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

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



Case Details (Reverse Sorted by Onset Date)

This is page 128 out of 3,524

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VAERS ID: 1331550 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 1 LA / IM

Administered by: Work       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: n/a
CDC Split Type:

Write-up: Injected 0.5 ml instead of 0.3 ml IM


VAERS ID: 1331551 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / UNK RA / IM

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

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

Write-up: Patient discharged denied any adverse affects, was turning to walk out of event and fell to the floor. This was a witnessed fall, but he appeared to just bend at the knees and folded on to the floor without hitting head or losing total consciousness. Vital signs stable throughout observation, cool cloths applied to forehead and neck, feet elevated A & O xs 3 at all times. Within 15 minutes patient was placed in a sitting position, given fluids and a complex carbohydrate. Patient states he felt he was back at his baseline except for being tired. Patient remained for 45 minutes total, left with coworker with intent to return to supervisor and was going to go home. Walked patient to his vehicle, gait was steady, patients friend drove the vehicle. Pt advised to follow up with PCP if any symptoms return and to call 911 for an SOB, hives, chest pain or swelling of throat. Pt verbalize teaching.


VAERS ID: 1331554 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 4 LA / IM

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

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

Write-up: Patient received vaccine, less than 10 minutes later patient was laying on ground 7 feet from the pharmacy and did reported waking up on the ground


VAERS ID: 1331735 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Agitation, Blood glucose normal, Crying, Dizziness, Dizziness postural, Dyspnoea, Facial nerve disorder, Feeling abnormal, Hyperventilation, Hypoacusis, Rash, Vision blurred
SMQs:, Anaphylactic reaction (narrow), Asthma/bronchospasm (broad), Anticholinergic syndrome (narrow), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Glaucoma (broad), Cardiomyopathy (broad), Lens disorders (broad), Eosinophilic pneumonia (broad), Retinal disorders (broad), Depression (excl suicide and self injury) (broad), Hearing impairment (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? Yes
Hospitalized? No
Previous Vaccinations: unknown vaccine at age 13, pt c/o dizziness, self resolved.
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: 5/19/2021 1440: Pt VS stable, pulse in 83, BP(139/83), 99% on RA, RR 16, no respiratory distress, no s/sx anaphylaxis. 5/19/2021 1500: Pt VS stable, pulse in 88, BP(123/83), 99% on RA, RR 18, no respiratory distress, no s/sx anaphylaxis. 5/19/2021 1530: Pt VS stable, pulse in 83, BP(139/90), 99% on RA, RR 16, no respiratory distress, no s/sx anaphylaxis. 5/19/2021 1545: Pt VS stable, pulse in 82 BP(118/79), 99% on RA, RR 18, no respiratory distress, no s/sx anaphylaxis. 1600: Pt''s Blood Glucose 93
CDC Split Type:

Write-up: Pt received vaccine with mother present at 1419, c/o dizziness, lightheadedness, blurry vision, difficulty hearing, at 1439. Pt states she did not eat lunch. Nursing team intervened by taking vitals, placing wet towel on forehead, lying pt in supine position with legs elevated. Pt VS stable, pulse in 80s, BP(120s/80s), 99% on RA, RR 16-18, no respiratory distress, no s/sx anaphylaxis. Pt states she did not eat lunch. Gatorade offered to pt. Dizziness improves in supine position but returns upon sitting. At 1532 pt states she has facial numbness. EMS called at 1535. EMS arrived at 1557 and assessed pt. Pt?s BG is 93, VS stable. Pt reports feeling dazed, unable to focus, blurry vision and difficulty hearing. At 1602 EMS informed pt that they will take her to Medical Center, pt immediately got agitated and started crying and hyperventilating. 1604 pt stated she had difficulty breathing and a light localized rash began to appear on her chest. 1605 EMS transported pt. Pt?s mother to follow.


VAERS ID: 1331737 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: California  
Vaccinated:2021-04-21
Onset:2021-05-19
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007C21A / 1 LA / IM

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

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

Write-up: there was no actual adverse events. pt got the vaccine less than 18 years of age, they actually lied on the online questionnaire form and then came in for second shot and it was discovered the pt was to young and when confronted about how he made appointment he just changed his dob one year earlier to get the shot early.


VAERS ID: 1331739 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 1 LA / IM

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

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

Write-up: patient got 0.5 cc instead of 0.3 cc


VAERS ID: 1331743 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 1 LA / IM

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

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

Write-up: Syncope shortly after the shot


VAERS ID: 1331744 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 LA / SYR

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

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

Write-up: Patient had syncope-type reaction, chills, sweating, and passing out. Started around 12:35-12:40pm, lasted until 12:50pm after pharmacist intervention.


VAERS ID: 1331745 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009C21A / 1 RA / IM

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

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

Write-up: Patient?s dad brought patient in for vaccination. Patient is not 16 yet and received the Moderna vaccine. Does not have any symptoms or side effects. Just wanted to report.


VAERS ID: 1331747 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 1 LA / IM

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

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

Write-up: The patient briefly fainted about 7 minutes after getting the vaccine. EMS were called into the scene and the patient was fine.


VAERS ID: 1331757 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 1 LA / IM

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

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

Write-up: patient got 0.5 cc instead of 0.3cc


VAERS ID: 1331765 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 035C21A / 1 LA / IM

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

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

Write-up: Administered to unauthorized age group


VAERS ID: 1331766 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808986 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood glucose normal, Blood pressure abnormal, Dizziness, Hyperhidrosis, Snoring, Tremor, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

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

Write-up: Patient had sweating , snoring, dizziness, shaking , throwing up .we called 911, before the paramedic came in, he started to talk and be more aware about everything around. they checked his blood sugar was 152, blood pressure was above the normal. the paramedic kept talking to him and he was responding good. Patient refused to go to the hospital


VAERS ID: 1331770 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Immediate post-injection reaction, Injection site erythema, Rash papular, Vaccination site swelling
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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: History of eczema and overall sensitive skin since early childhood.
Allergies: Eggs, almonds, cashews
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Pt received vaccine in R arm at approx. 3:45 PM and was advised to wait in observation area for 30 minutes due to patient history of having multiple allergies. At approx. 4:15 PM pt alerted observation RN of a single isolated raised bump on R arm located approximately 4 inches away from vaccination site. Raised bump is noted to be 0.5 square inches large with surrounding redness. Pt denies any itchy, irritation, to the bump and otherwise reports no symptoms. Pt advised to stay in observation for an additional 15 minutes. 3 RN skin check of his chest, back, and abdomen revealed no other bumps or redness of any kind. Pt discharged at 4:35 in his mother''s care. Pt and pt''s mother advised to go to urgent care/emergency room in the event that any further reactions occur while at home.


VAERS ID: 1331772 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0175 / 1 LA / IM

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

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

Write-up: Patient fainted after standing up. Immediately came to, Bp was 146/76. Gave water, pt sat with feet up. After 35 minutes felt better, bp now 121/85. Pt left with father.


VAERS ID: 1331775 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 1 - / IM

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

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

Write-up: patient got 0.5 cc instead of 0.3 cc


VAERS ID: 1331781 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034C21A / 1 LA / IM

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

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

Write-up: Patient fainted after receiving vaccine. Patient said she had history of fainting with other vaccines and blood draws in the past. Patient fainted about 5 minutes after receiving vaccine. Patient fell off the post vaccine chair. Patient was coherent


VAERS ID: 1331789 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 1 LA / IM

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

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

Write-up: patient got 0.5 cc instead of 0.3 cc


VAERS ID: 1331791 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Florida  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Flushing, Speech disorder
SMQs:, Anaphylactic reaction (broad), Dementia (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Hypersensitivity (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: not sure
Current Illness: crohn disease
Preexisting Conditions: crohns
Allergies: no
Diagnostic Lab Data: EMS came and took patient to hospital
CDC Split Type:

Write-up: Patient stopped by stated he is planning a trip and that his doctor wants him to get Jansen vaccine . we I gave him the shot 20 minutes later he started showing flushing and difficulty talking.


VAERS ID: 1331797 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027C21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Ear pain, Hypoaesthesia, Muscle spasms, Seizure like phenomena, Tremor, Tunnel vision, Unresponsive to stimuli
SMQs:, Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Convulsions (narrow), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Optic nerve disorders (broad), Retinal disorders (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Patient experienced sharp ear pain, tunnel vision, numbness of the hands and face, muscle tensing and shaking, and mild seizure like behavior (she was unresponsive for 5 seconds and then came back to responsiveness) starting 2 hours after her vaccine. She was taken by ambulance to the ER.


VAERS ID: 1331799 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-05-18
Onset:2021-05-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / SYR

Administered by: Private       Purchased by: ?
Symptoms: Activated partial thromboplastin time shortened, Contusion, Full blood count, Platelet count decreased, Rash
SMQs:, Anaphylactic reaction (broad), Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (broad), Accidents and injuries (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (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: none
Current Illness: none
Preexisting Conditions: none
Allergies: NKDA
Diagnostic Lab Data: CBC- platelets 2 PTT- 55.6
CDC Split Type:

Write-up: PAtient had second Covid vaccine one day prior and presented to urgent care complaining of rash, easy bruising


VAERS ID: 1331808 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Maine  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Depressed level of consciousness, Feeling hot, Hyperhidrosis, Pallor, Speech disorder, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

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

Write-up: Upon administration of vaccine, patient became unresponsive with regards to decreased speech and alertness. Patient did not faint/pass out, but experienced sweating, feeling hot and pallor appearance. No treatment necessary as patient slowly regained responsiveness.


VAERS ID: 1331823 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Fatigue, Feeling cold, Hypoacusis, Vision blurred
SMQs:, Anticholinergic syndrome (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Hearing impairment (narrow), Vestibular disorders (broad), Hypoglycaemia (broad)

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

Write-up: Patient was waiting in the waiting area for 6 minutes after getting the pfizer covid vaccine when she started to feel like she was going to faint. Her mom was with her. Her mom had already given her a snack when I was notified. Pt stated her vision was blurry and her hearing was "like she was in a tunnel". She was feeling cold and was feeling scared of that feeling. I asked if I could apply a cold pack and asked her to rest the back of her head against the wall and to close her eyes. I applied the cold pack to her forehead and observed her. She started to sweat and was calmer. She was feeling better and her hearing and vision was back to normal. I had her wait for a total of 30 minutes and had my technician stay with her at that time. She was feeling better and I asked her mom to hang on to her while walking to their car. I followed up with the patient 4 hours later and she was doing well. She said she was feeling well and her arm was not even sore just some fatigue.


VAERS ID: 1331828 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN EE7938 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Product administered to patient of inappropriate age
SMQs:, Anticholinergic syndrome (broad), Vestibular 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: dizziness


VAERS ID: 1331835 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 1 LA / IM

Administered by: School       Purchased by: ?
Symptoms: Anxiety, Apnoeic attack, Bradycardia, Electrocardiogram normal, Malaise, Muscle rigidity
SMQs:, Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (narrow), Acute central respiratory depression (narrow), Respiratory failure (narrow), Hypoglycaemia (broad)

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

Write-up: 17 year old patient with no known allergies who was given 1st dose of Pfizer vaccine at 1655. At 1700 during observation patient mentioned to the mother that she was not feeling well, was slumped over. The RN on observation noticed that she was apneic, whole body was rigid. Vital signs at 1701: BP 153/88, HR: 64. Oxygen saturation 99%. After 5 minutes a recheck of the vital signs: BP 115/74, HR: 64. Oxygen 97%. Patient did state that she gets anxious when she gets shots.The paramedics were called. Vital signs on arrival: 117/83, HR: 58, Oxygen saturation 100%. Blood sugar 70. After a few minutes patient stated that she was feeling a little better. Patient was able to walk to the ambulance for them to perform an EKG: Results were normal sinus bradycardia.(Patient is an athlete). Patient''s mother declined further treated and signed AMA form.


VAERS ID: 1331992 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8730 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: intense itching and redness TDap and HPV vaccines do not know details of the vaccines or when given- were not administered by ou
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: no
Allergies: strawberries and bees
Diagnostic Lab Data:
CDC Split Type:

Write-up: Intense itching of the arm and shoulder. Started approximately 40 minutes after injection. Patient was given Benadryl 50mg and observed for an additional 40 minutes. No trouble breathing and no swelling occurred. Patient is following up with PCP.


VAERS ID: 1332006 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033B21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Dyspnoea, Hyperhidrosis, Nausea, Pallor
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: pcn
Diagnostic Lab Data:
CDC Split Type:

Write-up: patient was extremely pale, dizzy, heavy breathing, nausea, sweating


VAERS ID: 1332027 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 023C21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cerebral haemorrhage, Seizure
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (broad), Haemorrhagic central nervous system vascular conditions (narrow), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown.
Current Illness: Unknown, patient answered NO to question "Are you sick today?" on vaccine questionnaire.
Preexisting Conditions: Osteoporosis.
Allergies: Unknown, patient attested NO on vaccine questionnaire.
Diagnostic Lab Data:
CDC Split Type:

Write-up: After leaving pharmacy, patient experienced a seizure while riding as a passenger in a vehicle. Patient was hospitalized and diagnosed with a "Brain Bleed" according to mother.


VAERS ID: 1332034 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Delaware  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1820095 / 1 LA / SYR

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

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

Write-up: during 15 minute observation period after the vaccine, patient passed out briefly.


VAERS ID: 1332208 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 1 LA / IM

Administered by: School       Purchased by: ?
Symptoms: Skin warm
SMQs:

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

Write-up: Patient reported feeling hot, felt head and it felt hot to touch. Nurse on site was called to check BP -- which was 142/90 hr 101. pt was told to take off mask and relax and drink some water. After about 20-25 minutes, pt felt ok and BP was 124/83 hr 91. Patient was monitored longer and then sent home.


VAERS ID: 1332220 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 1 LA / IM

Administered by: School       Purchased by: ?
Symptoms: Hypotension, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

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

Write-up: patient fainted 5 minutes after receiving pfizer vaccine. became alert after 30 seconds. school nurse attended to patient and checked vitals - bp was low and final bp returned to levels within range after 30 minutes. mother took patient homE


VAERS ID: 1332222 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 1 LA / IM

Administered by: School       Purchased by: ?
Symptoms: Hypotension, Malaise, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Dehydration (broad), Hypokalaemia (broad)

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

Write-up: Five minutes after administration, patient''s father approached pharmacist and stated pt wasn''t feeling well. Upon approaching pt, patient threw up. Nurse was called and patient had low blood pressure. Patient was told to sit longer and then patient drank water and felt fine after 25-30 minutes.


VAERS ID: 1332226 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 1 RA / IM

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

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

Write-up: Dad came in with daughter (got his id), Pt and filled out consent form with dob (12 y.o) we gave 1st dose of pfizer and the vaccine was billed later, insurance came back with invalid dob, called ins and found out that they have her dob of exact date.


VAERS ID: 1332228 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 1 RA / IM

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

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

Write-up: patient fainted after receiving pfizer vaccine. became alert after 1 minute. school nurse attended to patient and checked vitals and mother took patient home after recovery within 15 minutes


VAERS ID: 1332231 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 RA / IM

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

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

Write-up: PATIENT PASSED OUT WITH EYES OPEN. SHE COULDN''T SEE ANYTHING FOR A FEW SECONDS. SHE CAME TO AND THEN ABOUT A MINUTE LATER, IT HAPPENED AGAIN. SHE WAS COMPLETELY PALE BUT CAME TO WITHIN A COUPLE OF SECONDS AND THEN FELT BETTER. WE DID CALL PARAMEDICS, WHO CHECKED HER HEART RATE AND BLOOD SUGAR. THEY DID NOT TRANSPORT HER.


VAERS ID: 1332238 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Balance disorder, Cold sweat, Immediate post-injection reaction, Impaired driving ability, Presyncope
SMQs:, Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Hypoglycaemia (broad)

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

Write-up: 3 minutes after injection patient started to stand up to get pharmacist''s attention and pharmacist looked over at patient and noticed patient was clammy and looking like he was going to fall over. Pharmacist told patient to sit back down and immediately grabbed e-kit and headed to patient''s side. Patient was clammy (like just got out of shower). At 3:45 PM BP was 128/63 and PR was 44. At 3:50 PM BP was 92/56 and PR 51, at this point RPh decided it was more than a vaso-vagal reaction and administered the epinephrine injection at 3:51 PM - EMS was called. At 3:52 PM BP was 130/76 and PR 59, 3:55 PM 134/86 PR 66, 3:58 PM BP was 148/83 and PR 68 at 3:59 PM EMS arrived and patient declined them taking him to hospital via ambulance due to no insurance. He had pharmacist escort him to his car so he could get his cell phone and back to pharmacy so he could call his son to pick him up and take him to the hospital. Unknown if patient ended up going to hospital.


VAERS ID: 1332241 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021C21A / 2 LA / IM

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

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

Write-up: minor client arrived for a second dose of Moderna, he had erroneously (underage) received the first dose of Moderna from Health Clinic. Site Lead RN escalated to Clinical Operations Coordinator to confirm that per CDC guidelines we would proceed and complete the COVID vaccination series for this minor 17yo. Client and his mother confirmed no medical illnesses or allergies and no adverse reactions from the first dose. Client also had no adverse reactions to the second dose during his 15min observation period. Client and his mother were educated on the CDC''s recommendations not to vaccinate minors under 18yo with Moderna, but the CDCs approval to proceed and complete the series.


VAERS ID: 1332243 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021C21A / 2 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039A21A / 1 UN / IM

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

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

Write-up: minor client arrived for a second dose of Moderna, he had erroneously (underage) received the first dose of Moderna from a Health Clinic. Site Lead RN escalated to Clinical Operations Coordinator to confirm that per CDC guidelines we would proceed and complete the COVID vaccination series for this minor 17yo. Client and his mother confirmed no medical illnesses or allergies and no adverse reactions from the first dose. Client also had no adverse reactions to the second dose during his 15min observation period. Client and his mother were educated on the CDC''s recommendations not to vaccinate minors under 18yo with Moderna, but the CDCs approval to proceed and complete the series.


VAERS ID: 1332245 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-05-18
Onset:2021-05-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Chest tightness


VAERS ID: 1332388 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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 FAINTED AFTER VACCINATION. PATIENT REGAINED CONSCIOUSNESS WITHIN 30 TO 60 SECONDS.


VAERS ID: 1332413 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: New York  
Vaccinated:2021-05-18
Onset:2021-05-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

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

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

Write-up: Fever exceeding 100?F even after taking tylenol, body aches, running nose, bedridden for over 20hrs up to now. Symptoms have still not subsided at time of report.


VAERS ID: 1332420 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036CZ1A / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Muscle spasms
SMQs:, Dystonia (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: muscle cramps pretty intense started at around 10:00p.m..


VAERS ID: 1332426 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-05-18
Onset:2021-05-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain upper, Erythema, Pain, Rash macular
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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: No
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None yet
CDC Split Type:

Write-up: On the next morning body pains big red painful marks all over her arm, stomach soreness


VAERS ID: 1332427 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-18
Onset:2021-05-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Rash, Swelling, Tenderness
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: Wellbutrin 300XL, acyclovir 400mg,
Current Illness: None
Preexisting Conditions: None
Allergies: Ketoconazone tablets
Diagnostic Lab Data:
CDC Split Type:

Write-up: Rash, bump feeling tender and swollen


VAERS ID: 1332430 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE AWARE OF
Current Illness: NO KNOWN ILLNESSES
Preexisting Conditions: NONE KNOWN
Allergies: NKDA
Diagnostic Lab Data: PARAMEDICS MONITORED PATIENT''S BLOOD PRESSURE AND PULSE
CDC Split Type:

Write-up: PATIENT FAINTED WITHIN 20 SECONDS OF RECEIVING PFIZER COVID-19 VACCINATION. PATIENT''S FATHER AND STORE MANAGEMENT CALLED 911. FATHER AND ADMINISTERING PHARMACIST MONITORED PATIENT; PATIENT REGAINED CONSCIOUSNESS SHORTLY AFTER FAINTING. PARAMEDICS ARRIVED APPROXIMATELY 10 MINUTES LATER AND FURTHER ATTENDED TO PATIENT. PARAMEDIC DIAGNOSED VASOVAGAL SYNCOPE. PATIENT AND FATHER WENT WITH AMBULANCE TO HOSPITAL FOR FURTHER EVALUATION.


VAERS ID: 1332433 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 023C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hyperhidrosis, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Hypoglycaemia (broad)

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

Write-up: Patient received Moderna COVID-19 vaccine dose 1. After Pharmacist administered vaccine, Patient stayed in waiting room for 15 minutes for observation. Patient was conscious but called Pharmacist over due to patient was shaking and sweating. The pharmacist monitored patient while Clerk called 911. Paramedics arrived and checked/monitored patient''s symptom and overall well being. Patient was taken to the emergency room. Pharmacist contacted Patient around 07:20pm but unable to reach. Pharmacist contacted Patient''s boyfriend who was present during shot. He stated that Patient was discharged two hours after and said Patient was doing well.


VAERS ID: 1332440 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Hawaii  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0171 / 1 RA / IM

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

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

Write-up: Patient fainted after vaccine administration. After lying down for 20 minutes, patient felt back to normal.


VAERS ID: 1332452 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-05-18
Onset:2021-05-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 2 RA / IM

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

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

Write-up: Fever, nausea, headache, fatigue, and chills. Treated symptoms with Benadryl and Tylenol


VAERS ID: 1332454 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chills, Influenza like illness, Nausea, Paraesthesia, Tremor
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypoglycaemia (broad)

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

Write-up: chills, prickling skin (like the flu), intense body tremors, ligth nausea


VAERS ID: 1332456 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-05-18
Onset:2021-05-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021C21A / 2 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Back pain, Food aversion, Headache, Musculoskeletal discomfort, Nausea, Pain, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Microgestin 1/20, Vyvanse, Guanfacine ER, Chelated Magnesium
Current Illness:
Preexisting Conditions:
Allergies: Sulfa, Penicillin, Cephalosporins
Diagnostic Lab Data:
CDC Split Type:

Write-up: - Nausea/Vomiting starting 10 hours after shot, lasting until 30 hours after shot. Did not respond to Nauzene or Pepto-bismol. Continue to have food aversion. - Extreme lower back and hip body aches (similar to severe period cramps) while not menstruating starting hour 18 and lasting until hour 32, mildly helped with Tylenol and heating pad. - Severe headache (though not a migraine) on entire left side of head, traveling down left side of neck starting at hour 18 and lasting until hour 30, mitigated with Tylenol.


VAERS ID: 1332653 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-05-12
Onset:2021-05-19
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Burning sensation, Dyspnoea, Neck pain, Nodule, Pain, Pain in extremity, Somnolence, Taste disorder, Tenderness, Throat clearing, Upper-airway cough syndrome
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Dementia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: 50000 Units of Vitamin D (Once a week)
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: None yet.
CDC Split Type:

Write-up: 5/12, 5/13 and 5/14 - Arm Pain, specially when trying to lift anything. 5/15, 5/16, 5/17 - noticed shortness of breath, very sleepy, throat clearing, heavy post nasal drip. Weird taste in mouth. 5/18 - Neck Pain 5/19 - Felt a small moving ball on top of the left side of my collarbone, closer to my throat, it is painful and tender to the touch. My neck feels in pain, actually more like a burning sensation


VAERS ID: 1332658 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA UNKNOWN / 2 RA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Adderall XR 20 MG Zyrtec
Current Illness: none
Preexisting Conditions: none
Allergies: Penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: within 1 hour after- arm soreness and fatigue 1 hour to 10 hours after- fatigue, progressive muscle soreness 15 hours after- fever, fatigue, muscle soreness, arm soreness, malaise


VAERS ID: 1332877 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prozac adapted all b12 probiotic flonase Allegra
Current Illness: None
Preexisting Conditions: None
Allergies: Outdoor seasonal allergies
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Horrible joint pains in all joints all night. Nausea.


VAERS ID: 1332879 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0170 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Adverse reaction, 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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Iron
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: n/a
Diagnostic Lab Data:
CDC Split Type:

Write-up: Client experienced a seizure reaction shortly after vaccine injection (2 mins.) for few seconds (5). Mother verbalized she always has that reaction after she shot. VS BP 95/66, P 90, O2Sat 100%. VS 114/73, P 90, O2Sat 100%. After 30 mins. of observation resident stated, "I am feeling great." Mom declined the need to go to the hospital. In stable condition, resident was send home.


VAERS ID: 1332982 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Fatigue, Flushing, Hyperhidrosis, Hypotension, Lethargy, Nausea
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypersensitivity (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (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: Systemic: Dizziness / Lightheadness-Severe, Systemic: Exhaustion / Lethargy-Severe, Systemic: Flushed / Sweating-Medium, Systemic: Hypotension-Medium, Systemic: Nausea-Severe


VAERS ID: 1332987 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 1 RA / IM

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

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

Write-up: PATIENT GIVEN 0.5 ML DOSE INSTEAD OF 0.3ML


VAERS ID: 1333178 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Hawaii  
Vaccinated:2021-05-15
Onset:2021-05-19
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Aspartate aminotransferase increased, Blood creatinine normal, Chest pain, Decreased appetite, Dizziness, Dry mouth, Feeling of body temperature change, Fibrin D dimer increased, Haematocrit normal, Liver function test normal, Lymphadenopathy, Malaise, Myocarditis, Nausea, Pain in extremity, Platelet count normal, Pyrexia, SARS-CoV-2 test negative, Sleep disorder, Troponin increased, White blood cell count normal
SMQs:, Liver related investigations, signs and symptoms (narrow), Acute pancreatitis (broad), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Dehydration (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: nkda
Diagnostic Lab Data: 05/19/2021: WBC 6.6, hct 42, plt 276. Scr 0.7. LFTs are normal except for an AST of 82. Troponin 17.2, which peaked at 19.4, now is down to 13. Ddimer 1089. COVID PCR negative
CDC Split Type:

Write-up: After having the shot, hedeveloped left arm pain and did develop some lymphadenopathy in his left axillary region. He was dealing with nausea and dizziness, and the following day, he went to work, although he was feeling a bit ill. While at work, he was found to have a fever, so he was sent home. He has been having hot and cold flashes since then. He has had a poor appetite. He has had a dry mouth and trouble sleeping. One day prior to admission, he then developed a chest pain that became constant and persisted, so he came into the emergency department on 05/19/2021 for further care. He has developed myocarditis after receiving the first of his Moderna Coronavirus Disease 19 vaccines.


VAERS ID: 1333185 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-05-18
Onset:2021-05-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 RA / SYR

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

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

Write-up: Following morning, fatigue, 100 degree temp, body chills, headache for 10 hours


VAERS ID: 1333194 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Cardiac monitoring, Malaise, Nausea, Pallor
SMQs:, Acute pancreatitis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: No known medications.
Current Illness: no known illnesses
Preexisting Conditions: no known health conditions other than allergies listed above
Allergies: walnuts, pecans, peanuts
Diagnostic Lab Data: unknown
CDC Split Type:

Write-up: Pt received vaccine...came out of vaccination room...sat down and started talking to mother...started to feel nauseous ? sat back and started to look limp...paramedics immediately contacted...pt never loss consciousness...looked pale... not feeling well...was responsive and breathing...respirations were being monitored...EMTs arrived and took over...did take pt to hospital...


VAERS ID: 1333213 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Amnesia, Drooling, Electrocardiogram, Loss of consciousness, Tremor, Unresponsive to stimuli, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Underweight BMI 0%ile
Allergies: NKDA/ NKA
Diagnostic Lab Data: EKG done at hospital records pending
CDC Split Type:

Write-up: Pfizer vaccine given 5/20/2021 Per mom/ pt the shot was given at 11:02 around 11:07 he leaned forward and became unresponsive. He was slightly drooling from the mouth. Mom says that his body was tight and that he was shaking a little. His eyes were closed and did not appear to be rolling back in his head. This episode lasted for less than 1 minute. He did not remember what happened and thought he wet himself after; which he did not. About 1-2 min after that episode mom states that he appeared to " passed out" for less than a minute. The ambulance was called and he was taken to hospital. He was evaluated and appeared well at that time. No fever. EKG was done and per pt it was normal. No EEG was done. He was discharged without admit That evening he has multiple episodes of vomiting $g 10 times. No diarrhea or fever. Seen today at medical office for follow up. Vaccine not given at our clinic


VAERS ID: 1333224 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: New York  
Vaccinated:2021-05-08
Onset:2021-05-19
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038C21A / 2 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Abdominal distension, Heavy menstrual bleeding
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

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

Write-up: Early menstrual cycle by 2 weeks. Heavy flow with cramping and bloating, during ovulation time. Normally have regular periods. Not on birth control. Flow started 12 days after 2nd dose.


VAERS ID: 1333226 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Idaho  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8736 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Cold sweat, Dizziness, Dry skin, Erythema, Hyperhidrosis, Injection site erythema
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Vestibular disorders (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Anphatmine salts (20 mg) - 1 a day for ADHD
Current Illness: None
Preexisting Conditions: Asthma Gillian-Barre
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Redness on arms after injection, light-headed Vital Signs: BP 120/84 HR 107 Resp 16 O2Sat 97% Skin Signs: Cool and dry, clammy, diaphoretic Circulation: Cap refill <2sec 1sec Respiratory: Breath sound clear bilaterally Initial Treatment: Vitals taken. Patient felt better after given juice and sitting down. 4:09 PM Vital Signs: BP 110/80 HR 107 O2Sat 99% Notes: Patient heart rate was still over 100 bpm. Other vitals were in good range. Cheeks still rosy with potential rash. Follow up with provider recommended. Parent provided CDC link with information regarding hx of GBS and safety of receiving COVID19 vaccine. Patient discharged home with parent.


VAERS ID: 1333227 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 1 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Amnesia, Blood pressure decreased, Fatigue, Flushing, Nausea, Presyncope, Seizure
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Dementia (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (broad), Hypoglycaemia (broad), Dehydration (broad)

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

Write-up: The patient had a Vasovagal response. She had a 15 second seizure ,blood pressure dropped, was flush, tired and nauseated. She has no memory of the event.


VAERS ID: 1333236 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lexapro 20mg, D3 2000mg, Flintstones Multi-vitamin.
Current Illness:
Preexisting Conditions: Depression/Anxiety
Allergies: sensitivity to Red Dye #40
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Itchy rash on right side chest. Treated with over-the-counter Cortizone, no signs of rash the following morning.


VAERS ID: 1333256 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-05-16
Onset:2021-05-19
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Memory impairment
SMQs:, Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Depression (excl suicide and self injury) (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient made appointment, came in, answered all questions on VAR form as her first dose. No records in our systems of any previous vaccine and verbally verified with patient prior to giving vaccine. We were notified by a family member after the fact that the patient had already received her Pfizer series earlier in the year and that patient is forgetful. Family reported three days post vaccine that patient was hospitalized


VAERS ID: 1333257 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048B21A / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Burning sensation, Muscle twitching, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Dyskinesia (broad), Dystonia (broad), Guillain-Barre 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: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: penicillins
Diagnostic Lab Data: Went to seek medical attention. Was told possibly touched a nerve. Gave a steroid shot. I called patient the next day, patient is doing much better.
CDC Split Type:

Write-up: Burning, tingling down the right arm immediately. After a few hours, involuntary twitching of same arm.


VAERS ID: 1333260 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-18
Onset:2021-05-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: Day after vaccine patient had chills and body aches. Patient also noticed arm swelling, redness, and warmth at the injection site that has persisted.


VAERS ID: 1333262 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-03-31
Onset:2021-05-19
   Days after vaccination:49
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH NA / 1 - / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH NA / 2 - / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Chills, Nausea, Pyrexia, SARS-CoV-2 test positive
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: Client admitted to Medical Center on 5/19/2021 due to fever, chills, and nausea. Covid plus admitted for further assessment.


VAERS ID: 1333264 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020B21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Dysgeusia, Fatigue, Feeling abnormal, Headache, Myalgia, Nausea, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Dementia (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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? 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: Starting with slight muscle aches, general blah feeling. at 1 am running fever, aches in joints and muscles. Next day (currently) some nausia, joint and muscle aches, headache, bad taste in mouth, tired.


VAERS ID: 1333268 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Idaho  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8736 / 1 LA / IM

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

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

Write-up: Patient received COVID19 vaccination and within 30 seconds experienced nausea and vomiting 2:03 PM Vital Signs: BP 104/62 HR 77 Resp 16 O2Sat 92% Skin Signs: Warm and dry Circulation: Cap refill <2sec Respiratory: Breath sound clear bilaterally Initial Treatment: Patient monitored, Nausea resolved. Provided water 2:18 PM Vital Signs: BP 108/71 HR 71 Resp 16 O2Sat 97 Skin Signs: Warm and dry Circulation: Cap refill <1sec Respiratory: Breath sound clear bilaterally BP 120/84 HR 87 Resp 17 O2Sat 99 Skin Signs: Warm and dry Circulation: Cap refill <1sec Notes: Patient advised to follow up with medical provider if other symptoms occur. Patient released with parent. Patient and parent instructed to keep well hydrated and to re-introduce food initially as per a BRAT diet.


VAERS ID: 1333283 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fall, Head injury, Heart rate increased, Hypotension, Seizure, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

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

Write-up: While waiting for 15 mins monitoring after getting Pfizer covid vaccine, she fainted and fell off the chair. She fell on the ground and hit her head. Nurse and pharmacy staff rushed to her aid. She appeared to have convulsions for about a couple seconds but regained conciousness right away. We checked vital signs : low blood pressure but high heart rate, oxygen level was good. We placed ice pack on her head where said was hurting. She and her mother refused to call 911. She felt better, however we recommended her mom to take her to urgent care for further evaluations


VAERS ID: 1333284 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Exposure during pregnancy, Hyperhidrosis
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Hypoglycaemia (broad)

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

Write-up: pt dizziness/ sweating BP: 78/46 Pulse 78 o2SAT 99% Advised patient to drink water and lay down. Patient stated her baseline BP is 100/58 or 110/60 BP: checked after 15 minutes 104/64 pulse 80 Patient recovered from adverse effects. Advised oatient to consult with her gynecologist before second shot regarding symptoms. Est, Expected date of delivery is 6/15/2021. #21 left for home


VAERS ID: 1333305 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-05-18
Onset:2021-05-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Unknown       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? 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: 30 hours after vaccine had a generalized siezure


VAERS ID: 1333316 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-05-18
Onset:2021-05-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8736 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Back pain, Chills, Fatigue, Headache, Injection site pain, Neck pain, Night sweats, Pain
SMQs:, Retroperitoneal fibrosis (broad), Extravasation events (injections, infusions and implants) (broad), Arthritis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Synthroid, Trintellix, Hydralazine, Diltiazem 24H ER(LA), Montelukast, Bupropion, Cetirizine HCI and Biotin.
Current Illness: N/A
Preexisting Conditions: Asthma, High blood pressure, depression, anxiety, and thyroid cancer (had a thyroidectomy).
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Full body chills, extreme body aches (specifically in back, neck and joints), site injection soreness, headache, night sweats and fatigue. Symptoms got better with 800 mg ibuprofen, but returned. Woke up 2nd day with same symptoms. Treated again with 800 mg ibuprofen. Reporting this on Day 2.


VAERS ID: 1333318 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: Idaho  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8736 / 1 LA / IM

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

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

Write-up: Syncopal Episode Vital Signs: BP 92/64 HR 60 Resp 14 O2Sat 98% Skin Signs: Clammy, diaphoretic Circulation: Cap refill 4-5 sec Respiratory: Breath sound clear bilaterally Initial Treatment: Patient received vaccine, fell to syncope - responsive after 5 seconds. Patient hit concrete floor with a loud sound. Patient awake after 5 seconds. A/Ox5 Patient moved to L lateral position with manual spinal check. 11:50 AM Vital Signs: BP 99/60 HR 78 Resp 18 O2Sat 97% Skin Signs: Diaphoretic Circulation: Cap refill <2sec Respiratory: Breath sound clear bilaterally Follow up Treatment: EMS on scene. Patient assessed by EMS. Spine cleared by EMS. Patient moved to superior posterior. Patient refused further transport to hospital. 12:00 PM Patient discharged home, escorted by EMS and significant other.


VAERS ID: 1333319 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Patient stated she has not eaten since breakfast earlier that morning.
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received vaccine and while walking around the store began to feel lightheaded/dizzy and fainted. Her parent caught her and brought her to the ground where she began to have a seizure. Paramedics were called and took over care of the patient. She was conscious and breathing after her seizure


VAERS ID: 1333332 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO183/PUBLIC / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Pruritus, 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NO RECENT ILLNESS AT TIME VACCINATED, NOT SICK IN THE LAST MONTH
Preexisting Conditions: ADHD, COUGH VARIANT ASTHMA, HYPERCHOLESTEROLANEMIA, VIT. D DEFICIENCY, ARTHRITIS, CHRONIC RHINITIS, IMMUNOGLOBULIN A VASCULITIS
Allergies: NKDA, NO KNOWN FOOD ALLERGIES
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: 8PM PT. STARTED BREAKING OUT WITH HIVES, HAVING SEVERE ITCHING, CALL PLACE TO OFFICE (OFFICE HOURS CLOSED) S/W DR., ADVISED TO MEDICATE WITH BENADRYL. ONLY HAD TO BE MEDICATED ONCE.


VAERS ID: 1333334 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-05-18
Onset:2021-05-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039B21A / 1 LA / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037C21A / 2 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: 103 fever, severe headache and chills, body ache, fatigue, nausea and dizziness.


VAERS ID: 1333335 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033B21A / 2 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, Cough, Fatigue, Pain in extremity, Rhinorrhoea, Sneezing
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: 1st night: mild cough, sneezing, runny nose, tiredness, sore arm and shoulder. - Slept all day. 2nd day: sneezing, runny nose, sore arm.


VAERS ID: 1333337 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0175 / 2 RA / IM

Administered by: Military       Purchased by: ?
Symptoms: Cough, Dizziness, Fatigue, Headache, Nasal congestion, Oropharyngeal pain
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Vestibular 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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Sinus congestion/sore throat/cough/headache/fatigue/lightheadedness 2 hrs post vaccine. Given supportive medication to manage symptoms


VAERS ID: 1333350 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Idaho  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8736 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Headache, Vital signs measurement
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: Zoloft
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: C/O dizziness and headache Vital Signs: BP 119/79 HR 66 Resp 15 O2Sat 98% Skin Signs: Warm and dry Circulation: Cap refill <2sec Initial Treatment: Patient sitting on floor and continues to C/O dizziness. No increase in S/S Notes: Parents instructed to follow up with PCP and to seek medical care if symptoms increase. Parents verbalized understanding. Home with parents.


VAERS ID: 1333368 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 2 LA / IM

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

Write-up: at 2:55pm pt. c/o dizziness and lightheadedness. pt assisted to gurney and placed in supine position with BLE elevated. pt offered fluids vs monitored vitals t-97.7 BP: 93/68 RR-17 o2 SAT 99%RA. pt reported hx of dizziness with needlestick. vitals- BP: 90/68 P-73 RR-19 o2 SAT 99%RA patient verbalized relief from symptoms noted with no dizziness an light headedness as reported by pt. zero change LOC Zero SOB alert and verbally responsive.


VAERS ID: 1333379 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-18
Onset:2021-05-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Chills, Injection site erythema, Injection site warmth, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: At 11:45 AM the day following my Vaccination, I began having chills. Then I had 102 degree fever. This last for roughly 24 hours. I has have heat and redness at the injection site.


VAERS ID: 1333410 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Alaska  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038B21A / 2 - / -

Administered by: Other       Purchased by: ?
Symptoms: Chest discomfort, Dyspnoea
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)

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

Write-up: Difficulty breathing and tightness in chest after 2nd dose Moderna. Resolved after 15 minutes.


VAERS ID: 1333419 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-05-18
Onset:2021-05-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027C21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site erythema, Injection site pain, Injection site swelling, Injection site warmth, Lymph node pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (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: Flu shot when I was 17 gave me a fever and body aches
Other Medications: Vit C, D, Quercitin, NAC, Methyl B-12
Current Illness: No
Preexisting Conditions: Anxiety
Allergies: No
Diagnostic Lab Data:
CDC Split Type:

Write-up: "Covid arm" My left upper arm has a swollen, red, hot, tender patch and my left underarm is sensitive


VAERS ID: 1333424 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 1 LA / IM

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

Write-up: at 3:43pm pt. reported dizziness. pt. placed assisted in gurney and placed in supine position. with BLE. elvauated vitals monitored pt was given fluids and snacks as requetsed Vitals BP 119/72 P-73 RR-18, o2 SAT 99% RA @4pm vitals BP 101/68 P-68 - RR-17 o2 SAT 99%RA


VAERS ID: 1333431 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

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

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

Write-up: Patient, is a 17 y/o male that received his first dose of Moderna vaccine. Pts. mother, incorrectly registered the pt under the incorrect DOB. Pts. card has Moderna written on the car window sent from registration. The tech, checked pt in and confirmed directly with the pt his DOB. Pt states, "yes, my DOB is" After being vaccinated by, RN, the vaccination card was handed back to the mother by. Pt mother states, "the DOB on the vaccination card is incorrect, pts DOB is", I told registration to correct it from the beginning." The pts. DOB was corrected in the system by the tech, after the incident occurred. Dr. was contacted and informed of the situation. Pt did not have any adverse reactions after waiting in observation for 15 mins. Pt is alert and oriented x4. Pt is walking and talking independently. VAERS report was completed and submitted.


VAERS ID: 1333447 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-05-18
Onset:2021-05-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Musculoskeletal stiffness, Peripheral swelling
SMQs:, Cardiac failure (broad), Angioedema (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (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: n/a
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: latex
Diagnostic Lab Data:
CDC Split Type:

Write-up: patient came in complaining of swollen hand and cant move fingers


VAERS ID: 1333462 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 1 RA / SC

Administered by: Public       Purchased by: ?
Symptoms: Paraesthesia, Tremor
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (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: Vit. C
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: n/a
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient complained of tingling all over the body and shakiness. 30 observation performed. VS BP 148/70, P 80, O2Sat 98%. Patient verbalized relief of symptoms after sit down calmly and performed deep breathing.


VAERS ID: 1333468 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025C21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? 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: Systemic: Fainting / Unresponsive-Medium, Additional Details: Pt received first dose of vaccine and had a syncopal episode within 5 minutes of the event. Serial vitals were taken by this NP and she was initially hypotensive in the systolic 90''s, but after 30 minutes had returned to 122/72. Durring the event the patient fell and sustained an abrasion to her left forearm and cheek. A full neuro exam was conducted after the event (normal) and the patient was instructed to have someone pick her up to transport her home and to follow up with her PCP.


VAERS ID: 1333470 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 1 RA / IM

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

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

Write-up: patient was given 0.5 ml instead of 0.3 ml


VAERS ID: 1333471 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Fatigue, Flushing, Hyperhidrosis, Lethargy, 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-Medium, Systemic: Exhaustion / Lethargy-Medium, Systemic: Fainting / Unresponsive-Medium, Systemic: Flushed / Sweating-Medium


VAERS ID: 1333474 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041C21A / 1 RA / IM

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

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

Write-up: Site: Swelling at Injection Site-Mild


VAERS ID: 1333476 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Hypoaesthesia, Injection site pain, Nausea, Pain, Paraesthesia
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)

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

Write-up: Site: Pain at Injection Site-Mild, Systemic: Dizziness / Lightheadness-Mild, Systemic: Nausea-Mild, Systemic: Numbness (specify: facial area, extremities)-Mild, Systemic: Tingling (specify: facial area, extemities)-Mild, Additional Details: pt felt nauseous and sharp pain . nauseous. kept moving arm and water and breaths. pt felt fine after sitting for 30 min.


VAERS ID: 1333481 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 1 LA / IM

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

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

Write-up: patient was given 0.5 ml instead of 0.3 ml


VAERS ID: 1333484 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Dysphagia, Flushing, Hyperhidrosis, Nausea, Paraesthesia, Throat tightness
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypersensitivity (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Allergic: Difficulty Swallowing, Throat Tightness-Medium, Systemic: Dizziness / Lightheadness-Medium, Systemic: Flushed / Sweating-Medium, Systemic: Nausea-Medium, Systemic: Tingling (specify: facial area, extemities)-Medium, Additional Details: tingling in fingers


VAERS ID: 1333485 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-01-19
Onset:2021-05-19
   Days after vaccination:120
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Confusional state, Contusion, Dizziness, Fall, Flushing, Head injury, Hyperhidrosis, Pallor, Syncope, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), 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), Accidents and injuries (narrow), 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: Confusion-Mild, Systemic: Dizziness / Lightheadness-Mild, Systemic: Fainting / Unresponsive-Mild, Systemic: Flushed / Sweating-Mild, Systemic: Weakness-Mild, Additional Details: PATIENT FELL OFF CHAIR AFTER HE GOT HIS PFIZER COVID VACCINE AND HIT HIS HEAD ON BOARD. HE DEVELOPED A BRUISE ON FOREHEAD. PATIENT LOOKED PALE. PHARMACY TECHNICIAN GAVE HIM SOME WATER AND TARGET STAFF APPLIED ICE PAK ON FOREHEAD AND OFFERED HIM SOMETHING TO EAT


VAERS ID: 1333486 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 1 RA / IM

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

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

Write-up: patient was given 0.5 ml instead of 0.3 ml


VAERS ID: 1333487 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0174 / 1 LA / IM

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

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

Write-up: BP 102/60, P 70, O2Sat 98%. As client walking to the observation room he passed out for a few seconds. Complained of dizziness. Assisted with ENT to observation. Stabilized after few minutes.


VAERS ID: 1333489 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anxiety, Dizziness, Heart rate increased, Hypotension, Nausea, Tachycardia
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

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

Write-up: Systemic: Dizziness / Lightheadness-Mild, Systemic: Hypotension-Medium, Systemic: Nausea-Mild, Systemic: Tachycardia-Mild, Additional Details: anxiety related episode, low bp high pulse, complained of symptoms of nausea, lightheadedness at 6:10pm, 1st bp: 100/61 pulse 103 at 6:14pm, 2nd bp:120/75 pulse 97 at 6:21pm, 3rd bp:116/82 pulse 102at 6:35pm, monitored pt for 30 minutes, left at 6:36pm with boyfriend advised not to drive


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