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From the 10/15/2021 release of VAERS data:

Found 800,916 cases where Vaccine is COVID19 and Patient Did Not Die



Case Details (Reverse Sorted by Onset Date)

This is page 13 out of 8,010

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VAERS ID: 1775011 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-10-08
Onset:2021-10-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Fatigue, Headache, Injection site pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: diverticulitis
Preexisting Conditions: diverticulitis, BMI=30, borderline diabetic
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: moderate headache, fever (100.1F), joint aches, and fatigue, soreness at site of injection


VAERS ID: 1775022 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-10-04
Onset:2021-10-09
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 1 RA / IM

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

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

Write-up: Patient was given 3rd dose COVID booster 1 month before scheduled time.


VAERS ID: 1775027 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-10-05
Onset:2021-10-09
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Chest pain, Chills, Decreased appetite, Discomfort, Headache, Hyperhidrosis, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Centrum multivitamin, Fish Oil, Finasteride, Htp-5
Current Illness: N/a
Preexisting Conditions: N/a
Allergies: Gluten
Diagnostic Lab Data:
CDC Split Type:

Write-up: Chest pain, sweating, discomfort. Began decrease after ibuprofen and 3hrs. Also, day 2&3 after second dose had fever (100-101.2 peak), aches, chills, shivering, sore, reduced appetite, headache. These all subsided in the 12-18hrs before the onset on chest pain.


VAERS ID: 1775035 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-10-08
Onset:2021-10-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / UNK RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Illness, Influenza like illness, Vaccine positive rechallenge
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: Illness, flu-like symptoms - 2nd Pfizer dosage 3/23/2021
Other Medications: None
Current Illness: None
Preexisting Conditions: Arthritis, diabetes
Allergies: None
Diagnostic Lab Data: None to date
CDC Split Type:

Write-up: very ill with flu-like symptoms


VAERS ID: 1775043 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-10-09
Onset:2021-10-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Headache, Immediate post-injection reaction, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (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: Patient stated that she had such reaction in the past to vaccine
Other Medications: None per Patient
Current Illness: None per Patient
Preexisting Conditions: None per Patient
Allergies: NKDA
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Immediately Patient got her shot, she fainted. Patient laid on the floor immediately with both legs elevated, she gained consciousness right away and was able to state her name and DOB, etc. Vital signs within normal limit-122/78, 99% 02 on room air, 94 HR, 18 RR, 98.Temp. Pt was monitored for 30mins, she feels fine other than slight headache, mom was instructed to give Patient Tylenol as prescribed for age-she verbalized understanding. Mom and Patient was also educated on possible side effect of vaccine, how to treat side effect and when to call 911-They both verbalize understanding


VAERS ID: 1775057 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-29
Onset:2021-10-09
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Eye irritation, Lip swelling, Oral discomfort, Paraesthesia, Paraesthesia oral, Swelling face, Throat irritation
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Corneal disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Swelling of lips and face. Tingling and burning of eyes, face, lips and throat.


VAERS ID: 1775068 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Maine  
Vaccinated:2021-10-09
Onset:2021-10-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 212A21A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Moderna Covid 19 vaccine
Other Medications: epi, alprazolam, Vyvanse
Current Illness: asthma
Preexisting Conditions: asthma
Allergies: Moderna COVID-19 vaccine, dilaudid
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient had adverse reaction to Moderna COVID-19 vaccine. Pt. was advised by PCP to take J&J. Given today = similar reaction, needed epi transported to local ER via EMS.


VAERS ID: 1775070 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: New York  
Vaccinated:2021-10-02
Onset:2021-10-09
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 212A21A / UNK LA / IM

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

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

Write-up: Subject is a 32 y/o male who approx. 5 minutes after receiving Johnson & Johnson vaccine experienced Grand Mal seizure activity lasting approx. 30 seconds.


VAERS ID: 1775083 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-10-09
Onset:2021-10-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 3 LA / IM
FLU4: INFLUENZA (SEASONAL) (AFLURIA QUADRIVALENT) / SEQIRUS, INC. P100352329 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Eye movement disorder, Fall, Loss of consciousness, Musculoskeletal stiffness
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Arthritis (broad), Hypoglycaemia (broad)

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

Write-up: Patient stated she was "feeling dizzy and felt like passing out" after receiving the Afluria vaccine as her Pfizer vaccine was administered. She started with rapid eye roll, lost consciousness, stiff movement of arms and legs, and fell backwards on head. 911 was called and she was taken to hospital


VAERS ID: 1775094 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Nebraska  
Vaccinated:2021-10-09
Onset:2021-10-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Seizure. Pharmacist told us it was normal and when she felt better, we could leave.


VAERS ID: 1775115 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-10-08
Onset:2021-10-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 11822811 / 1 LA / IM

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

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

Write-up: PATIENT''S REPRESENTATIVE REPORTS NAUSEA, VOMITTING, FATIGUE THAT BEGAN WITHIN 24 HOURS OF RECEIVING VACCINE DOSE.


VAERS ID: 1775136 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-10-09
Onset:2021-10-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF3590 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Dyspnoea
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Vestibular disorders (broad)

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

Write-up: After received the shot about 5 min later patient start to have dizziness and hard time of breathing. We called the paramedics and paramedic took patient after accessment


VAERS ID: 1775140 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-10-09
Onset:2021-10-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2590 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: metformin
Current Illness:
Preexisting Conditions: diabetes type 2
Allergies: shrimp, cats, dogs
Diagnostic Lab Data: unknown
CDC Split Type:

Write-up: Patient reported feeling dizzy, light headed and a feeling of pins and needles after his first covid pfizer vaccine. His blood pressure was monitored and readings were as follows: approx 30 min after vaccine 149/92 hr 69, 2:00pm 148/85 HR 67, 205pm 162/105 HR 74 208pm 166/94 HR 71. 1 dose of Epinephrine autoinjector 0.3mg was given at 210pm. 212pm: 154/85 HR 71, 216pm 145/86 HR 86 EMS was called at 2:10pm after epeneprine. EMS arrived and transported patient to hospital


VAERS ID: 1775148 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-10-09
Onset:2021-10-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048F21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: influenza vaccine-hives
Other Medications:
Current Illness:
Preexisting Conditions: history of seizures
Allergies: patient stated she was allergic to flu vaccine and it caused hives.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient passed out and was unresponsive. She was breathing and had heart rate. Epinephrine was administered. Patient became coherrent. EMS transported patient to hospital for evaluation


VAERS ID: 1775164 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-10-08
Onset:2021-10-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30130BA / 2 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Blood glucose increased, Dizziness
SMQs:, Hyperglycaemia/new onset diabetes mellitus (narrow), 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: high sugar 400,57,9-7-21,pfizer vaccine
Other Medications: metformin, labetalol, aspirin, vitamin D3
Current Illness: Diabetes
Preexisting Conditions:
Allergies: chlorohexidine , Iodine
Diagnostic Lab Data: sugar extremely high 300
CDC Split Type:

Write-up: I woke up with dizziness - huge dizziness also, my sugar was extremely high in the 300


VAERS ID: 1775165 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-10-09
Onset:2021-10-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: no
Preexisting Conditions: not available
Allergies: no
Diagnostic Lab Data: none
CDC Split Type:

Write-up: seizure for 10-20 seconds right the the shot


VAERS ID: 1775168 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-09
Onset:2021-10-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Patient developed hives on arms and hands minutes after immunization. Treated with diphehydarmine and began to improve.


VAERS ID: 1775171 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: New York  
Vaccinated:2021-10-09
Onset:2021-10-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Presyncope, Vision blurred
SMQs:, Anticholinergic syndrome (broad), Glaucoma (broad), Lens disorders (broad), Retinal 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: Multi-vitamin
Current Illness: None
Preexisting Conditions: GI problems
Allergies: None
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Near Syncope, Blurry Vision


VAERS ID: 1775173 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-10-08
Onset:2021-10-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8737 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: she had a cold that ended approximately 2 weeks prior
Preexisting Conditions: none
Allergies: only to pollen and other unknown...somewhat severe
Diagnostic Lab Data: none yet
CDC Split Type:

Write-up: severe headache, fever of 103


VAERS ID: 1775176 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-10-09
Onset:2021-10-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 320308D / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Loss of consciousness, Pain in extremity
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), 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Clindamycin/BPO gel topical
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: unknown result but was awake and stable. believed to be transported out of caution
CDC Split Type:

Write-up: Patient was given vaccination as usual and vaccine was confirmed and accurate. No previous reactions were reported prior to administration. Patient expressed the vaccine hurt more on her arm that dose 1 as she was returing to her mother in the waiting area. She began to state she was passing out as she reached her chair in which her mother was attending to her and had her in chair safe. Pharmacist was alerted immediately and patient was moving and responsive when he arrived but past out shortly after arrival. technician retrieved blanket and bottle of water as patient was safely lowered to ground by pharmacist and mother after assessing she was safe but unconscious. patient was responsive to name and mom state


VAERS ID: 1775177 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-09
Onset:2021-10-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 053E21A / 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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None stated.
Current Illness: none stated
Preexisting Conditions: None stated
Allergies: penicillin V
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Patient was given 1st dose of Moderna vaccine, Lvn supervisor Monitored patient for 45 minutes after injection in lobby. no side effects noted. Supervisor informed mother of vaccine administration and will follow up in the upcoming days and set up a follow up appt. with PCP. Informed mother if patient begins to have any adverse reactions to the vaccine do not hesitate to go to urgent care or local hospital.


VAERS ID: 1775181 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-10-09
Onset:2021-10-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Injection site pruritus, Injection site swelling
SMQs:, Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (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: 10/09/21 BP 138/79 PULSE 67
CDC Split Type:

Write-up: AFTER 15 MINUTE WAITING PERIOD PATIENT STATED HER ARM FELT VERY ITCHY AND LIKE IT WAS SWELLING, ALSO FELT A LITTLE LIGHT HEADED. GAVE 25MG BENADRYL AND MONITORED ADDITIONAL 30 MINUTES. TOOK BLOOD PRESSURE, PULSE, AND HAD PATIENT STAND WITH ME PRIOR TO LEAVING. BP AND PULSE NORMAL, PATIENT COHERENT AND ABLE TO STAND WITHOUT DIZZINESS, LIGHTHEADED, OR FAINTING.


VAERS ID: 1775182 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-10-09
Onset:2021-10-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 2 LA / IM

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

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

Write-up: Patient had a allergic reaction to her 2nd Pfizer vaccine. She experienced ichiness all over her hand, arm, back and stomach.


VAERS ID: 1775186 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-10-09
Onset:2021-10-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30155BA / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Dizziness, Malaise, Seizure, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

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

Write-up: patient started feeling light-headed after receiving the shot, she said she was fine at first and went to observation chair to sit. after 5 minutes, she did not feel better and laying down to the ground saying she feeling dizzy. pharmacist on duty came to check her and she said she didnt feel very well. after saying that, she went into seizure for 5-6 seconds. patient did not respond to her mom calling her. when she regained consciousness, she had no recollection of the event. pharmacist on duty, patient''s mom and another customer also witnessed the event. 911 was called and arrived on scene. patient felt weak and could not walk so she was taken to ER to further evaluate. No family history of seizure confirmed with the mom.


VAERS ID: 1775192 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-10-08
Onset:2021-10-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 3 LA / SYR

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

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

Write-up: Swelling, pain, red lump at injection site


VAERS ID: 1775196 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-10-09
Onset:2021-10-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034C21A / 1 LA / IM

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

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

Write-up: None yet


VAERS ID: 1775197 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-10-08
Onset:2021-10-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chills, Extra dose administered, Headache, Lethargy, Nausea, Pain, Pyrexia
SMQs:, 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), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Body aches, headache, chills, nausea, lethargy, Low grade fever (100.2 oral)


VAERS ID: 1775200 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-10-09
Onset:2021-10-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1820096 / 1 - / -

Administered by: Work       Purchased by: ?
Symptoms: Device connection issue, Syringe issue, Underdose
SMQs:, Medication errors (broad)

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

Write-up: The Leur lock on the needle was not tightened and the needle detached from the syringe during administration and part of the dose was lost.


VAERS ID: 1775204 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-10-09
Onset:2021-10-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034C21A / UNK - / -

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

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

Write-up: Patient was given vaccine under age approved


VAERS ID: 1775205 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: California  
Vaccinated:2021-10-09
Onset:2021-10-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822809 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: CA134B1001

Write-up: Medication Error: Patient disclosed he received AstraZeneca dose while in the recovery area, after he received the Johnson and Johnson vaccine. Patient educated that there is no current recommendations for booster of AstraZeneca or Johnson and Johnson. After 15 minute recovery, patient advised to monitor for any reactions and to follow up with doctor.


VAERS ID: 1775211 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-09
Onset:2021-10-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Hypoaesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Sexual dysfunction (broad)

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

Write-up: At 12:54 pm 40 year old female patient stated she felt left side face numbness. Vital signs, b/p: 149/90, p: 113, o2: 96%, R: 20. Monitored and patient did not complain and further symptoms, but per unit manager to call emergency services to get transferred to hospital for evaluation.


VAERS ID: 1775212 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-10-08
Onset:2021-10-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH PFIZERFF2590 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Decreased appetite, Fatigue, Headache, Injection site pain, Malaise, Nausea
SMQs:, Acute pancreatitis (broad), Extravasation events (injections, infusions and implants) (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: IC Famotidine, Digest Gold, Quercetin, super Acerola Plus-500 my vitamin C, D3-1000 mg, Acetaminophen-500mg twice a day
Current Illness: Sinus dilation procedure Oct 5,2021 11:15 am
Preexisting Conditions: Sinus issues, digestion
Allergies:
Diagnostic Lab Data: none to date and time
CDC Split Type:

Write-up: injection pain site sore, tiredness, headache, chills, nausea, feeling unwell, decreased appetite


VAERS ID: 1775225 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-10-09
Onset:2021-10-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30155BA / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Dizziness, Pallor
SMQs:, Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (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: NA
Current Illness: NA
Preexisting Conditions: NA
Allergies: iodine, APAP, Shellfish
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: 10 minutes post dose patient starting to feel weak and light headed, became pale and felt as if she was going to pass out.


VAERS ID: 1775226 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-10-08
Onset:2021-10-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / 2 LA / IM

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

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

Write-up: Severe headache, tinnitus


VAERS ID: 1775237 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-10-09
Onset:2021-10-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204B21A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Cold sweat, Dizziness
SMQs:, Anticholinergic syndrome (broad), 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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Lightheaded, dizzy, clammy to touch @ 12:25PM. BP 100/60 Left arm while having symptoms. BP 110/80 left arm after symptoms. Pt ate snacks and drink water. He felt better and stated he was ready to go home after 30'' monitoring


VAERS ID: 1775241 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: California  
Vaccinated:2021-10-09
Onset:2021-10-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301358A / 3 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Cold sweat, Dizziness, Fall, Mobility decreased, Myalgia, Sleep disorder, Syncope, Visual impairment
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Glaucoma (broad), Optic nerve disorders (broad), Cardiomyopathy (broad), Lens disorders (broad), Eosinophilic pneumonia (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (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: Vitamin D - 1000 IU
Current Illness: No illnesses, but I donated blood recently on 10/02/21. I had no complications during the donation but I feel they may be related.
Preexisting Conditions:
Allergies: Allergy to sulfa
Diagnostic Lab Data:
CDC Split Type:

Write-up: I woke up in the middle of the night to go urinate on the night I got vaccinated with the booster dose of Pfizer for COVID. I felt very weak with muscle aches which I know to be normal symptoms. However, I began to feel dizzy while peeing and I fainted and fell. Later that morning at about 9am on 10/09/2021 I tried to get out of my bed but began feeling faint again within being up for 2 minutes. Some of the symptoms include dizziness, visual darkening, a cold sweat, and syncope with standing. I did a whole blood donation recently on 10/02/2021 without any complications but I suspect these two things are related.


VAERS ID: 1775242 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: New York  
Vaccinated:2021-10-09
Onset:2021-10-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 1 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Chills, Dizziness, Erythema, Fall, Fatigue, Injection site pain, Myalgia, Nausea, Pain in extremity, Swelling, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Accidents and injuries (narrow), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: The patient was fine for 15 minutes after taking the shot. However, After 25 minutes the patient fell on the chair and started calling for help. He was feeling dizzy and fainting. He was saying that he is feeling like throw up. He was feeling nauseous, had a sore arm, swelling, redness, and pain at injection site. Tiredness, muscle pain, and chills was also reported.


VAERS ID: 1775250 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: New York  
Vaccinated:2021-10-09
Onset:2021-10-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 076C21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Syncope following a vaccine received in 2012, patient documented she received Pneumonia that year but couldn''t specify if that v
Other Medications:
Current Illness:
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received vaccination and proceeded to waiting area for 15 minutes of observation. Patient was noticeably dropping a few of her belongings while she was seated and our Pharmacy Technician inquired how she was feeling, and she responded was okay. However, 9 minutes after administration, she experienced syncope and slipped from her chair to the ground. A team member dialed 911 and the pharmacist remained with the patient until EMS arrived to continue care for patient. She had recovered consciousness within 1 minute of fainting and was alert and oriented. After EMS evaluation, they determined hospitalization was not required. Individual was released from their care and remained in the pharmacy for another 5 minutes of observation before leaving.


VAERS ID: 1775252 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-09
Onset:2021-10-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

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

Write-up: Minutes after the vaccine I had severe dizziness.


VAERS ID: 1775257 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-10-09
Onset:2021-10-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF3389 / 3 - / IM

Administered by: Other       Purchased by: ?
Symptoms: Dysgeusia, Paraesthesia oral
SMQs:, Taste and smell disorders (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad)

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

Write-up: Patient reported feeling tingling at tip of his tongue. also tasted a metallic taste at tip of tongue. no swelling of face or throat. no other symptoms. patient closely monitored for 30 minutes. vitals stable. upon discharge patient reported symptoms improving. patient notes he has had this occur to him in the past.


VAERS ID: 1775263 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: California  
Vaccinated:2021-10-07
Onset:2021-10-09
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 8839 / UNK LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Erythema, 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Atorvastatin, Vitamin D, Mesima Mushroom
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Itchiness started after approx 36 hrs after booster shot. Hives/redness/itchiness on neck, arm pit, groins


VAERS ID: 1775264 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-10-09
Onset:2021-10-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Aphasia, Cold sweat, Fall, Head injury, Hyperhidrosis, 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), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: None reported
Preexisting Conditions: Diabetes, and Hypertension
Allergies: None reported
Diagnostic Lab Data: Unknown, no tests were performed under our care.
CDC Split Type:

Write-up: Patient was waiting for 15 minutes after vaccination outside of the pharmacy. He came up to the pharmacy looked like he was going to say something and then lost consciousness. He fell and landed on his head. He was bleeding from his head we put pressure on the wound and waited on EMT to get here. He was very sweaty and cold to the touch. He had trouble talking but was able to get across that he was diabetic and had not eaten anything today and that he had hypertension. EMS showed up and transported him to the hospital out of our care.


VAERS ID: 1775271 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-10-06
Onset:2021-10-09
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Troponin increased
SMQs:, Myocardial infarction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: Troponin at 6.05 . Ref range of 0.00 to 0.03ng/ml
CDC Split Type:

Write-up: patient received vaccine within 48 to 72 hours from time of dose patient presented to the emergency department with chest pain and an elevated troponin of 6.05.


VAERS ID: 1775275 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: California  
Vaccinated:2021-10-08
Onset:2021-10-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Lethargy, Malaise, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Amlodipine Elequis Hydrochlorothiazide Levothyroxine Metoprolol Probenecid Valsartan
Current Illness:
Preexisting Conditions: Hypertension, heart disease, gout, hypothyroidism, high cholestrol
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Muscle ache, lethargy, malaise


VAERS ID: 1775276 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-10-09
Onset:2021-10-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 035C21A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, Hyperhidrosis, Nausea
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypoglycaemia (broad)

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

Write-up: Patient was diaphoretic, nauseous and felt weakness. EMS attended and cleared patient.


VAERS ID: 1775298 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-10-02
Onset:2021-10-09
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site erythema, Injection site nodule, Injection site pruritus, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (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: Covid arm- Red knot at injection site, itchy, warm to touch.


VAERS ID: 1775307 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-10-08
Onset:2021-10-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822811 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hyperhidrosis, Myalgia, Nausea, Ocular discomfort, Pain, Pyrexia, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Tylenol, lidocaine patches, naproxen, vitamin d, fish oil
Current Illness: No illnesses
Preexisting Conditions: Von Willebrand disease
Allergies: No allergies
Diagnostic Lab Data: October 13, 2020 lab tested for COVID-19 via PCR. Confirmed severe levels of disease process.
CDC Split Type:

Write-up: Symptoms began within 12 hours. Woke up from sleep drenched in sweat, body aches in every joint, muscle pain throughout the body when I?d move, 102 temperature. Symptoms did not subside for over 6 hours. Took 1000 mg Tylenol to break the fever and manage pain. Persisting feelings of arthritis in joints through the day. Symptoms started again no less than 10 hours later. Eyes pulsating, nausea, skin pulsing with beats of the heart.


VAERS ID: 1775320 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-10-09
Onset:2021-10-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011F21A / 1 LA / IM

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

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

Write-up: The patient, who is 16 years of age, was given Moderna vaccine in error. She should have received the Pfizer vaccine.


VAERS ID: 1775322 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: Kansas  
Vaccinated:2021-10-09
Onset:2021-10-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 019F21A / 1 - / -

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

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

Write-up: Patient received the vaccine and at 11:02am felt light headed and at 11:03am patient fainted. Patient regained concience at 11:04am and was fine after that. I applied an ice pack to patient and he was fine.


VAERS ID: 1775325 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-08
Onset:2021-10-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301358A / 1 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Chills, Myalgia, Pain, 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: VitaminD3 Calcium Citrate Magnesium w/Zinc Multi Vitamin Green tea extract Quercetin Omega 3?s Ubiquinol Citrus Bergamot Artichoke Extract Milk Thistle Beet Root Dandelion Root Burdock Root Licorice Root Turmeric CoQ10 B6 Floate Biotin Pant
Current Illness: 0
Preexisting Conditions: Obese
Allergies: 0
Diagnostic Lab Data: None of the above
CDC Split Type:

Write-up: Muscle and Body aches Chills Fever 101


VAERS ID: 1775327 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-10-08
Onset:2021-10-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Back pain, Bone pain, Dizziness, Dry eye, Dysmenorrhoea, Fatigue, Hunger, Hypoaesthesia, Myalgia, Pain in extremity, Pain of skin, Palpitations, Toothache
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Corneal disorders (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Conjunctival disorders (narrow), Lacrimal disorders (narrow), Osteonecrosis (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad), Dehydration (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Suboxone film, alprazolam for anxiety
Current Illness: Kyphosis, scoliosis, disc herniated to thoracic spine, asthma although I haven?t used an inhaler in years prior to the first vaccination I need it daily now
Preexisting Conditions: Back problems , asthma, early onset COPD
Allergies: Penecillin
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: After work I came home made supper, cleaned and because we recently moved I was unpacking boxes wheb I started noticing sharp, throbbing pains to my feet and legs, I work 12-16 hour day shifts as a nurse I wear compression to minimize pain and swelling from being on my feet constantly but this pain was different. I had to stop what I was doing I got into shower immediately felt like my heart was pounding and I was surely going to pass out. My husband helped me back to bed we took my temp, it read at 104.1, my O2 sats were 92/RA, B/P: 188/44, P: 144, R: 18-20, I felt dizziness, my right arm not my left where I gotten the booster, was completely numb. I took Tylenol, interchanged with Motrin, went to sleep, woke up a few hours later my temp was at 99.1, I felt hungry and calm. Only two hours from that time about 0500 my temp went back up to 103.9, I did the same regimen also pushed fluids and rested. What is striking me as off is the degree of bone and muscle pain, I had some with the second dose but this is bad my skin even hurts. Dry eyes, exhausted, extreme pain in my upper and lower back and feelings of mentstral cramping but I no longer get a period, my teeth even hurt my teeth are aching.


VAERS ID: 1775335 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-09
Onset:2021-10-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301458A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cold sweat, Dizziness, Face injury, Hyperhidrosis, Limb injury, Loss of consciousness, Malaise, Nervousness
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: After administration, pt stated she wanted some water, didn''t feel good. She said she was feeling light headed and wanted to lay down on floor. Stood up to lay down on pharmacy carpet and passed out, hit her hand and cheek on pharmacy shelf. Was clammy started sweating, BP was in the 140 range, was aware of her name and dob. Confirmed she was nervous and had not ate prior to vaccine. Called 911. Her BP was rechecked in the 120 range, blood sugar ok. Fireman had her sit in chair, and walked her to the car. Mom states she would take her to urgent care


VAERS ID: 1775339 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-10-09
Onset:2021-10-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025C21A / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, Cold sweat, Deafness, Disorientation, Feeling hot, Pallor, Syncope, Tinnitus
SMQs:, Torsade de pointes/QT prolongation (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), Cardiomyopathy (broad), Hearing impairment (narrow), Hypotonic-hyporesponsive episode (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: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: PT is 20 YO male, here for first dose of Moderna, received at 1610. At approximately 1620, PT was in post vaccination area and c/o of faintness, weakness, that he couldn?t hear, was ?disoriented?, had ringing in ears. ?Felt like I was dying.? No LOC noted. Warm, slightly diaphoretic, clammy, presented with pallor. Declined wheelchair, moving to stretcher, or putting head between knees despite encouragement. Given apple juice and apple slices, small granola bar; well tolerated along with water bottle. States ?haven?t had much to eat today.? Pale in color at onset, resolved with more color at discharge. Stated faintness was improving. PT was able to stand and walk without assistance. PT was talking more, stated he was feeling better, was more responsive. DC/d with steady gait, able to clothe self, finish snacks. States no allergies, has passed out in shower after taking herbal supplements in the past. Education regarding vasovagal reactions provided. PT was encouraged to eat more before 2nd dose, advised to be hydrated and to tell vax team of previous issues when he comes for second dose. Exited at 1440 with friend, who will drive. Vital Signs: 1620: BP 90/50 sitting, HR 49, SPO2 100% RA, RR 12 1625: BP Sitting 110/60, HR 57, SPO2% RA, RR 14 1629: HR 65, SPO2 100% RA, RR 14 1637: BP 110/62 sitting, HR 52, SPO2 100%, RR 16


VAERS ID: 1775341 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-10-09
Onset:2021-10-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 212A21A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Feeling hot, Hyperhidrosis, Malaise, Pallor, Visual impairment
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Pt is here for Johnson and Johnson vaccine, received at 1745. At 1746, while still at vaccination table, PT reported that he didn?t feel well and presented with diaphoresis, pallor, a sensation of being hot and light-headed, reported that his vision was dimming/everything was getting darker. No LOC noted. PT provided ice pack at 1747, applied to back of neck. PT reports that this has happened to him before with blood draws and that he had severe phobia r/t needles. PT also reported it had been about 6 hours since he?d eaten, but he declined the juice offered before his vaccination. He also reports that he has lost 35 LBS in 3 months r/t a diet. VS at 1746: HR 56, SPO2 98% %A. At 1755: BP sitting is 90/60, HR is 76, SPO2 is 98%. At 1800, BP sitting is 118/80, HR is 84, SPO2 98% and PT is reported he feels ?100% better.?. At 1803, PT continued with diaphoresis, but color had improved. PT accepted apple juice. At 1808, PT stood from chair unassisted with steady gait. Pt denied SOB, respiratory distress, itching. At 1828, PT exited facility with steady gait, stable and able to walk on his own, denying dizziness and reporting that he ?feels good.?.


VAERS ID: 1775344 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-08-08
Onset:2021-10-09
   Days after vaccination:62
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Electric shock sensation, Headache, Pyrexia
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre 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: escitalipram, spironalactone, mini pill birth control
Current Illness: No r
Preexisting Conditions: Anxiety
Allergies: Amoxicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Brain zaps along with fever, chills, and headache


VAERS ID: 1775345 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-10-08
Onset:2021-10-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 59267-1000-01 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Chills, Headache, Injection site pain, Muscle spasms, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (broad), Extravasation events (injections, infusions and implants) (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: PENICILLIN, AS A CHILD, DON''T RECALL REACTIONS
Other Medications: METFORMIN, ALBUTEROL, OMEPRAZOLE, MULTI VITAMINS, TYLENOL 500, THYMEX (STANDARD PROCESS BRAND), ZYRTEC, FEOSOL, TURMERIC CURCUMIN W/ BIOPERINE 95%- 500MG, GARDEN OF LIFE PRIMAL DEFENSE PROBIOTIC, METAMUCIL, GINGER ROOT 500MG
Current Illness: HAD SOME STOMACH UPSET MY PC DR HAD INCREASED THE OMEPRAZOLE FROM 1 TO 2 A DAY
Preexisting Conditions: ASTHMA, OBESE, SKIN CANCER IN THE PAST, OSTEOARTHRITIS, DEGENERATIVE JOINT DISEASE, SLAP TEAR OF RIGHT SHOULDER, CARPAL TUNNEL SYSNDROME BOTH WRISTS,
Allergies: PENICILLIN, SULFA, ONIONS
Diagnostic Lab Data: N/A I WILL CONTACT DR IF SYMPTOMS PERSIST TOMORROW
CDC Split Type:

Write-up: CHILLS, HEADACHE, BODY ACHE, FEVER (NORMAL IS ABOUT 97 AT LAST CHECK IT WAS 100.1), JOINT PAIN MORE THAN NORMAL, INJECTION SITE IS NORMAL- A LITTLE SORE BUT OTHERWISE NORMAL, BACK AND LEG MUSCLES CRAMPING ALL STARTED SINCE 4:45PM EST 10/09/2021. PRETTY CONSISTENT WITH WHAT FEELS LIKE A FEVER


VAERS ID: 1775346 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-10-07
Onset:2021-10-09
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site reaction, 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Progesterone-only contraceptive, probiotic, Allegra, D-3, B-12, Ester-C, Ubiquinol, Biotin, Zn/Cu
Current Illness: NA
Preexisting Conditions: Obesity
Allergies: Walnut, soy
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: Covid arm (itchy rash about an inch in diameter and an inch or so below the injection site).


VAERS ID: 1775352 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-10-01
Onset:2021-10-09
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 061E21A / 1 LA / IM

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

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: Liposomal Glutathione, Pre-natal, Probiotic
Current Illness: none
Preexisting Conditions: Fibroadenoma of breast
Allergies: Aplisol PPD (mild reaction)
Diagnostic Lab Data: n/a at the moment
CDC Split Type:

Write-up: The morning after receiving the first vaccination dose, a small (almost 1 cm) hard, non-tender, immobile lump appeared on the right-outer area of my hard palate. It has been 8 days and the lump is still present; however, it is smaller in size. To be seen by my ENT for follow-up if lump remains persistent after 2 weeks.


VAERS ID: 1775355 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: California  
Vaccinated:2021-10-09
Onset:2021-10-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822809 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Cough, Flushing, Pruritus, Rash, Rash pruritic, Swelling, Throat irritation
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: 1730 30 year old male patient arrived ambulatory, alert, complaint of itching, pt appears flushed, rash all over arms,back,and stomach. 1733 Pt reports he was vaccinated approx 1345 with Janssen vaccine, while at home at 1650 approx reported new onset of rash, itchy bumps, generalized body while eating "pozole". Pt reports he had itchy throat, coughing, some mild swelling. Pt called sister and was brought in by private vehicle for observation of rash to facility. Initial VS taken, stable 02 98% on room air, Bp 132/84, P 63, pt alert, no shortness of breath or respiratory distress. 1741 VS 136/84 02 96% P61. Pt assisted to gurney, alert, ambulatory. EMS called for further assessment. Pt denies known allergies, no medical hx, athlete. 1747 Pt alert no respiratory distress, reports feeling better, flushing diminished. VS 137/83 P 59 02 97% room air, alert, no distress. 1752 EMS arrived, assessed pt recommended pt should take Benadryl q6 hours at home, also call 911 if throat starts to itch, or coughing. VS taken by EMS 129/86 HR 56, pt alert denies sob or itching, no throat swelling. Pt advised to treat symptoms at home, pt declined to transport per EMS advice, pt agreed. 1802 pt left facility in no distress, ambulatory, accompanied by sister. Instructed to call 911 if symptoms return or worsen.


VAERS ID: 1775357 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-10-08
Onset:2021-10-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 2 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Blood test, Diplegia, Fatigue, Feeling cold, Full blood count, Gait inability, Hypothermia, Incontinence, Magnetic resonance imaging, Mobility decreased, Multiple sclerosis, Muscle fatigue, Myalgia, Pain, SARS-CoV-2 test, Sleep disorder, Tremor
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Accidents and injuries (broad), Optic nerve disorders (broad), Demyelination (narrow), Eosinophilic pneumonia (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (narrow), COVID-19 (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: Multiple sclerosis Raynauds Syndrome Pituitary Adenoma Hashimito''s Thyroiditis All under control
Allergies: Tramadol Nitrous Oxide Ocrevus verified lab results Sept 2021
Diagnostic Lab Data: Complete Viral, covid, meningitis CBC and MRIs to clear for vaccine and new long term MS therapies on 8/232021 thru 9/13/2021
CDC Split Type:

Write-up: RE: COVID-19 2nd shot adverse reactions Patient 2:04 PM Woke up at 3am in hypothermic body shaking under 5 blankets but body was fine and warm. Having a psychosomatic freezing reaction. Lost all muscle functioning ability from mid back down thru toes. Completely unable to walk exactly 12 hours from shot. Incontinence w/complete voiding on the floor. Like the shot used and attacked my body using my MS as the pathway. Unable to move hips or legs, lower body paralysis, and no strength and had to crawl across the floor with my fingertips pulling me to shower. Took 1 hour to crawl. Excruciating muscle pain throughout lower half of body. My MS has never hurt. Had worse reaction than the Ocrevus infusion for MS that left me with walking issues and lost complete ability to dance and run 3 weeks after 2nd half dose. Had battled back from that with significant improvement this month. In 12 hours time while sleeping complete exhaustion, extreme muscle pain and muscle fatigue. At 24 hours past injection and still cannot sit up or prop myself over. Can barely roll over. I am in so much pain! No issues with 1st shot. All symptoms of Guillaine Barre which was not supposed to happen with the pfizer shot. Paralysis and body aches have now subsided at 1800hrs 10/9. 27 hours of agony


VAERS ID: 1775358 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-04-01
Onset:2021-10-09
   Days after vaccination:191
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / SYR

Administered by: Work       Purchased by: ?
Symptoms: Alopecia, Alopecia universalis, Rash, Thyroid function test normal
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: DELZICOL
Current Illness: Ulcerative colitis
Preexisting Conditions:
Allergies: Aspirin for ulcerative colitis
Diagnostic Lab Data: Thyroid test, everything was fine.
CDC Split Type:

Write-up: Body rash and hair loss, I got Alopecia universalis.


VAERS ID: 1775366 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-10-08
Onset:2021-10-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Contusion, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemorrhage terms (excl laboratory terms) (narrow), Accidents and injuries (narrow), Haemodynamic oedema, effusions and fluid overload (narrow)

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

Write-up: I wake up the next day with black and blue Bruise and swollen


VAERS ID: 1775367 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-10-09
Onset:2021-10-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822811 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Diarrhoea, Headache, Photophobia, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Noninfectious meningitis (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Corneal disorders (broad), Retinal disorders (broad), Noninfectious diarrhoea (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: Apidex
Current Illness: No
Preexisting Conditions: None
Allergies: NKDA
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Fever, diarrhea, chills, headache, light sensitivity


VAERS ID: 1775374 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-09
Onset:2021-10-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822809 / 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? 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: No reactions


VAERS ID: 1775379 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: New York  
Vaccinated:2021-10-07
Onset:2021-10-09
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / SYR

Administered by: Senior Living       Purchased by: ?
Symptoms: Dizziness, Lymph node pain, Lymphadenopathy, Vertigo
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lexapro 20mg Vyvanse 20mg Amlodepine benazypril
Current Illness: None
Preexisting Conditions: High blood pressure; adhd; depression; obesity
Allergies: Preservatives
Diagnostic Lab Data:
CDC Split Type:

Write-up: Dizziness/vertigo beginning in morning 2 days after booster. Swollen and very painful lymph node in armpit of injection site arm


VAERS ID: 1775386 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Alaska  
Vaccinated:2021-03-09
Onset:2021-10-09
   Days after vaccination:214
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Acne, Contusion, Induration, Lipoma, Vaccination site erythema, Vaccination site pain, Vaccination site reaction
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Accidents and injuries (narrow), Extravasation events (injections, infusions and implants) (broad), Lipodystrophy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Losartan,met Forman,clonidine,glipizide
Current Illness: Uti
Preexisting Conditions: Diabetes, hypertension,
Allergies: Zyban,
Diagnostic Lab Data: Nothing happened today. Just the soreness upon touching
CDC Split Type:

Write-up: No issues at the time. But now 7 months later soreness with pencil eraser sized red broken pinmpilish looking skin at vacinesite. Unread area has movable sore lipoma feeling that can be pushed around, feels bruised, but only red at the pencil sized pimplish area. Under the skin of harder lump is about an 6 inch area circumference


VAERS ID: 1775429 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-10-08
Onset:2021-10-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Influenza like illness, Injection site pain, Pain
SMQs:, Extravasation events (injections, infusions and implants) (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: tylenol
Current Illness: rapid pulse
Preexisting Conditions: bi-polar, high blood pressure, high cholesterol. osteo arthritis
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: sore arm at injection site ib 10/8,10/9 and 10/10 on 10/9 ached all over my body and felt like I had the flu


VAERS ID: 1775430 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-10-08
Onset:2021-10-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 - / IM

Administered by: Public       Purchased by: ?
Symptoms: Injection site pain, Joint range of motion decreased, Mobility decreased, Musculoskeletal stiffness, Pain, Pain in extremity, Sleep disorder
SMQs:, Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (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: Prozac 60 mg, Claritin, bentyl 10 mg, famotadine 40 mg, multivitamin
Current Illness:
Preexisting Conditions: Migraines
Allergies: Sulfa drugs
Diagnostic Lab Data:
CDC Split Type:

Write-up: Full body aches and pain so bad it woke me up. Legs, back, arm and injection site hurt so bad I could barely move. OCT pain killers and a heating pad helped enough. Was very sore and stiff all day, OTC helped enough, but pain lasted all day. Decreased mobility and range of motion all day. No fever, pain almost fully gone on the next day.


VAERS ID: 1775432 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-10-08
Onset:2021-10-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 772589 / 3 - / SYR
UNK: VACCINE NOT SPECIFIED (OTHER) / UNKNOWN MANUFACTURER - / 1 - / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: venlafaxine, buproprion, clonazepam, buspirone. levonorgestrel,
Current Illness: Flu vaccine on same date
Preexisting Conditions: Generalized anxiety and major depressive disorder
Allergies: tylenol with codeine - causes itching
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: urticaria rash started 24hrs after injection


VAERS ID: 1775434 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-10-08
Onset:2021-10-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF 2590 / UNK LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Back pain, Chills, Injection site pain, Insomnia, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Both Pfizer vaccines caused fever and body aches
Other Medications: Niacin, allegra, pantropazol, vitamin D3
Current Illness: Seasonal allergies
Preexisting Conditions: Left knee pain Right shoulder rotator cuff
Allergies: Zocor, penicillin, yellow dye #5
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Body aches, back aches, chills, shivering, fever. Sore muscle at injection site. Little to no sleep first night. Symptoms began approximately 12 to 14 hours following injection. Took tylenol. 2 every 6 hours. Fever gone in about 12 hours. Still some body aches and sore injection site but greatly reduced at 48 hours following injection.


VAERS ID: 1775437 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-10-08
Onset:2021-10-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 3 RA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Hyperhidrosis, 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), 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: Pristiq, Synthrois, Tamoxifin, Multivitamins, Calcium with D2 and E2
Current Illness: cancer
Preexisting Conditions: fibromyalgia, hypothroidism
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Nauseous, chills, sweats, fever reached 104.3 Rest, Ibuprofen, ice


VAERS ID: 1775445 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-10-09
Onset:2021-10-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30125BA / 2 RA / IM

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

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

Write-up: PATIENT CAME IN FOR HIS SECOND DOSE OF MODERNA AND TECHNICIAN GAVE PATIENT PFIZER -BioNTech INSTEAD


VAERS ID: 1775459 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-10-09
Onset:2021-10-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822811 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Flu shot(did not get the brand name) aproximately 3 years prior, age 52, hives and histamine response, requiring steroids
Other Medications:
Current Illness: Healthy
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Severe reaction with histamine response and rash to arms, neck, face, and spreading to legs


VAERS ID: 1775464 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-10-08
Onset:2021-10-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Pyrexia, Tinnitus, Vaccination complication
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hearing impairment (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Tinnitus, came on as fever and other regular reaction symptoms started. As of mid sunday morning other symptom have resolved tinnitus has not


VAERS ID: 1775474 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-10-08
Onset:2021-10-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK RA / SYR

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

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

Write-up: VERTIGO/LIGHTHEADEDNESS/DIZZINESS


VAERS ID: 1775476 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: New York  
Vaccinated:2021-10-08
Onset:2021-10-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 80777027398 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Loss of consciousness, Pain, 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: 150mg Venlafaxine (Effexor) daily
Current Illness: Unknown
Preexisting Conditions: Depression
Allergies: Unknown
Diagnostic Lab Data:
CDC Split Type:

Write-up: I faint and blackout when I use the toilet. Aches and pains everywhere


VAERS ID: 1775503 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-10-08
Onset:2021-10-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ???? / 3 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Oropharyngeal pain
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (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: Blood pressure meds.
Current Illness:
Preexisting Conditions: Spinal bifida
Allergies:
Diagnostic Lab Data: None, cleared up in one day
CDC Split Type:

Write-up: Sore throat


VAERS ID: 1775511 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-05-19
Onset:2021-10-09
   Days after vaccination:143
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0150 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: COVID-19, Chest X-ray normal, SARS-CoV-2 test positive, Vaccine breakthrough infection
SMQs:, Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: albuterol, eliquis, ASA-dipyridamole, atorvastatin, biotin, symbicort, coreg, vit D, clonidine, flexeril, ferrour sulfate, glipizide, hydralazine, insulin glargine, omeprazole, valsartan
Current Illness: no
Preexisting Conditions: severe uncontrolled HTN, CKD4, T2DM, PAD, recurrent unprovoked DVTs, and COPD, DVT, chronic pain
Allergies: clopidogrel, codeine
Diagnostic Lab Data: CXR: clear, PCR + 10.9/2021
CDC Split Type:

Write-up: breakthrough covid +, no change in chronic O2 requirements


VAERS ID: 1775512 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-10-08
Onset:2021-10-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Public       Purchased by: ?
Symptoms: Abdominal discomfort, Chills, Fatigue, Injection site erythema, Injection site swelling, Injection site warmth, Pain
SMQs:, Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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: Annuity Ellipta, losarten ,spironolactone,montelukast
Current Illness: None
Preexisting Conditions: Asthma, high blood pressure
Allergies: Erythromycin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Large red bump at injection sight. Warm to the touch. Chills, body aches ,upset stomach & fatigue all day 10/09/2021 & 10/10/2021


VAERS ID: 1775522 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-10-09
Onset:2021-10-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Dyspnoea, Feeling hot, Limb discomfort, Pain in extremity, Pharyngeal swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: Constant Allergies and post-partum recovery
Preexisting Conditions: Allergies
Allergies: Amoxicillin, Clindamycin, Silk, Wool, Dust Mites, Plants in all seasons, Many foods but strongest reactions to shrimp and onions
Diagnostic Lab Data:
CDC Split Type:

Write-up: My vaccine was scheduled for 5:00. I had slight dizziness, throat swelling, and uncomfortableness in my arm within the first 15 minutes, though I do not know exactly what time it started. Throat swelling is normal for some of my allergies, so I thought I was fine and went home. Unfortunately, at home, by 8 PM, my throat had swollen significantly and breathing was more difficult. I took 75 mg of diphenhydramine at around 9 and then went to sleep. The next morning when I awoke around 9, my throat felt better. I am still a bit dizzy with a feverish feeling and my arm is in significantly more pain that goes almost to my elbow. Some arm pain is normal for vaccination shots for me, though this is more than usual. I do not typically have such significant throat swelling following a vaccine, so I am trying to contact my allergist to see what she thinks about the throat swelling.


VAERS ID: 1775533 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-10-07
Onset:2021-10-09
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 1 LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2590 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Erythema, Eye swelling, Pain, Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Armor Thyroid, Vitamin D3, Magnesium
Current Illness: none
Preexisting Conditions: none
Allergies: none known
Diagnostic Lab Data: none
CDC Split Type:

Write-up: 10/8 - achey, chills, fever. 10/9 - rash on right side of face 10/10 - under eye swelling and dark red


VAERS ID: 1775535 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-10-08
Onset:2021-10-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 2 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Fatigue, Injection site oedema, Injection site warmth, Lymphadenopathy, Malaise, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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: Penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever, body aches, edematous lymph nodes, malaise, fatigue , edema and fever a injection site


VAERS ID: 1775545 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-10-07
Onset:2021-10-09
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 076C21A / 3 LA / IM

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

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

Write-up: Swollen lymph nodes in armpit area of same arm vaccination was administered causing soreness and tenderness.


VAERS ID: 1775552 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: New York  
Vaccinated:2021-10-08
Onset:2021-10-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / N/A LA / SYR

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

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

Write-up: Redness and swollen, painful arm on the below shot site


VAERS ID: 1775565 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-10-08
Onset:2021-10-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / SYR

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

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

Write-up: Temp swings. 99-95. Slight fever. Muscle aches


VAERS ID: 1775571 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-10-09
Onset:2021-10-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039D21A / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Dyspnoea, Flushing, Immediate post-injection reaction
SMQs:, Anaphylactic reaction (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypersensitivity (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Cancer
Allergies: Sulfa, Hydroxyzine HCL, Amoxicillin, Chlorpheniramine, and Coconut
Diagnostic Lab Data: The patient refused medical intervention
CDC Split Type:

Write-up: Initially had flushing and shortness of breath. Had an immediate chest pain in the center of chest a little below the breast bone. The flushing and shortness of breath only lasted a minute or two but the chest pain remained strong for 20 minutes. The patient also complained of a numbness in hand of injection arm after 10 minutes. We gave her a bottle of water and checked her blood pressure. Her BP was 138/90 and pulse of 85. Patient did not want to go to hospital to be checked. After 30 minutes the chest pain was resolved.


VAERS ID: 1775577 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-10-09
Onset:2021-10-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Chest pain, Headache, Nausea
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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: Systemic: Chest Tightness / Heaviness / Pain-Medium, Systemic: Headache-Medium, Systemic: Nausea-Medium


VAERS ID: 1775579 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-09
Onset:2021-10-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30155BA / 1 RA / IM

Administered by: Pharmacy       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: Systemic: Dizziness / Lightheadness-Mild


VAERS ID: 1775580 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: California  
Vaccinated:2021-10-09
Onset:2021-10-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017F21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Incorrect route of product administration
SMQs:, Drug abuse and dependence (broad), Medication errors (narrow)

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

Write-up: Error: Wrong Route


VAERS ID: 1775584 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-10-09
Onset:2021-10-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 061E21A / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Injection site pruritus, Pruritus
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Site: Itching at Injection Site-Medium, Systemic: Allergic: Itch (specify: facial area, extremeties)-Medium, Systemic: Allergic: Itch Generalized-Medium, Systemic: Dizziness / Lightheadness-Mild


VAERS ID: 1775591 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-10-08
Onset:2021-10-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK RA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Arthralgia, Asthenia, Chills, Dizziness, Headache, Influenza like illness, Injection site pain, Joint stiffness, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Flu like symptoms, muscle aches. Joint pain and stiffness, severe headaches and dizziness. Lack of energy, chills and severe pain and burning sensation at the injection sight.


VAERS ID: 1775597 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-10-09
Onset:2021-10-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fall, Flushing, Headache, Hyperhidrosis, Seizure, Syncope, Tremor, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Parkinson-like events (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), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Fainting / Unresponsive-Mild, Systemic: Flushed / Sweating-Mild, Systemic: Headache-Mild, Systemic: Seizure-Mild, Additional Details: pt was sitting after adminstering the shot, 5 minutes later he fell off the chair and when i reached out to him he was shaking for 5 seconds i am not sure if it was a seizure or not. he responded back immediately. i watched him for about 20 minutes after that. he mentioned that he always faint after blood drawing.


VAERS ID: 1775602 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Hawaii  
Vaccinated:2021-10-09
Onset:2021-10-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 019F21A / 1 LA / IM

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

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

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


VAERS ID: 1775603 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-10-09
Onset:2021-10-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Flushing, Hyperhidrosis, Hypotension
SMQs:, Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypersensitivity (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? 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: Flushed / Sweating-Medium, Systemic: Hypotension-Medium


VAERS ID: 1775605 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-10-09
Onset:2021-10-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301458A / 2 RA / IM

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

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

Write-up: Error: Improper Storage (temperature)-


VAERS ID: 1775606 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-10-09
Onset:2021-10-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Circumstance or information capable of leading to medication error, Extra dose administered
SMQs:, Medication errors (narrow)

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

Write-up: Error: Wrong Patient (documentation in EMR)-


VAERS ID: 1775609 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-10-08
Onset:2021-10-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301458A / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Valsartan, gabapentin, famotadine, montelukast, flonase, super B complex, vitamin B12, magnesium glacinate, preservision Areds II, vitamin D, vitamin C with bioflavinoids, probiotic.
Current Illness: Sinus infection.
Preexisting Conditions: Hypertension, allergies, high triglycerides.
Allergies: Benadryl, HCTZ, barium.
Diagnostic Lab Data: None at this time.
CDC Split Type:

Write-up: About 20 - 24 hours after vaccine administration, 4:30 pm on 10/9/2021, I experienced a couple of heart palpitations and my heart rate became elevated. My resting heart rate went to 105 bpm and my normal resting heart rate is 75 -78 bpm. The elevated heart rate lasted a few hours. Palpitations only happened a couple of times. The next day, 10/10/2021 my resting heart rate was back to normal.


VAERS ID: 1775611 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-09
Onset:2021-10-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: No adverse event reported. Pfizer vaccine expired on 10/8/21, 5pm. Vaccine was administered on 10/9/21, 11am.


VAERS ID: 1775616 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-10-08
Onset:2021-10-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939676 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dyskinesia, Injection site pain, Injection site reaction
SMQs:, Neuroleptic malignant syndrome (broad), Dyskinesia (narrow), Noninfectious encephalopathy/delirium (broad), Extravasation events (injections, infusions and implants) (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: Site: Pain at Injection Site-Mild, Systemic: involuntary muscle movement at site of injection-Mild, Additional Details: involuntary spontaneous muscle movement only at injection site


VAERS ID: 1775617 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-10-09
Onset:2021-10-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301558A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: over 42 days, 1st dose 06/2/21 and 2nd dose 10/9/21


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