immunocompromised; also had slight adverse reaction to 2nd dose of vaccine but definitely not as severe


VAERS ID: 1582340 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: New York  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 3 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Prevnar 13, 2019 November, Pfizer, Knot in arm and overall major flu like symptoms/knocked out.
Other Medications: Celebrex, humira, praulent, curcumin, glucosamine, centrum men, vitamin D, allopurinol, zetia, colchicine
Current Illness: None
Preexisting Conditions: Ankylosing Spondylitis Psoriatic Arthritis
Allergies: Statins, Bactroban
Diagnostic Lab Data: None yet
CDC Split Type:

Write-up: Received my vaccination at 730p in my right arm. AT 800p I had a ringing in my right ear. I''ve taken my normal medicines as well as a dose of tylenol and slept 8hr. My ringing is still present.


VAERS ID: 1582348 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dyspnoea, Tachycardia, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None stated to administering RN
Current Illness: None Stated
Preexisting Conditions: Juvenile idiopathic arthritis
Allergies: Banana, Infliximab, Latex, Secukinumab, Hx: Anaphylaxis with IM injection of Cosentyx
Diagnostic Lab Data:
CDC Split Type:

Write-up: Difficultly breathing, tachycardia, emesis


VAERS ID: 1582380 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 053E21A / 2 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Heart rate abnormal, Paraesthesia, Paraesthesia oral, Vaccination complication
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), 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: synthroid (Levothyroxene 25mcg) metoprolol 25 mg mesalamine 1.2 gm tab
Current Illness: none
Preexisting Conditions: proctitis (ulcerative colitis)
Allergies: penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: I left the store after 15 minutes. On my drive home I started feeling tingling in my lips, face and scalp. As I was driving into my driveway (20-25 minutes after the shot) my tongue started feeling strange. I called my husband and then my doctor. Doctor told me to take 50 mg of Benadryl. I felt my heart rate fluctuating, dropping. I felt like I could pass out. I had to focus on staying calm and breathing slowly. After about 30 minutes I started feeling better and by 1 1/2 hours the adverse reaction had passed.


VAERS ID: 1582390 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-08-15
Onset:2021-08-17
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Heavy menstrual bleeding, Menstrual disorder, Thrombosis
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad)

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

Write-up: Early menstrual with heavy bleeding and clots two days after being vaccinated.


VAERS ID: 1582411 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-08-16
Onset:2021-08-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017B21A / 1 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Disorientation, Dizziness, Headache, Injection site pain, Pain, Productive cough, Visual impairment
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (narrow), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Extravasation events (injections, infusions and implants) (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Dehydration (broad)

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

Write-up: Received 3rd dose of Moderna. (Booster shot) Body aches, chills, headaches, double and triple vision, woozy, disoriented, light headed, coughed green mucous, pain in injection site.


VAERS ID: 1582413 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-03-19
Onset:2021-08-17
   Days after vaccination:151
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007B21A / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032B21A / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, Asthenia, Blood glucose increased, COVID-19, Chest pain, Confusional state, Cough, Dyspnoea, Headache, Hemiparesis, Laboratory test, Mobility decreased, Nausea, SARS-CoV-2 test positive, Sinus congestion, Tachycardia, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Dehydration (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Atrial fibrillation and flutter Arrhythmia CAD Chronic pain Elevated troponin Hyperlipidemia Iron deficiency anemia due to chronic blood loss Morbid (severe) obesity due to excess calories Presence of aortocoronary bypass graft Type 2 diabetes mellitus without complication, unspecified long term insulin use status Essential (primary) hypertension Coronary artery disease involving native coronary artery of native heart with angina pectoris Hyperlipidemia, unspecified hyperlipidemia type Hip fracture, left Muscle spasm Cardiac arrhythmia, unspecified cardiac arrhythmia type Lumbar disc herniation Femoral neuropathy of left lower extremity Aortic root dilation Controlled substance agreement signed Left leg cellulitis Encounter for palliative care
Allergies: Simvastatin Statins-Hmg-Coa Reductase Inhibitors Ace Inhibitors Eliquis [Apixaban] Gabapentin Robaxin [Methocarbamol]
Diagnostic Lab Data: Positive for SARS-CoV-2 RNA by PCR Abnormal E Gene Ct cycles 29.9 Comment: Cycle threshold (Ct) values are not comparable between tests and may not be comparable between different lots of the same test. Currently there is no consensus as to whether or not particular Ct values correlate with a person being or not being infectious or risk level for disease severity. So, appropriate care should be taken with interpretation of Ct values. N2 Gene Ct cycles 32.2 Comment: Cycle threshold (Ct) values are not comparable between tests and may not be comparable between different lots of the same test. Currently there is no consensus as to whether or not particular Ct values correlate with a person being or not being infectious or risk level for disease severity. So, appropriate care should be taken with interpretation of Ct values. Resulting Agency NMRL Specimen Collected: 08/17/21 18:26 Last Resulted: 08/17/21 20:03
CDC Split Type:

Write-up: Patient is a 75 y.o. male taking Eliquis with a history of atrial fibrillation, CAD, type II DM, and HTN who presents to the emergency department via EMS for evaluation of weakness. Per EMS, the patient reported increased weakness to his wife this morning around 8:30 AM. He appeared increasingly weak and confused throughout the day, prompting his wife to call emergency services. The patient was tachycardic and his blood pressure was 200/140 for EMS. He reported some chest pain and shortness of breath. He was brought into the stabilization room with concern for "EKG changes", per EMS. Blood sugar was 360. He was given one Nitro, 4 mg of Zofran, and 324 mg of Aspirin en route. Just prior to arrival to the ED, he became nauseas and vomited. Here, the patient reports that he developed left sided weakness today and has difficulty moving his left lower and upper extremities. He notes that he''s had 3-4 days of sinus congestion, cough, and breathing difficulties He endorses abdominal pain and headache. He reports that he has been fully vaccinated against COVID.


VAERS ID: 1582446 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-08-12
Onset:2021-08-17
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 2 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Depo Birth Control Shot & Methylprednisolone 4MG
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: I had a seizure after getting the depo shot on 08/17/2021 and my Vaccine on 08/12/2021. I''ve never had seizures before so my primary doctor thought it best I follow up with this


VAERS ID: 1582460 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-02-26
Onset:2021-08-17
   Days after vaccination:172
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011A21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain lower, Abdominal pain upper, Alcohol test, Blood thyroid stimulating hormone, CYP2C19 gene status assay, Catheterisation cardiac, Chest pain, Computerised tomogram abdomen, Computerised tomogram thorax, Dyspnoea, Echocardiogram, Electrocardiogram abnormal, Fibrin D dimer, Full blood count, Influenza virus test, International normalised ratio, Lipids, Metabolic function test, Nausea, Respiratory syncytial virus test, SARS-CoV-2 test, Stool analysis, Troponin increased, Urine analysis
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), COVID-19 (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: troponin, CBC , BMP, inr, lipids, cardiac catheterization, echo, CT chest and abdomen, multiple EKGs, TSH, CYP 2C19, urin, flu, SARS-COV-2, RSV, fecal testing, d-dimer, alcohol level
CDC Split Type:

Write-up: shortness of breath, chest pain, abnormal EKG, elevated troponin, epigastric pain, left lower quadrant abdominal pain, nausea


VAERS ID: 1582499 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-08-16
Onset:2021-08-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009D21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Extra dose administered, Fatigue, Pain
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 had some mild fatigue/body aches the next day, but symptoms are now completely gone back to normal. We gave him the booster dose for the moderna but patient was not immunocompromised. It was in error. His second dose of the moderna was back in March. Patient is aware, doctor is aware.


VAERS ID: 1582501 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Nebraska  
Vaccinated:2021-08-16
Onset:2021-08-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / UNK LA / IM

Administered by: Private       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: Norethindrone 5 mg, fluticasone propionate 0.05% topical cream, Flonase 50 mcg/act, zyretec 10 mg, lactobacillus, vitamin D3.
Current Illness: Von Willebrand''s disease, iron deficiency anemia due to chronic blood lose
Preexisting Conditions: Von Willebrand''s disease, iron deficiency anemia due to chronic blood lose from heavy menstrual periods.
Allergies: Gluten, mosquitos, Neutrogena sunblock, and seasonal allergies.
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Hives on bilateral legs


VAERS ID: 1582509 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-08-16
Onset:2021-08-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009D21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Extra dose administered, Headache
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 hada headache the next day, but that symptom resolved and feels completely back to norma. We gave her the booster dose for the moderna but patient was not immunocompromised. It was in error. Her second dose of the moderna was back in March. Patient is aware, doctor is aware.


VAERS ID: 1582514 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: Hawaii  
Vaccinated:2021-01-08
Onset:2021-08-17
   Days after vaccination:221
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1284 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1686 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: Fully vaccinated, tested COVID 19 positive


VAERS ID: 1582525 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Erythema, Pain of skin, Pruritus, Skin erosion, Skin warm
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Escitalopram, buspirone, femotidine, hydroxyzine, calcium, vitamin D
Current Illness: None
Preexisting Conditions: Depression, anxiety, insomnia, reflux, obesity, acne, eczema
Allergies: Fluoxetine - mood swings, suicidal Bupropion - migraines Sertaline - hypersensitive hearing Morphine - itching Hydrocodone - vomiting Doxycycline- vomiting if not taken with food Fluticasone - minor nose bleed (pink boogers) NuvaRing - frequent headaches, worse acne, more painful period cramps, weight gain Gluten, soy, peppers - fatigue, reflux, loose stools, itching if I eat to much of any of these I have to be cautious about which cosmetics, shampoos, lotions and soaps I use because some cause rashes, eczema, cheilitis, perioral dermatitis or worse acne
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Sudden, intense itching of the front of neck and upper chest began 2 hours after receiving the vaccine. Treated with Benadryl and triamcinolone cream. The itching returned the next day and also included skin redness, warmth to the touch and skin feeling raw and sore.


VAERS ID: 1582534 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Body temperature increased, Dizziness, Erythema, Fatigue, Gastrointestinal disorder, Headache, Hyperhidrosis, Muscle fatigue, Musculoskeletal stiffness, Oral discomfort, Paraesthesia oral, Pruritus, Skin warm, Tongue discomfort, Urticaria, Vertigo, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (narrow), Hypersensitivity (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Antibiotic
Current Illness: Infected bug bite
Preexisting Conditions:
Allergies: Brazil nuts, cantaloupe, salmon, mussels
Diagnostic Lab Data:
CDC Split Type:

Write-up: No pain from shot. At 4 minutes in, sweating, 5 minutes in, burning tongue. At 10 minutes, lips burned, tingled. Told pharmacist I was fine, had daughter with me, we left. In car at about 10 min, dizzy, vertigo, mild headache, neck became stiff. At the 1 hour mark, red patchy skin on arm, hot to the touch, slight hives near elbow, GI issues, slight muscle fatigue in legs. Took temp twice. 99 and 100 at separate times. Symptoms lasted about 3 hours. Once began subsiding, all over body itch. Took 2 Benadryl, waited a bit, took 1 more Benadryl. Felt better on 8/18, but had difficulty keeping food/liquid down in morning. Skipped all meds. All over tired feeling. Never had any real pain like a typical vaccine. Felt like an allergic reaction. Notified doctor and the vsafe. Did not seek medical attention, as it did not involve difficulty breathing.


VAERS ID: 1582544 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-08-16
Onset:2021-08-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Alopecia
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Spironolactone 50 mg twice daily, Estradiol 1 mg twice daily, rishi mushroom 600mg twice daily, DGL 750 mg twice daily, 1 tsp. black elderberry extract 850mg once daily, 2 probiotic 78 mg once daily
Current Illness:
Preexisting Conditions: Occupational joint injuries
Allergies: potassium sorbate
Diagnostic Lab Data:
CDC Split Type:

Write-up: Ongoing ,excessive hair fall beginning the day after vaccination.


VAERS ID: 1582562 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-08-16
Onset:2021-08-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

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

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

Write-up: Initial symptom of a mild headache (2/10 pain) 10 minutes following vaccine administration, headache resolved w/o intervention w/in 5 minutes. Chills started approximately 6 hours following vaccine dose, a fever followed w/in the next hour. Dizziness occurred whenever ambulation was attempted. A migraine headache started approximately 7 hours following the vaccine administration that gradually grew to an intensity of 8/10 pain over the course of 2 hours. The migraine continued until on over the counter migraine medication was taken at 08:00 and reduced the pain down to a 4/10. The fever was also greatly reduced by the medication. Residual headache still present 36 hours post vaccine administration. Pain is 2/10.


VAERS ID: 1582565 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Maine  
Vaccinated:2021-08-09
Onset:2021-08-17
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Erythema, Injection site reaction, Pruritus, Skin reaction, Skin swelling, Skin warm
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: ?Covid arm? - delayed reaction on my arm at injection site. Skin is red, swollen, hot to touch and itchy.


VAERS ID: 1582577 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 1 RA / IM

Administered by: Work       Purchased by: ?
Symptoms: Dyspnoea, Heart rate increased, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

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

Write-up: Heart rate increased, difficulty breathing and developed hives


VAERS ID: 1582586 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Eye swelling
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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Atorvastatin, Vitamin D(otc), Fenofibrate, Tramadol
Current Illness: none
Preexisting Conditions: none
Allergies: Pencillins
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Patient reported to the ER a few hours after receiving vaccine having eye swelling. He was discharged after treatment for this. patient treatment included: diphenhydrAMINE (BENADRYL) injection 25 mg (25 mg Intravenous Given 8/17/21 2142) famotidine (PEPCID) injection 20 mg (20 mg Intravenous Given 8/17/21 2141) methylPREDNISolone sodium succinate (SOLU-Medrol) injection 40 mg (40 mg Intravenous Given 8/17/21 2145)


VAERS ID: 1582595 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052E21A / 3 LA / IM

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

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

Write-up: Patient received 2 doses of Pfizer covid vaccine. She then received the Moderna vaccine for 3rd dose


VAERS ID: 1582603 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: New York  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood glucose normal, Blood pressure decreased, Hyperhidrosis, Immediate post-injection reaction, Joint lock, Loss of consciousness, Malaise, Pallor, Posture abnormal, Tremor
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (narrow), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: PARAMEDICS CHECKED HIS BLOOD PRESSURE WHICH WAS LOW 80/45 AND HIS BLOOD SUGAR WAS 103. PATEINT WAS ABLE TO WALK TO THE AMBULANCE AND WAS TRASFERED TO THE HOSPITAL.
CDC Split Type:

Write-up: IMMEDIATELY AFTER GIVING THE VACCINE, PATIENT SAID HE IS NOT FEELING WELL, TURNED PALE AND PASSED OUT, HIS ARMS LOCKED, HE START SHAKING AND HIS HEAD TUNRED ON THE SIDE. HE LOST CONSCIOUSNESS. AFTER FEW SECONDS HE RECOVERED, BUT WAS VERY PALE AND HE WAS SWEATING. 911 WAS CALLED AND PARAMEDICS CAME.


VAERS ID: 1582606 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-25
Onset:2021-08-17
   Days after vaccination:145
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8732 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0162 / 2 RA / IM

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

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

Write-up: Breakthrough COVID case. Tested positive on 8/17/2021 via PCR test.


VAERS ID: 1582608 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-08-16
Onset:2021-08-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 2 LA / IM

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

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

Write-up: Fever, chills, body aches


VAERS ID: 1582611 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-08-16
Onset:2021-08-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Cough, Fatigue, Headache, Oropharyngeal pain, Pain, Pyrexia, Rhinorrhoea, Throat irritation, Upper-airway cough syndrome, Vertigo
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Vestibular disorders (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: 2nd hepb vaccination, anaphylaxis, taken to ER by ambulance from Health Department. Was early September 2002. Age was 48. Two fl
Other Medications: Synthroid, Pregabalin, Potassium, low dose aspirin, Zyrtec, Allegra, Pepcid, Occusoft, Restassis, Flonase, Pilocarpine, Hydroxychloroquine, Amovig, vitamin d2, Montelukast, oxybutinin, Meclizine, Dulera, multi-vitamins, Biocomplete, apple c
Current Illness: Sinus issues
Preexisting Conditions: Asthma, allergies, connective tissue disease, sicca, possibly Sjogren''s or Lupus, RSD, oral herpes, Raynaud''s, Meniere''s, vestibular migraines
Allergies: Sulfa, Keflex, Neomycin, Erythromycin, Floxin, Hepb immunization (anaphylaxis), flu vaccine, latex, rubber, trees, mold, grasses, dogs, cats, all foods tested for, dust mites, cockroaches,
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Extreme fatigue, body aches, headache, coughing, sore throat, tickle in throat, postnasal draining/ runny nose, slight vertigo (the first shot was worse), fever (highest was 99.9 then took Advil. A lot of these symptoms are the same as my possible Sjogren''s and my daily low-grade fevers, it''s just that these are worse. The body aches and fatigue was present when I awoke shortly before 7 am, by about 3 pm the sore/ticklish throat and coughing started along with the postnasal drip/runny nose. The headache started at around 6 pm. It is now Wednesday, and everything is still going on.


VAERS ID: 1582614 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-02-10
Onset:2021-08-17
   Days after vaccination:188
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1284 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: PCR COVID-19 test with a positive result
CDC Split Type:

Write-up: Patient was vaccinated with the COVID-19 vaccine on 1/20/21 and 2/10/21, so was fully vaccinated when he tested positive for COVID on 8/17/21.


VAERS ID: 1582626 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-08-10
Onset:2021-08-17
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 LA / IM

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

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

Write-up: The patient called on 8/17/21 and said that night or the next morning she had a left swollen lymph node in her neck and that it had stayed swollen since 8/10/21. She said she had no other symptoms. She was concerned it may be due to the vaccine. I recommended that she be checked by her PCP or a walk in office.


VAERS ID: 1582627 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: New York  
Vaccinated:2021-08-16
Onset:2021-08-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

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

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

Write-up: headache, ear pain, dizziness


VAERS ID: 1582629 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-03-22
Onset:2021-08-17
   Days after vaccination:148
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003B21A / 1 - / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 042B21A / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Back pain, COVID-19, Mental status changes, SARS-CoV-2 test positive
SMQs:, Retroperitoneal fibrosis (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: FOSAMAX ALLOPURINOL ELIQUIS BROVANA VITAMIN C PULMICORT VITAMIN D3 COLCRYS IMDUR ACIDOPHILUS TOPROL XL PERCOCET POTASSIUM TRAZODONE PROBIOTIC
Current Illness:
Preexisting Conditions: CHF UTI AFIB COPD DM2 SLEEP APNEA
Allergies: PENTAZOCINE CONTRAST MEDIA PENICILLINS CEPHALEXIN CIPRO ADHESEIVE TAPE VALSARTAN LATEX
Diagnostic Lab Data: POSITIVE COVID TEST
CDC Split Type:

Write-up: LOWER BACK PAIN AND AMS


VAERS ID: 1582630 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-16
Onset:2021-08-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 - / -

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

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

Write-up: Severe chest pains, was diagnosed with Myocarditis by healthcare provider.


VAERS ID: 1582635 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: South Dakota  
Vaccinated:2021-06-16
Onset:2021-08-17
   Days after vaccination:62
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA EW0186 / 1 - / IM

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

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

Write-up: Patient was given Moderna vaccine while an inpatient facility () . Immunization record came through clinic, it was Data from outside sources need reconciliation. Moderna vaccine was administered 6/16/21. This patient is not of age to receive the Moderna vaccine. Pfizer was given as the second dose on 8/17/20.


VAERS ID: 1582647 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Nebraska  
Vaccinated:2021-08-16
Onset:2021-08-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

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

Write-up: Swelling above upper lip


VAERS ID: 1582653 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: New York  
Vaccinated:2021-08-16
Onset:2021-08-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Erythema, Feeling hot, Nausea, Pruritus, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Multivitamin Client states she does not know names of meds and does not have list of meds on her.
Current Illness: No
Preexisting Conditions: None
Allergies: NKDA
Diagnostic Lab Data: Went to ED. Received Benadryl and steroid IV and medication for stomach (name unknown by patient).
CDC Split Type:

Write-up: Complain of nausea, then emesis X 2, described hands as "hot" and red in color, then redness spread to both wrist area, then developed itching of hands/wrists, then developed itching across chest and back.


VAERS ID: 1582656 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-05-14
Onset:2021-08-17
   Days after vaccination:95
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 2 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH PAA165969 / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Malaise
SMQs:

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

Write-up: Pt admitted to the Hospital for COVID 19 symptoms post vaccination.


VAERS ID: 1582661 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036B21A / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036B21A / 1 RA / IM

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

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

Write-up: Patient started complaining of itchy neck at 4:20. She began coughing and vomitting x1. She was given benadryl 25 mg by mouth. Her symptoms improved. Before she left, she had no signs of swelling or distress.


VAERS ID: 1582666 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Motor dysfunction, Peripheral swelling
SMQs:, Cardiac failure (broad), Angioedema (broad), Peripheral neuropathy (broad), Akathisia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

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

Write-up: patient states his hand started to swell up on same side he got vaccination about 10 minutes after getting the shot. Patient states that it got worse over 24 hours and then he was having trouble grasping objects with the swollen hand.


VAERS ID: 1582683 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 053E21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Condition aggravated, Limb discomfort, 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: None
Current Illness: None reported
Preexisting Conditions: Previous history of Hypoglycemic spells, fainting dizziness
Allergies: None known
Diagnostic Lab Data: Unknown at this time
CDC Split Type:

Write-up: Patient received vaccine and several minutes later had a fainting spell in the aisle. I attended to patient, we called 911. The patient was alert and responsive to questions. We had patient lay in recovery position while we monitored and waited for EMS to transport. No problems with airway or breathing, no visible reaction at injecton site. Patient did complain after the shot her arm felt heavy.


VAERS ID: 1582686 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Incorrect dose administered, Pain in extremity, Underdose
SMQs:, Tendinopathies and ligament disorders (broad), 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: NA
CDC Split Type:

Write-up: wrong dose of Pfizer vaccine given (0.5ml instead of 0.3ml). Phone call to parent at 3pm. Text sent this morning to parent-only complaint is a sore arm.


VAERS ID: 1582691 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040C21A / 1 RA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Anxiety, Hypertension, Pruritus, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Hypertension (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: APPROXIMATELY 3 HOURS AFTER RECEIVING THE VACCINE, RECIPIENT STARTED ITCHING IN HER EXTREMITIES. SHE INFORMED THE NURSE AT THE DESK WITH HER AND THE NURSE NOTED THAT RECIPIENT HAD WELPS FORMING. RECIPIENT TOOK AN OTC ANTIHISTAMINE (CLARITIN). BP WAS NOTED TO BE HIGH (194/104), RECIPIENT STATES SHE DOES NOT HAVE HTN, SHE WAS ANXIOUS ABOUT THE WELPS THAT WERE DEVELOPING. RECIPIENT DENIES ANY RESPIRATORY DISTRESS OF ANY KIND. STATES SHE MET WITH AN MD (PRESUMABLY THE MEDICAL DIRECTOR AT FACILITY) WHO TOLD HER TO TAKE A BENADRYL WHEN SHE GOT HOME, WHICH SHE DID. SHE IS BACK AT WORK TODAY AND STATES THAT ALL SIGNS/SYMPTOMS OF A REACTION ARE GONE. BP WAS NORMAL THIS AM AND THE WELPS /HIVES SHE DEVELOPED YESTERDAY HAVE SUBSIDED.


VAERS ID: 1582703 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-08-13
Onset:2021-08-17
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821286 / 1 RA / -

Administered by: Public       Purchased by: ?
Symptoms: Arthralgia, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: birth control
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: tingling in legs (mild), sharp pain inside of elbow, arm tingling


VAERS ID: 1582716 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Diarrhoea, Fatigue, Hypoaesthesia, Pain, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Pseudomembranous colitis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Sexual dysfunction (broad)

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

Write-up: Body aches, numb/tingling face, weakness, Fatigued, diarrhea


VAERS ID: 1582717 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 2020A21A / 1 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Feeling abnormal, Feeling jittery
SMQs:, Dementia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin C+D with Zinc
Current Illness: None
Preexisting Conditions: Denies
Allergies: NKA
Diagnostic Lab Data: Possibly EKG in ED
CDC Split Type:

Write-up: 8/17/2021 at 1210, approximately 10 mins post vaccination, reported feeling jittery "I feel like I''m running" . VS checked: BP 129/80, HR fluctuates between 112-120 bpm. RR 12-20. Oxygen Sat 96% on RA. Denies CP, Palpitations, SOB, light headedness, HA. Symmetrical smile, No c/o of extremity weakness. transported to ED for further obseravation.


VAERS ID: 1582725 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: Nevada  
Vaccinated:2021-08-16
Onset:2021-08-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injected limb mobility decreased, Lymphadenopathy, Pain in extremity
SMQs:, Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Pt received Pfizer injection IM in Right Arm on 8/16. Pt came back on 8/18 with swelling in the lymph nodes under the right arm, with stiffness and discomfort in the right arm. Pt was advised that this may sometimes occur, but infrequently. Pt advised to take Ibuprofen or Naproxen OTC, and to see his Dr. if he has additional concerns.


VAERS ID: 1582738 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026C21A / 1 LA / IM

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

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

Write-up: Moderna COVID-19 Vaccine EUA The child came with his mother to get vaccination. There is no adverse event reported. Moderna vaccine was administered to him when he does not fall within the age group for EUA. It completely escaped my attention and I had a recollection yesterday evening when I left the pharmacy. The parent telephone number provided was called but no one picked however a voicemail message was left for her to call the pharmacy at her earliest convenience.


VAERS ID: 1582764 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-06
Onset:2021-08-17
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 019B21A / 1 LA / IM

Administered by: Military       Purchased by: ?
Symptoms: Injection site erythema, Injection site rash, Injection site warmth, Rash papular
SMQs:, 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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Metamcuil
Current Illness: n/a
Preexisting Conditions: chronic headaches, chronic GI disorder
Allergies: n/a
Diagnostic Lab Data:
CDC Split Type:

Write-up: Developed a rash in the shape of a swan below injection site. Slightly raised, red in color, and warm to touch.


VAERS ID: 1582773 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Kansas  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040C21A / 3 RA / IM

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

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

Write-up: The patient was to receive Pfizer, but was administered Moderna instead. The patient has not had any issues, but per company policy we report vaccines errors to VAERS. As of today 8/18 (the vaccine was given 8/17) the patient has not reported any adverse events.


VAERS ID: 1582776 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: Mississippi  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0170 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Anxiety, Paraesthesia oral, Rash, Throat tightness
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Pt waited 15 minutes prior to leaving clinic then returned again with rash on trunk of body and arms, lips tingling, anxious, and c/o of throat feeling tight. Benadryl 50 mg po administered; pt was alert and oriented. Ambulance called. EMS first to respond. O2 sat 99 %; BP: 154/90, HR 104, R 24; epinephrine prepared but did not have to be administered. Pt observed and started to calm and did not want to go to the hospital. Nurse f/u with pt and he reported still doing well once at home; no further problems reported.


VAERS ID: 1582780 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017E21A / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Eye pain, Headache, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Glaucoma (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: plendil
Current Illness: mild headache
Preexisting Conditions: high blood pressure, migraines
Allergies: torodol, nubaine, lisinopril, imitrex, stadol, penicillin, clonidine
Diagnostic Lab Data: none
CDC Split Type:

Write-up: I got my vaccine about 10:30 AM. I had a slight headache (about 2 out of 10) but after the shot the headache went completely away. Several hours later I had muscle pain in my legs and upper back and a return of a quick jolting migraine ( about 5 out of 10 that quicky went to a level seven within 10 minutes). I spoke with (my roomate) and told her that I was going to the doctor for headache and muscle pain. I went to the ER. I was asked by the doctor about my symptoms and I told him that I had felt the headache and muscle pain after getting my shot earlier. I told hom that I had a very slight headache prior to the shot but shot took headache away. Dr asked me what was usually given for my headaches and I told him morphine. I had no nausea But I did have an unusal pain behind my right eye that I never had before. I went back out into the lobby and a nurse came out and asked me about my symptoms. I told her what I had told the doctor. I said that the muscle pain was probably due to the shot since I wasn''t sore prior to that time. The nurse told me that it wasn''t the vaccine but it was just a coincidence because i was having a migraine and was probably upset even though I was never upset. Another nurse gave me morphine, ativan, benadryl and phenergan for pain and then took my vital signs. After my pain had subsided I went home and went to sleep and felt fine the next morning.


VAERS ID: 1582784 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0171 / 1 RA / IM

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

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

Write-up: THE VIAL OF VACCINE WAS DILUTED INCORRECTLY. 0.8 ML OF DILUANT WAS USED AND NOT 1.8 ML. THE PATIENT WAS MONITORED FOR THE REQUIRED 15 MIN POST VACCINE, THE ERROR WAS NOT RECOGNIZED UNTIL AFTER PATIEN HAD LEFT THE OFFICE.


VAERS ID: 1582794 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-08-16
Onset:2021-08-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / IM

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

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

Write-up: fever (100 degrees F) chills aches all symptoms lasted 40 hours


VAERS ID: 1582798 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0171 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Incorrect dose administered, No adverse event, Product preparation issue
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: VACCINE WAS DILUTED INCORRECTLY. ONLY 0.8 ML OF DILUANT WAS USED INSTEAD OF 1.8 ML. PATIENT WAS MONITORED FOR THE REQUIRED 15 MIN, NO REACTIONS NOTED. ERROR NOT DISCOVERED UNTIL AFTER PATIENT HAD LEFT THE OFFICE.


VAERS ID: 1582800 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-08-05
Onset:2021-08-17
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Condition aggravated, Genital herpes
SMQs:, Opportunistic infections (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: nadolol 40 mg daily, omeprazole 40 mg daily, metronidazole gel 15 daily
Current Illness: none
Preexisting Conditions: Barrett''s esophagus, GERD, high blood pressure., genital HSV2
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: vaccine triggered an HSV2 outbreak, 08/16/2021 prodrome, 08/17/2021 worse than normal outbreak, patient had been outbreak free for more than a decade. 08/17/2021 started valcyclovir


VAERS ID: 1582830 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 088D21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Incorrect route of product administration
SMQs:, Drug abuse and dependence (broad), 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: Enbrel, lexapro, xanax, crestor, losartan , pantoprazole and ibuprofen
Current Illness: no illness
Preexisting Conditions: ankylosing spondylitis
Allergies: nka
Diagnostic Lab Data: none
CDC Split Type:

Write-up: patient states the technician immunizing was removing the needle as injecting and gave the shot into the sq instead of in the muscle.


VAERS ID: 1582838 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 2 RA / -

Administered by: Military       Purchased by: ?
Symptoms: Chills, Cough, Dizziness, Headache, Hyperhidrosis, Nausea, Pharyngeal swelling, Respiratory tract congestion
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Headache, chills, sweating, nausea, dizziness, swollen throat, congestion, cough beginning around 9 hours after receiving the vaccine.


VAERS ID: 1582844 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-08-16
Onset:2021-08-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 2 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dyspnoea, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (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: Cetirizine
Current Illness: none
Preexisting Conditions: Asthma and environmental allergies
Allergies: none
Diagnostic Lab Data: Release of information pending.
CDC Split Type:

Write-up: febrile, short of breath, taken to local ER. Treated and released.


VAERS ID: 1582860 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-03-18
Onset:2021-08-17
   Days after vaccination:152
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029A21A / 1 LA / IM

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

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

Write-up: Patient was given Moderna on 3/18/2021 and his booster on 4/12/2021- patient was not 18 at time of vaccine administration.


VAERS ID: 1582868 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-08-16
Onset:2021-08-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Myalgia, Urticaria
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Angioedema (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Magnesium, Vitamin D3 and Zinc
Current Illness: General anxiety, back pain, gastritis
Preexisting Conditions: General anxiety and gastritis
Allergies: Vitamin B12
Diagnostic Lab Data:
CDC Split Type:

Write-up: urticaria, muscle pain in the middle of chest and arm.


VAERS ID: 1582879 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Hypoaesthesia, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Flu
Other Medications: Metoprolol Fish oil Vitamin E Vitamin C Vitamin D Melatonin Magnesium Hydroxide
Current Illness: No Known Allergies
Preexisting Conditions: Osteoporosis Essential hypertension Hypercholesterolemia Palpitations Subacromial impingement Degenerative arthritis of R shoulder region Rotator cuff impingement syndrome
Allergies:
Diagnostic Lab Data: Pt sent to ED for evaluation on 8/17 directly from vaccine clinic
CDC Split Type:

Write-up: Pt reported numbness in shoulder down to finger tips and slight swelling in neck


VAERS ID: 1582880 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 2 RA / IM

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

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

Write-up: SECOND DOSE WAS ADMINISTERED TOO EARLY


VAERS ID: 1582881 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-08-16
Onset:2021-08-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test abnormal, Chest X-ray normal, Chest discomfort, Chest pain, Chills, Computerised tomogram, Dyspnoea, Electrocardiogram normal, Fear, Heart rate increased, Lymphadenopathy, Non-cardiac chest pain, Palpitations, Pulmonary pain, Pyrexia, Sleep deficit, Vaccination complication
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

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

Write-up: I woke up at midnight with very severe chest pains, could not take a deep breath. I felt like my lungs were on fire and someone was sitting on my chest. I had to prop myself up on pillows just to be able to breathe. I didn''t sleep at all that night because I was afraid I wouldn''t wake up. Intense heart pounding, very rapid. The next morning my chest still hurt very bad but I felt I could catch my breath a little better. Had a little bit of a fever & chills. I called my doctor and she told me to go the emergency room. I got an EKG, blood work, and chest X-ray. All came back normal except my blood work showed I had elevated levels for a blood clot, so I needed a CT scan. No blood clots were shown, but my left lymph node under my armpit was extremely swollen (injection site was left arm). They concluded that all of my problems were a reaction to the vaccine.


VAERS ID: 1582891 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-08-11
Onset:2021-08-17
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Diarrhoea, Flatulence, Headache, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Arthritis (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Rosuvastatin 5mg Aspirin 81mg Turmeric 1500mg Ubiquinol 100mg Vitiman C 1000mg
Current Illness: None
Preexisting Conditions: None
Allergies: No
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Aching muscle, pain at some joints, 99.5 fever, minor headache, excessive gas and diarrhea


VAERS ID: 1582892 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Cold sweat, Insomnia, Migraine, Renal pain, Sensitive skin
SMQs:, Hypoglycaemia (broad)

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

Write-up: Kidney pain, skin sensitivity, migraine and cold sweats which worsened throughout the night prohibiting sleep. Kidney pain is continuing through the next day. Continuing to monitor.


VAERS ID: 1582894 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Amnesia, Chills, Coordination abnormal, Dizziness, Feeling drunk, Headache, Hypoaesthesia, Lethargy, Tinnitus
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hearing impairment (narrow), Vestibular disorders (broad), Hypoglycaemia (broad), Sexual dysfunction (broad)

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

Write-up: Giddiness, dizziness, "feeling drunk", failed finger-to-nose test, uncoordinated, and memory loss of events x 10 hours. He was able to answer questions, but kept repeating same questions over. Approximately 13 hours from onset of adverse event, he stated feeling "punched in the face", headaches, and ringing in one ear. Also experienced numbness in fingertips. Approximately 24 hours after vaccination, ringing in ears/numbness in fingertips resolved, but some dizziness. Now with lethargy, and chills - which are some of the expected side effects. He states, "I lost at least 8 hours of my life."


VAERS ID: 1582899 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-08-16
Onset:2021-08-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC30180 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Lymphadenopathy, Mobility decreased, Pain, Pain in extremity
SMQs:, Parkinson-like events (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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Flonase omeprazole diclofenac 75 mg dosage
Current Illness: no
Preexisting Conditions: no
Allergies: sulfa
Diagnostic Lab Data:
CDC Split Type:

Write-up: I had my 1st shot of the Pfizer vaccine on Aug 16 around 11:30am. My appointment was at 11am, but with paper and others ahead of me. My right arm was swore a few hours later, and my body began to ache as well. The next day my body ached pretty bad. Those things I expected. WHAT I didn''t expect was my lymph nodes in my right armpit to swell to the size of a golf ball. I couldn''t raise my arm above shoulder height. I couldn''t get into an urgent care till 6pm that evening. The DR told me to rest a few days, and it should go away. He also told me that I needed to report this event, so it could be tracked. Item 20 on form, I am still recovering now.


VAERS ID: 1582900 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / UNK UN / IM

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

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

Write-up: Patient reported becoming hot and dizzy within a few minutes of receiving the vaccine. She was escorted to the ED via stretcher.


VAERS ID: 1582902 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Extra dose administered, No adverse event, Wrong 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: Patient presented to the pharmacy to receive the shingles vaccination. Pharmacist verified patient demographics, completed paperwork/pre-work for the shingles vaccination. Patient completed their portion of the Vaccine Administration Record. Pharmacist completed the pharmacy''s portion of the VAR for the Covid-19 vaccination. Patient was taken into vaccination area by the pharmacist and dispensed the Covid-19 vaccination. Patient was not dispensed the shingles vaccination. Patient experienced no immediate symptoms/reactions. This was the patient''s 3rd Covid-19 vaccination. Patient was not authorized for it under the current guidelines.


VAERS ID: 1582903 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-01-14
Onset:2021-08-17
   Days after vaccination:215
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH N/A / UNK - / -

Administered by: Work       Purchased by: ?
Symptoms: COVID-19
SMQs:, Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: pt currently has Covid 19, no lot #s available on either vaccine


VAERS ID: 1582908 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-01
Onset:2021-08-17
   Days after vaccination:169
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6198 / 2 - / -

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

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: cardiac disease
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Dose 1 02/08/2021 Pfizer lot # EN6201


VAERS ID: 1582915 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-08-15
Onset:2021-08-17
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM0180 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Feeding disorder, Noninfective gingivitis, Oral pain, Stomatitis
SMQs:, Severe cutaneous adverse reactions (broad), Gingival disorders (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Mouth pain, can''t eat, open, open, deep sore in gums, and on roof of mouth. Went to dentist. Dentist said it was an immune system reaction to the vaccine.


VAERS ID: 1582923 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-02-17
Onset:2021-08-17
   Days after vaccination:181
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH E19267 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Laboratory test
SMQs:

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

Write-up: routine testing for work


VAERS ID: 1582930 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-04-07
Onset:2021-08-17
   Days after vaccination:132
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Ageusia, Anosmia, Cough, Rhinorrhoea
SMQs:, Anaphylactic reaction (broad), Taste and smell disorders (narrow), Immune-mediated/autoimmune disorders (broad)

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

Write-up: CASE IS SYMPTOMATIC, RUNNING NOSE, NO TASTE OR SMELL AND COUGH, ONSET DATE: 8/12/2021


VAERS ID: 1582956 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-04
Onset:2021-08-17
   Days after vaccination:194
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA MOD 026L20A / 1 - / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA MOD 029K20A / 2 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Chest X-ray abnormal, Dyspnoea, Hypoxia, Pneumonia, Pyrexia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: 57-year-old male with history of diabetes, presented to the emergency room department due to worsening shortness of breath and hypoxia, patient was diagnosed with COVID-19 infection about a week ago, he denies any sick contacts at home, he has not received COVID-19 vaccination, his symptoms have been progressively worsening over the past couple days, he checked his oxygen levels at home and was 88%, he denies any associated chest pain, nausea, vomiting, dizziness or focal weaknesses. He denies any productive cough or chest pain. He had a fever 100.9 in the emergency department. Chest x-ray showed multi focal pneumonia, he received IV antibiotics per ED provider and currently admitted for further evaluation. He is currently requiring 3 L O2 via nasal cannula


VAERS ID: 1582960 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Aspirin 81 mg, atorvastatin 80 mg, clopidogrel 7 mg, insulin 70/30, metformin 1000 mg (twice daily)
Current Illness: N/A
Preexisting Conditions: Diabetes
Allergies: NKDA
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Vaccine was first punctured at 9:05 am, and vaccine for this patient was administered at 4:25 pm, 20 minutes past the 6 hour vaccination window. This mistake was later noticed by the provider who collected vaccines at the end of the day, and was investigated at 5:30 pm the same day. The patient has not reported any adverse effects, and the manufacturer was contacted for guidance.


VAERS ID: 1582982 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-04-13
Onset:2021-08-17
   Days after vaccination:126
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046B21A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: Anticoagulant Therapy, Bleeding Tendencies, CAD, CABG, Congestive Heart Failure, Chest Pain, Dizziness, DVT, Hypertension, Hyperlipidemia, MI and Stent(s)
Allergies: Quinapril, atenolol
Diagnostic Lab Data: Positive covid antigen 8/17/21
CDC Split Type:

Write-up: Hospitalized with covid after being fully vaccinated


VAERS ID: 1582989 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939902 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Asthenia, Chest discomfort, Chest pain, Fatigue, Feeling abnormal, Headache, Injection site pain, Insomnia, Lethargy, Malaise, Pain
SMQs:, Anaphylactic reaction (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Arthritis (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Synthroid 0.075mg, Paroxetine 10mg, Tylenol, Bendaryl (Diphenhydramine)
Current Illness: None
Preexisting Conditions: Wheat/Gluten due to Celiac Disease, Hashimotos Thyroiditis
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Around three hours post-vaccination, I developed a headache and arm pain at the injection site. As the afternoon progressed, the headache intensified and I became more tired and lethargic, and just not feeling well. Around 9 PM I laid down to try and go to sleep but the severe pain in my arm made it difficult. The pain radiated down to my elbow, up into my armpit, and across my chest. I experienced some chest tightness. The headache remained. All of my joints ached and were painful. I took an epsom salt bath and soaked. I took Tylenol and Bendryl to try and help me sleep. The next day, I feel drained, weak, lethargic, and tired. I still have a headache and don''t feel well. It has been over 24 hours since my injection and I still don''t feel like myself.


VAERS ID: 1583009 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / UNK - / -

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

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

Write-up: pt states numbness around vaccine site


VAERS ID: 1583019 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: South Dakota  
Vaccinated:2021-01-08
Onset:2021-08-17
   Days after vaccination:221
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3246 / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prozac, Levothyroxine, Zetia
Current Illness: none
Preexisting Conditions: HTN, hypothyroid
Allergies: Statins, Sulfa, hay fever, contact dermatits
Diagnostic Lab Data: Covid PCR test
CDC Split Type:

Write-up: 12/18/20 Covid Pfizer 1/8/21 Covid Pfizer 8/7-8/13 Travel to Montana, family reunion 8/12 + Covid exposure to Sister in law 8/17 ill, tested +Covid, PCR 8/28 potential to RTW


VAERS ID: 1583028 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Mississippi  
Vaccinated:2021-08-13
Onset:2021-08-17
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site erythema, Injection site nodule, Pain in extremity, Peripheral swelling, Swelling, Swelling face
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Patient contacted pharmacy on 8/17/21 in the afternoon concerned with arm soreness from Covid 19 Pfizer vaccine administered on 8/13/2021. Patient complained of a knot at the injection site along with some redness and soreness. I explained that this might be a normal injection site reaction, but to call us back if there were any changes or worsening of symptoms. Patient''s mother, called back today 8/18/21 and explained that the knot on patient''s arm was now the size of a lime, and that she had swelling up her arm into her neck, and the side of her face was swollen. She said she had taken a Benadryl. I instructed them to seek medical attention ASAP, and to call us with any updates. Patient''s mother also noted that the injection site seemed "low" on her arm.


VAERS ID: 1583032 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Headache, Vomiting
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? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None.
Allergies: None.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Dizziness, vomiting, severe headaches.


VAERS ID: 1583035 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-02-25
Onset:2021-08-17
   Days after vaccination:173
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, COVID-19, Cough, Fall, Mobility decreased, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Tendinopathies and ligament disorders (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: This is an 89-year-old gentleman with a history of CVA X as well as factor V Leiden mutation who presents to hospital after feeling very weak specifically he describes an episode where he felt that his legs were paralyzed. He sustained a fall he was on the ground for several hours. The patient has had some cough denies fevers chills headache sore throat dysphagia odynophagia chest pain shortness of breath abdominal pain nausea vomiting diarrhea. No melena hematemesis hematochezia no dysuria hematuria. The patient tested positive for COVID-19.


VAERS ID: 1583042 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-29
Onset:2021-08-17
   Days after vaccination:19
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad)

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

Write-up: pt called hospital call center to report side effects. Pt stated pt got covid vaccine Pfizer 7/29/2021 and pt got pain(pain score 8/10) on left arm injection site for 2 weeks in consistence. Noted no swelling or redness on injection site. Proceed covid vaccine side effects questions. Noted pt has no emergency s/sx at this time. Noted pt is taking Tylenol for pain. Pt is educated covid vaccine side effects. Pt requested to make appt with MD for consultations.


VAERS ID: 1583046 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: New York  
Vaccinated:2021-08-16
Onset:2021-08-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 3 LA / IM

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

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

Write-up: Systemic: Body Aches Generalized-Medium, Systemic: Chills-Medium, Systemic: Exhaustion / Lethargy-Medium, Systemic: Fever-Medium, Systemic: Headache-Medium


VAERS ID: 1583047 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-08-09
Onset:2021-08-17
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site erythema, Injection site reaction, Injection site swelling, Rash pruritic
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Itchy Rash, swelling, redness at injection site. Began as soon as I awoke on 8/17. Larger in size and shape and redness on 8/18.


VAERS ID: 1583057 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 053E21A / 3 LA / IM

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

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

Write-up: Error: Wrong Vaccine Formulation (ex. different manufact. initial and booster)-


VAERS ID: 1583072 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 053E21A / 3 LA / IM

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

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

Write-up: Error: Wrong Vaccine Formulation (ex. different manufact. initial and booster)-


VAERS ID: 1583076 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW1083 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cardiac flutter, Cough, Electrocardiogram normal, Hot flush, Nausea, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Tachyarrhythmia terms, nonspecific (narrow)

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: influenza
Other Medications: proventyl symbicort, lisinopril, singular, spirva
Current Illness: none
Preexisting Conditions: copd, migraines, asthma,
Allergies: latex, influenza, Asa, cipro, sulfa, citrus,
Diagnostic Lab Data: ekg , neg acute findings
CDC Split Type:

Write-up: coughing , nausia vomiting hot flash, heat fluttering., treated with EPi prednisone and benadryl


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