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

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



Case Details (Reverse Sorted by Onset Date)

This is page 130 out of 6,867

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VAERS ID: 1569228 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-08-15
Onset:2021-08-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052E21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Exposure during pregnancy, Feeling hot, Headache, Immediate post-injection reaction, Nausea, Paraesthesia, Presyncope, Vomiting
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), 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:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient is 8 weeks pregnant and experiencing significant nausea and vomiting--patient stated that she had vomited on the way to the store. After receiving the vaccine, the patient immediately said she thought she was going to pass out. She experienced tingling in arms and legs particularly in forearm of left arm. She also complained that she felt dizzy, warm and lightheaded. Patient was assisted in laying down, given an icepack (applied to back of neck) and water to drink. Patient''s temperature was taken and determined to be normal. After 30 minutes of observation, patient said she felt better and only had a mild headache. A friend drove her home. Patient also mentioned that her anxiety levels have been very high during this pregnancy, but she is not currently taking anything for anxiety.


VAERS ID: 1569234 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-15
Onset:2021-08-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain upper, Dizziness, Dry mouth, Dysarthria, Malaise
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Vestibular disorders (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Lexapro, hctz, amlodipine
Current Illness:
Preexisting Conditions:
Allergies: nkda
Diagnostic Lab Data: none
CDC Split Type:

Write-up: She started feeling dizzy while waiting after taking the shot. Then she said her stomach began to hurt and she wants to vomit. She reported extreme dry mouth. She describes a feeling of being sick to her stomach. She describes slurring.


VAERS ID: 1569236 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-08-13
Onset:2021-08-15
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Petechiae
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Type 1 diabetes
Allergies: Gluten
Diagnostic Lab Data: Nkne
CDC Split Type:

Write-up: Petechiae on face


VAERS ID: 1569238 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-08-13
Onset:2021-08-15
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002F21A / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Gait disturbance
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre 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: N/A
Current Illness: NONE TO MY KNOWLEDGE
Preexisting Conditions: HYPERTENSION
Allergies: PENICILLIN, MACROLIDE,PHENOTHIAZINES
Diagnostic Lab Data: NONE TO MY KNOWLEDGE
CDC Split Type:

Write-up: HER LEG IS DRAGGING. WHEN SHE HOLDS BOTH UP, THEY ARE UNEVEN. HER WALK IS UNSTEADY


VAERS ID: 1569244 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-15
Onset:2021-08-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939902 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Flu vaccine, 2012. patient stated she had anaphylactic reaction.
Other Medications: na
Current Illness: na
Preexisting Conditions: na
Allergies: flu vaccine
Diagnostic Lab Data: na
CDC Split Type:

Write-up: Patient had closing of the throat and trouble breathing 26 minutes after vaccine was given.


VAERS ID: 1569246 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-08-13
Onset:2021-08-15
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 LA / IM

Administered by: School       Purchased by: ?
Symptoms: Chills, Menstrual disorder, 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: kariva, lexapro
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever, Chills for 24 hours after injection Not normal period 2 days after


VAERS ID: 1569247 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-08-15
Onset:2021-08-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dry throat, Oropharyngeal pain
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Dehydration (broad)

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

Write-up: PT COMPLAINED OF SORE/ DRY THROAT - STARTED 30 MINUTES TO AN HOUR AFTER VACCINE


VAERS ID: 1569250 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-08-15
Onset:2021-08-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 RA / IM

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

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

Write-up: Patient received Janssen Covid-19 vaccine 8/15/2021; after 7 minutes in the waiting room, he fainted and was unconscious. 911 was called immediately. He was very pale and sweaty. After several minutes, he gained consciousness and was able to sit in his chair. Ambulance arrived and they assessed patient. Patient stated he was fine, and was able to answer several questions from ambulance team. Patient walked out of the store and went home. He was advised to seek medical attention if the adverse event occurs again in the future.


VAERS ID: 1569266 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-14
Onset:2021-08-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 0S3E21A / 3 LA / SYR

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

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

Write-up: Painful red bump on left arm on injection site . Put ice and took antihistamine and it still is painful and big.


VAERS ID: 1569275 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-08-14
Onset:2021-08-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

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

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

Write-up: Facial swelling approx. 16 hours after 2nd dose. Zyrtec and supportive cares given, to monitor at home at this time.


VAERS ID: 1569279 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-08-15
Onset:2021-08-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 LA / IM

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

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

Write-up: Patient fainted about 5 minutes after administration. Patient became aware within 30 seconds. Paramedics arrived and did vitals. Patient was then released on his own accord.


VAERS ID: 1569284 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-15
Onset:2021-08-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939902 / 1 LA / IM

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

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

Write-up: Patient was okay during vaccine, started getting sweaty a min after the vaccine and threw up for a few min. She then passed out and fell on the floor. She felt okay after passing out. After few second pt regains conscience. Checked her vitals and all was good. EMS was called and everything checked out okay. Pt refused to to be taken to the hospital as she started to feel better.


VAERS ID: 1569296 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-15
Onset:2021-08-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal distension, Dysphagia, Eructation, Nausea, Oral pain, Pharyngeal swelling
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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: Ibuprofen, Zinc, Allegra, Turmeric, B-12, Magnesium, Collagen Protein, Allergy drops, Medroxyprogestrone 10mg.
Current Illness: Cervical/ Uterus/ovarian polyps, cysts and fibroids.
Preexisting Conditions: None
Allergies: Fruits, most tree nuts, contrast, latex, and many unknown discoverable upon exposure.
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Slight nausea, needed to take deep breaths. After getting home cooking and eating, then realized swelling of throat occurred as had difficulty swallowing. Usual allergic reaction afterwards, body begins sequence of burping, encapsulating food items in saliva and continue to burp until the food comes out. All food that has gone thru produces stabbing pain at mouth of stomach and has began to produce bloating. Just as symptoms were realized to be present, I consumed benadryl, holding my Auvi-Q close. Submitting this report, prior to finalizing the complete reaction. Spouse has been informed and asked to monitor.


VAERS ID: 1569300 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Kansas  
Vaccinated:2021-08-15
Onset:2021-08-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Eye movement disorder, Heart rate increased, Hyperhidrosis, Mydriasis, Nausea
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Ocular motility disorders (narrow), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: took 2 tylenol before immunization
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: blood pressure 109/68 pulse 58 once in a laying down position.
CDC Split Type:

Write-up: felt faint and had nausea, patient was sweating and heart rate increased, pupils dilated, head and eyes rolled back. Placed cold compress on back on neck, laid patient on the ground, raised the feet on the chair, monitored blood pressure, pulse, and breathing. EMS was called because it took longer than ten minutes for patient to start looking better. EMS confirmed the blood pressure, pulse, breathing, and oxygen levels were ok. They suggested to mom that patient goes to the hospital to get checked out.


VAERS ID: 1569301 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-08-15
Onset:2021-08-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002F21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood pressure increased, Dizziness, Hyperhidrosis, Loss of consciousness, Respiratory arrest, Skin discolouration, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypertension (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (broad), Respiratory failure (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: fainted from a flu shot in the past. he was not sure on when
Other Medications: na
Current Illness: na
Preexisting Conditions: na
Allergies: na
Diagnostic Lab Data: blood pressure 142/82
CDC Split Type:

Write-up: The patient came in to receive his first dose of moderna vaccine, he stated a history of fainting. We watched him after his dose of Moderna and about 5 minutes later(3:55pm) he became sweaty and stated he was light headed. I gave him a cold compress and he proceeded to lose consciousness. we had him on the floor with his legs up however the patient did stop breathing and turn purple. At this point I gave a dose of epipen. the patient did wake up after the epipen. He was out for about 15 seconds but unresponsive for a couple of minutes until after the epipen dose. (given at 4:00pm) we had 911 on the line and the paramedics were here by 4:08pm and his blood pressure was at 142/82. he left with the paramedics.


VAERS ID: 1569306 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-08-15
Onset:2021-08-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 181286 / 1 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Dizziness, Hyperhidrosis, Paraesthesia, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Patient had a brief and resolved vasovagal syncopal episode. Stated feelings of dizziness, tingling/cramps to R upper leg, and sweating/diaphoresis. This occurred about 5min post vaccination and resolved completely about 15min post vaccine.


VAERS ID: 1569307 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-07-25
Onset:2021-08-15
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-08-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 LA / IM

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

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

Write-up: Patient/Father lied about DOB and consequently the pharmacist to an 11 year old when pfizer is only approved for 12 and up. Patient reports no adverse effects from vaccine


VAERS ID: 1569312 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Idaho  
Vaccinated:2021-08-09
Onset:2021-08-15
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-08-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH Q182 / 1 - / SYR

Administered by: Private       Purchased by: ?
Symptoms: Blood thyroid stimulating hormone normal, Cardiac monitoring, Chest X-ray normal, Chest pain, Fibrin D dimer normal, Full blood count normal, Human chorionic gonadotropin negative, Hypertension, Laboratory test normal, Limb discomfort, Metabolic function test, Tachycardia, Troponin normal, Ventricular extrasystoles
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Ventricular tachyarrhythmias (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Hypertension (narrow), Cardiomyopathy (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: Flu shot in 2005
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: Sulfa medication
Diagnostic Lab Data: CBC, CMP, Troponin, HCg, thyroid profile, d-dimer. All labs came back within normal limits.
CDC Split Type:

Write-up: Stabbing chest pain and heaviness. Tachycardia and hypertensive upon ER admission with premature ventricular contractions on heart Monitor. I was given IV fluids. Labs and chest ray came back normal. I was discharged because they couldn?t find any thing wrong other than PVCs. Chest pain continues after discharge. I have not had any prior heart condition or any other medical conditions..


VAERS ID: 1569314 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-08-11
Onset:2021-08-15
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-08-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site erythema, 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Not known
Current Illness: NKMC
Preexisting Conditions: NKMC
Allergies: NKDA
Diagnostic Lab Data: Not known at time of reporting
CDC Split Type:

Write-up: Patient contacted pharmacy on 08/15/2021, stating she had swelling and redness in the injection site and asked if this was normal. I instructed pt to get the vaccination site looked at by MD, classic description of cellulitus. Patient said she would go to urgent care to have it looked at and will report back to us with any findings. Initiating Vaers reporting, will update as needed once additional information is obtained.


VAERS ID: 1569315 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Utah  
Vaccinated:2021-08-15
Onset:2021-08-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 181286 / 1 RA / IM

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

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

Write-up: Patient had a brief vasovagal episode about 10 min post vaccination with symptoms of lightheadedness, dizziness, sweating and brief syncope lasting about 2minutes. Girlfriend present during episode as well as nurse. Nurse practitioner was called to site during reaction. Patient advised to lay on bed. Symptoms completely resolved. Advised to wait the full 15min. onsite.


VAERS ID: 1569317 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-15
Onset:2021-08-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 LA / IM

Administered by: Public       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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Brotixin
Current Illness: N/A
Preexisting Conditions: A history of anxiety and depression.
Allergies: N/A
Diagnostic Lab Data:
CDC Split Type:

Write-up: History of fear of needles, feeling faint after receiving the J&J vaccine. SOB 97.9 , B/P - Refused, p-88 . R-19


VAERS ID: 1569320 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-08-12
Onset:2021-08-15
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-08-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052E21A / 1 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Eye swelling, Taste disorder
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NOT KNOWN
Current Illness: NOT KNOWN
Preexisting Conditions: NOT KNOWN
Allergies: NOT KNOWN
Diagnostic Lab Data:
CDC Split Type:

Write-up: funny taste in mouth, swollen left eye, and lightheaded. told patient to use advil 400 mg and ice on the eye


VAERS ID: 1569918 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-14
Onset:2021-08-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052E21A / 7+ RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache, Injection site pain, Palpitations
SMQs:, Arrhythmia related investigations, signs and symptoms (broad), Extravasation events (injections, infusions and implants) (broad), Cardiomyopathy (broad)

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

Write-up: Patient''s husband called and told me that her wife has headache, pain in site of injection and heat palpitation following the yesterdays'' 2nd Moderna covid 19 vaccine immunization. I told him pain with immunization is a usual side effect of vaccine , however for heart palpitation, she may may need see a Doctor , and if necessary need to visit Emergency room.


VAERS ID: 1569920 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-08-15
Onset:2021-08-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052E21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Syringe issue
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: unknown
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Needle /syringe was faulty and injection came out of back of needle; pt did not receive dose; Prepared another dose and successfully gave immunization to pt because he did not receive faulty dose


VAERS ID: 1569925 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-08-11
Onset:2021-08-15
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-08-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cardiac flutter, Chest pain, Dyspnoea
SMQs:, Anaphylactic reaction (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Tachyarrhythmia terms, nonspecific (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: Chest pain Shortness of pain Fluttering in chest


VAERS ID: 1570765 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-15
Onset:2021-08-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002F21A / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Dizziness, Loss of consciousness, Nausea, Pallor, Tremor
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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? 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: latex
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was nervous before the shot. She felt fine after the shot but a few minutes later started feeling lightheaded and turned pale. Patient then lost consciousness for a few seconds and was shaking but regained consciousness. She was pale and nauseated. We gave her an ice pack and just had her remain sitting in her chair. 911 was called and we were told not to move her. The EMTs arrived within 10 minutes of the incident and took over patient''s care.


VAERS ID: 1570766 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-15
Onset:2021-08-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 2 LA / IM

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

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

Write-up: 2nd dose of Pfizer vaccine was given on 16th day after first dose. Informed consent questionnaire was reviewed by RPh. Pt''s guardian did not indicate that any prior COVID vaccine received when asked on the form. Pharmacy will implement strategies such as reviewing form verbally with parent and checking health agency website.


VAERS ID: 1570767 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-01
Onset:2021-08-15
   Days after vaccination:106
Submitted: 0000-00-00
Entered: 2021-08-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Hypoxia, Nausea, SARS-CoV-2 test positive, Vomiting
SMQs:, Acute pancreatitis (broad), Asthma/bronchospasm (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Respiratory failure (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: insulin, tylenol
Current Illness: n/a
Preexisting Conditions: diabetes, obesity
Allergies: Eggs. Watermelon
Diagnostic Lab Data: Test positive 8/15/21
CDC Split Type:

Write-up: Hospitalization for Covid-19 on 8/15/21. Mild hypoxia, n/v at presentation- day 4 of symptoms


VAERS ID: 1570768 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-14
Onset:2021-08-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Back pain, Breast pain, Fatigue, Lymphadenopathy, Migraine, Pyrexia, X-ray
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Lipodystrophy (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? Yes
Hospitalized? No
Previous Vaccinations: Under arm lymph node swelling and breast pain
Other Medications: Adderal
Current Illness:
Preexisting Conditions: Family history of cancer (colorectal and T cell Lymphoma)
Allergies: No
Diagnostic Lab Data: X-ray 8/11
CDC Split Type:

Write-up: Under arm lymph node swelling Breast pain Lower back pain Fatigue Fever Migraines


VAERS ID: 1570777 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-08-15
Onset:2021-08-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040C21A / 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: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Patient came in asking for moderna 1st dose. checked registry and showed no dose given. Asked verbally if pt received another dose before and they said no. When processing the claim insurance said they received Janssen 4/8/21 at pharmacy. Confirmed with pharmacy


VAERS ID: 1570782 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-08-04
Onset:2021-08-15
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-08-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 088D21A / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Injection site rash
SMQs:, Hypersensitivity (narrow)

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

Write-up: Large rash above my upper arm where the vaccine was injected


VAERS ID: 1571053 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Montana  
Vaccinated:2021-08-15
Onset:2021-08-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Feeling hot, Hyperhidrosis, Tinnitus, Tunnel vision
SMQs:, Neuroleptic malignant syndrome (broad), Optic nerve disorders (broad), Retinal disorders (narrow), Hearing impairment (narrow), Hypoglycaemia (broad)

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

Write-up: Approximately 7 minutes after the patient received the Pfizer COVID-19 vaccine, she reported feeling very hot, was sweating, had visual disturbances (tunnel vision), and ringing in her ears. She was seated at the time, was conscious, and aware of her surroundings. She was provided cold water and a towel, and was given and agreed to take 10mL of diphenhydramine based on a possible injection arm reaction. After about 5 minutes of me talking with her, the sweating resolved and her body temperature returned to normal, including the color in her arm. I kept her for observation for an additional 15-20 minutes and confirmed she was ok upon leaving the pharmacy.


VAERS ID: 1571059 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-08-15
Onset:2021-08-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Headache, Pain in extremity, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Pfizer covid vaccines, same side effects
Other Medications: Humira, Zoloft, buspirone, multivitamin, Claritin, trazodone,
Current Illness: No
Preexisting Conditions: Rheumatoid arthritis
Allergies: Enbrel
Diagnostic Lab Data:
CDC Split Type:

Write-up: Sore arm, fever, headache, fatigue


VAERS ID: 1571063 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-15
Onset:2021-08-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037C21A / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Anxiety, Condition aggravated, 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:
Current Illness:
Preexisting Conditions: Anxiety
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Client reported dizziness. The client ambulated and sat down in the anti-gravity chair. Vitals obtained at 1:25 PM were as follows: BP 128/83, HR 93, O2 98%. The client reported a history of anxiety, which he stopped taking his medications for. Repeat vitals obtained at 1:30 PM were as follows: O2 95%, HR 91, BP 139/79. The client stated the dizziness was getting better and was sitting upright in the anti-gravity chair. Repeat vitals obtained at 1:37PM were as follows: O2 97%, HR 94, BP 140/88. The client denied any persistent dizziness and stated he was calm. The client asked to leave at 1:44 PM. At that time the client stated he was feeling better and stated his anxiety was under control.


VAERS ID: 1571068 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-13
Onset:2021-08-15
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test, Chest X-ray, Electrocardiogram, Palpitations, Tachycardia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Chest X-ray, Blood work, EKG (8/15/2021)
CDC Split Type:

Write-up: Tachycardia and heart palpitations


VAERS ID: 1571220 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-13
Onset:2021-08-15
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Erythema, Rash, Skin warm, Tenderness
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: levothyroxine 200mg
Current Illness: none
Preexisting Conditions: thyroidectomy
Allergies: omega 3 and omega 6 fatty acids. eggs, almonds, walnuts, broccoli, mango, fish, shellfish, steak red meat. medication allergies: All NSAIDS (motrin, naproxen, asprin, celebrex, vioxx) flexeril
Diagnostic Lab Data:
CDC Split Type:

Write-up: it started as a small 1 inch red line and blew up into a huge itchy rash. extremely painful to touch. and very hot feeling on the skin like a sunburn. it grew in 12 hours to 5 inches across and about 4 inches down.


VAERS ID: 1573581 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-08-14
Onset:2021-08-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Fatigue, Headache, Lymphadenopathy, Malaise, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Headache, fatigue, fever, body aches, lightheaded and swollen lymph node in armpit of arm shot was injected in. She has been taking ibuprofen and outcome still undetermined as it?s been 39 hours since she was administered shot and still not feeling well.


VAERS ID: 1573582 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-08-10
Onset:2021-08-15
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Laboratory test, Magnetic resonance imaging, Sacroiliitis, Urine analysis
SMQs:, Arthritis (narrow)

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

Write-up: Sacroiliitis


VAERS ID: 1573586 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-08-15
Onset:2021-08-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 LA / IM

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

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, Additional Details: The patient was reaaly terrified about getting the Vaccine but mom decided to go ahead since his older brother got it and was fine. After the vaccination patient was fine and I moved her to the waiting area. it was at this point she fainted and fell to the ground. she did hit her head on the floor before I could catch her. I called the paramedics and after evaluations she checked out ok and all her vitals were great. Mom opted to take the patient home instead of going to the hospital


VAERS ID: 1573610 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-08-15
Onset:2021-08-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1820096 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Site: Pain at Injection Site-Medium, Additional Details: Patient''s symptoms resolved within about 40 minutes after vaccination given. EMS was called. Patient stabilized and refused ER visit/


VAERS ID: 1573612 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-08-15
Onset:2021-08-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal discomfort, Hypoaesthesia, Syncope, Unresponsive to stimuli, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Sexual dysfunction (broad)

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

Write-up: Systemic: Fainting / Unresponsive-Mild, Systemic: Numbness (specify: facial area, extremities)-Mild, Additional Details: Patient fainted about 12 minutes after receiving vaccine. She had numbness in her left hand and started to feel sick to her stomach, then fainted. She became responsive, and slowly started to feel better. Patient vomited a very small amount approximately 3 minutes after becoming responsive, then felt better immediately.


VAERS ID: 1573615 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-08-15
Onset:2021-08-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 LA / IM

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

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

Write-up: Systemic: Fainting / Unresponsive-Mild, Systemic: Flushed / Sweating-Mild, Systemic: Hypotension-Mild


VAERS ID: 1573616 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-08-15
Onset:2021-08-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 2 RA / IM

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

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

Write-up: Error: Diluent Administered Instead of Vaccine-


VAERS ID: 1573617 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-08-15
Onset:2021-08-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 LA / IM

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

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

Write-up: Systemic: Fainting / Unresponsive-Mild, Systemic: Flushed / Sweating-Severe, Additional Details: Patient got her vaccine and was fine but she started turning pale while she was in the the waiting area. I offered her some water to keep her hydrated and tried taking her bllod pressure but she fainted before I could get that. I laid her down on the floor, elevated her feet while my technician called 911. she Regained consciousness before paramedics arrived. They took her blood pressure and everying was withing range. she opted out of going to the hospital and was fine before she left.


VAERS ID: 1573618 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-08-15
Onset:2021-08-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 066D21A / 1 LA / IM

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

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

Write-up: Systemic: Dizziness / Lightheadness-Severe, Systemic: Fainting / Unresponsive-Severe, Systemic: Flushed / Sweating-Medium, Systemic: Headache-Mild, Systemic: Shakiness-Medium, Systemic: Tingling (specify: facial area, extemities)-Mild, Additional Details: Patient suddenly fainted while seated during observation, about 5-10 minutes after moderna shot.I (RPh) tried to catch his fall but did not catch him in time, he fell and hit his head on the floor.Regained consciousness within about a minute or so,but had a small cut in his head which stopped bleeding quickly.Had him seated while waiting for 911 but he got lightheaded again,had him lie down on floor till EMS arrived.


VAERS ID: 1573620 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Utah  
Vaccinated:2021-08-15
Onset:2021-08-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 181286 / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Flushing, Hyperhidrosis, Presyncope, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Dizziness / Lightheadness-Mild, Systemic: Fainting / Unresponsive-Mild, Systemic: Flushed / Sweating-Mild, Additional Details: Patient had a brief (approx 2min) episode of vasovagal syncope while waiting post vaccine in the wait area. Symptoms occurred approximately 10min post vaccine and fully resolved at the end of his wait period. Patient c/o dizziness, sweating and had brief syncope. patient was advised to lay down in bed. Vaccine administered by LPN.


VAERS ID: 1573621 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-08-15
Onset:2021-08-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 LA / IM

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

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

Write-up: Error: Diluent Administered Instead of Vaccine-


VAERS ID: 1573622 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-08-15
Onset:2021-08-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 066D21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Flushing, Headache, Hyperhidrosis, Paraesthesia, Syncope, Tremor
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Dizziness / Lightheadness-Severe, Systemic: Fainting / Unresponsive-Severe, Systemic: Flushed / Sweating-Medium, Systemic: Headache-Mild, Systemic: Shakiness-Medium, Systemic: Tingling (specify: facial area, extemities)-Mild


VAERS ID: 1573625 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-08-15
Onset:2021-08-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017E21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Erythema, Head injury, Syncope, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Fainting / Unresponsive-Mild, Additional Details: Patient fainted for less than a minute. She hit the right side of her head. It was red but no bruising. Observered for 30 minutes. She stated that she had a history of fainting in relation to blood


VAERS ID: 1573626 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-15
Onset:2021-08-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 088D21A / 2 LA / IM

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

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

Write-up: Systemic: Tinnitus-Mild, Additional Details: Patient reports mild ringing in her left ear and that she can''t hear as well. She first noticed symptom at 4:30pm (about 3-4 hrs after 2nd dose of Moderna)


VAERS ID: 1573629 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-15
Onset:2021-08-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Hizentra Humira Lefunamide Synthroid
Current Illness: na
Preexisting Conditions: stiff person Hashimoto Ra Autonomic gangliopathy
Allergies: sulpha Adhesive
Diagnostic Lab Data:
CDC Split Type:

Write-up: Booster had swelling Ang itching within three hours of injection. No fever at this point. Did not have this reaction prior. Short was one day after hizentra treatment. Doing fine with otc but felt it should be reported


VAERS ID: 1573630 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-05-15
Onset:2021-08-15
   Days after vaccination:92
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Confusional state, Dizziness, Fatigue, Flushing, Hyperhidrosis, Hypotension, Lethargy, Loss of consciousness, Syncope, Tachycardia, Tremor, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (narrow), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (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: Confusion-Medium, Systemic: Dizziness / Lightheadness-Severe, Systemic: Exhaustion / Lethargy-Severe, Systemic: Fainting / Unresponsive-Severe, Systemic: Flushed / Sweating-Medium, Systemic: Hypotension-Mild, Systemic: Shakiness-Medium, Systemic: Tachycardia-Mild, Additional Details: patient complained of dizziness, became tachycardic (130-145bpm) lost consciousness for 30 to 45 seconds, once in supine position became conscious, blood pressure measured x 3 (wnl) HR monitored x 15min (wnl). pt obtained ride home with girlfriend. she will continue to monitor for next 24 hours.


VAERS ID: 1573801 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-08-13
Onset:2021-08-15
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 LA / SYR

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

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

Write-up: Chills, body aches, fever, and headache


VAERS ID: 1573810 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-08-12
Onset:2021-08-15
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Alanine aminotransferase increased, Aspartate aminotransferase increased, C-reactive protein increased, Cardiac monitoring, Chest X-ray normal, Chest pain, Dyspnoea, Echocardiogram normal, Electrocardiogram ST segment elevation, Head discomfort, Headache, Intensive care, Pain, Pericarditis, SARS-CoV-2 test negative, Troponin increased, White blood cell count increased
SMQs:, Liver related investigations, signs and symptoms (narrow), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Myocardial infarction (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 8/16 CVICU note: Diagnoses Pericarditis I31.9 Assessment/Plan 15 year old perviously healthy male who presents with chest pain, ST segment elevation and elevated troponin after receiving his second Covid vaccine (Pfizer) on Thursday. CV/Pulm: - Cardiorespiratory monitoring - Cardiology consult - EKG- ST, HR 127 with ST segment elevation - ECHO normal structure and biventricular function - Troponin 17.5, trend q 6 hours - Currently on RA with sats $g95% - CXR- No cardiomegaly, no pulm edema or evidence of pneumonia FEN/GI: - Resume diet for age - AST/ALT mildly elevated, will trend Heme/ID: - Monitor for fevers - ID consult, no indication for IVIG at this time although awaiting for ECHO results - Resp PCR + Covid negative - No need for antibiotics at this time - WBC 16, CRP 55, will trend - Will need to report to VAERS database one mom brings Vaccine card
CDC Split Type:

Write-up: 15 y/o M presents to the ED with chest pain onset 1 day ago. Per mom the pt received his second dose of the COVID-19 vaccine 3 days ago. Pt developed headaches, "head pressure," body aches, and pain 2 days ago. Pt developed chest pain and SOB 1 day ago. The chest pain and SOB worsened this morning. Pt reports the chest pain is exacerbated when he lays down. Denies fever.


VAERS ID: 1573812 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-02-05
Onset:2021-08-15
   Days after vaccination:191
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007M20A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010A21A / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory failure, COVID-19 pneumonia, Cough, Dyspnoea, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: albuterol 2.5mg/3mL (0..083%) inhalation solution nebulized q6hr amlodipine 10mg PO qday Aspirin enteric coated 325mg PO qday EPA fish oil 1000mg PO bid hydroclorothiazide25mg PO day lovastatin 40mg PO day multivitamin PO day Proair HFA 90
Current Illness:
Preexisting Conditions: emphysema/COPD essential hypertension left ventricular hypertrophy osteoarthritis paraplegia, incomplete obesity prediabetes vitamin D deficiency
Allergies: NKMA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt is being admitted for acute hypoxic respiratory failure secondary to COVID pneumonia. Patient developed shortness of breath, fever/chills, and cough that started about 5 days ago. He just returned from a cruise yesterday and reports that he was COVID negative 5 days ago.


VAERS ID: 1573824 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-01-30
Onset:2021-08-15
   Days after vaccination:197
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3249 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Exposure to SARS-CoV-2, Fatigue
SMQs:, COVID-19 (narrow)

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

Write-up: He presented to the ED for fatigue. Had recent exposure to a family member who was COVID-19 positive. Denies fever, shortness of breath, or any other symptoms. Was able to be discharged home.


VAERS ID: 1573827 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-02-19
Onset:2021-08-15
   Days after vaccination:177
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006M20A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, COVID-19, Cough, SARS-CoV-2 test positive, Vaccine breakthrough infection
SMQs:, Anaphylactic reaction (broad), Guillain-Barre syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: degenerative disc disease, fibromyalgia, hyperlipidemia, hypertension, TIA, stroke
Allergies: pentazocine (hallucinations), nitrofurantoin (rash)
Diagnostic Lab Data: 8/15 SARS-CoV-2 Detected by Roche COBAS Liat system
CDC Split Type:

Write-up: Breakthrough COVID in fully vaccinated patient requiring hospitalization, patient admitted with weakness and cough, requiring 2L O2


VAERS ID: 1573829 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-01-30
Onset:2021-08-15
   Days after vaccination:197
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3249 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Dyspnoea, Exposure to SARS-CoV-2
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), COVID-19 (narrow)

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

Write-up: She presented to the ED for concerns of COVID-19. Four day history of shortness of breath and weakness. Recent exposure to family member who was positive for COVID. She was able to be discharged home.


VAERS ID: 1573864 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-08-07
Onset:2021-08-15
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

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

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

Write-up: Swelling, tough, itchy lump on skin on left shoulder around injection site.


VAERS ID: 1573867 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-03-07
Onset:2021-08-15
   Days after vaccination:161
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6202 / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: amLODIPine 5 mg Tablet Directions: 1 tablet oral daily (Active) aspirin 81 mg tablet,chewable Directions: 1 tablet oral daily (Active) atorvastatin 20 mg Tablet Directions: 1 tablet oral daily at bedtime (Active) multivitamin with foL
Current Illness:
Preexisting Conditions: COPD, Dyslipidemia, HTN; osteopenia, arthritis, sciatic, herniated discs. R THA, lumpectomy R, benign tumor removed from back, B/L cataract surgery.
Allergies: Ibuprofen
Diagnostic Lab Data: 8/14 - COVID 19 Antigen (-) 8/14 COVID 19 PCR (+)
CDC Split Type:

Write-up: Patient admitted to hospital with being treated with remdesivir and dexamethasone. COVID 19 Antigen (-) , PCR (+)


VAERS ID: 1573882 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-03-16
Onset:2021-08-15
   Days after vaccination:152
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805031 / 1 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, COVID-19, Cough, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Guillain-Barre syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: insulin degludec 100 unit/mL (3 mL) Insulin Pen Directions: 66 unit subcutaneous daily every morning (Active) ramipril 5 mg Capsule Directions: 1 capsule oral twice a day (Active) semaglutide (Ozempic) 0.25 mg or 0.5 mg dose (2 mg/1.5
Current Illness:
Preexisting Conditions: CKD, diabetes mellitus, hypertension, obesity
Allergies: Ibuprofen
Diagnostic Lab Data: COVID 19 PCR (-) 06/21/2021 and 07/19/2021 COVID-19 Antigen (+) 08/14/2021 COVID-19 PCR (+) 08/14/2021
CDC Split Type:

Write-up: Admitted after returning and feeling weak with cough.


VAERS ID: 1573929 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-04-18
Onset:2021-08-15
   Days after vaccination:119
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: Kidney Transplant 7 years ago
Allergies: no
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt recieved vaccines in march and april. Pt was hospitalized on 08/15 with a covid diagnosis


VAERS ID: 1573942 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-15
Onset:2021-08-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Hyperhidrosis, Muscle spasms, Nausea, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dystonia (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Patient became dizzy and fainted a few minutes after getting shot. Pt got sweaty, stated nauseous and said he felt like his hands felt crampy. Patient sat for about 10 to 15 minutes and stated feeling fine.


VAERS ID: 1573958 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-08-12
Onset:2021-08-15
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Skin mass, Tenderness
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: Losartan 25mg, Estradiol 1mg, Viviscal PRO manufactured by Church & Dwight, Amino Energy manufactured by Optimum Nutrition
Current Illness: N/A
Preexisting Conditions: Leaking Mitral Valve
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Approximately 1/2 inch lump above left collarbone and is sore to the touch


VAERS ID: 1573977 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-02-27
Onset:2021-08-15
   Days after vaccination:169
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012A21A / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Levothyroxine 112 micrograms po daily Famotidine 40 mg po daily sucralfate 1 gram po BID
Current Illness:
Preexisting Conditions: Hypothrydoisism, meniscal tear, partial lobectomy for benign lung lesion
Allergies: NKDA
Diagnostic Lab Data: COVID-19 Antigen POSITIVE 08/15/2021
CDC Split Type:

Write-up: Admitted with ++COVID-19 testing 0n 08/15/2021


VAERS ID: 1573979 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-15
Onset:2021-08-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 1 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Aleve, vitamin D3, Zinc
Current Illness: None
Preexisting Conditions:
Allergies: Latex
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Metallic/medicinal taste in mouth, no treatment


VAERS ID: 1573984 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-08-11
Onset:2021-08-15
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Disorientation, Eye pain, Fatigue, Injection site mass, Injection site pain, Lymphadenopathy, Musculoskeletal stiffness, Oropharyngeal pain, Pain, Sleep disorder, Swelling
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Dystonia (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Glaucoma (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Daily birth control tablets, 10-20mg Adderall daily
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: Codeine derivitives
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: About 2-3 hours after the first shot, I was extremely tired and disoriented but was unable to sleep. That lasted through Saturday. Now yesterday I started to develop an extremely sore throat with a swollen neck and lymph nodes. The exhaustion has returned and it hurts to keep my eyes open. The injection site has been sore with a lump since the day I got it. My shoulders and chest feel stiff and tight and it hurts to move. Please note that I tested positive for COVID-19 back in April and this was way worse than any symptoms I experienced back then. Stop forcing people to put an unapproved "vaccine" into their bodies, this is so wrong.


VAERS ID: 1574033 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-08-10
Onset:2021-08-15
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 041A21A / 1 RA / IM

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

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

Write-up: On day 5 following vaccination (8/15/21), patient began to develop an itchy rash on multiple areas of the body. On day 6 (8/16/21) rash was covering entire body from head to toes and patient was experiencing intense itching everywhere. He called the pharmacy for advice and to report this rash on 8/16/21 at 12:20pm and had already taken diphenhydramine. I recommended he try to get in to see his primary care, have a teledoc visit or go to urgent care. He was not having any swelling of the face, tongue, lips or throat and was not having difficulty breathing.


VAERS ID: 1574036 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-14
Onset:2021-08-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0169 / 1 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypoaesthesia, Pain in extremity
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Tendinopathies and ligament disorders (broad), Sexual dysfunction (broad)

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

Write-up: Sore arm, numb sensation to thumb.


VAERS ID: 1574041 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-04-29
Onset:2021-08-15
   Days after vaccination:108
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021B21A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039B21A / 2 - / -

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

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

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


VAERS ID: 1574043 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-08-14
Onset:2021-08-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Arthralgia, Chest pain, Chills, Dizziness, Fatigue, Hyperhidrosis, Nausea, Pain, Pyrexia, Vision blurred
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Pt. states that after receiving the 1st dose of J&J 08/14/2021, symptoms started 08/15/2021 02:00am experiencing body aches throughout the body, joints and shoulders with extreme, chills, feverish, sweating, nausea, dizziness, blurry vision, and extreme fatigue. Sharp chest pains running through the chest, subsided by 08/16/2021. Still experiencing symptoms. No noted Primary visit noted.


VAERS ID: 1574052 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-08-09
Onset:2021-08-15
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 088D21A / 1 LA / IM

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

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

Write-up: Painful swelling of the lymph node in my left armpit.


VAERS ID: 1574076 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-01-27
Onset:2021-08-15
   Days after vaccination:200
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / 2 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9264 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, COVID-19, Dyspnoea, Productive cough, Pyrexia, SARS-CoV-2 test positive, Sputum discoloured
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Non-Hospital Dyslipidemia Microcytosis Red Blood Cell Diabetes Mellitus Type 2 Hyperglycemia Tachycardia Supraventricular Paroxysmal Primary Osteoarthritis Knee Bilateral Incontinence Urinary Rotator Cuff Disorder Left Pain Low Back Incontinence Urinary Stress And Urge Dyspnea Hypertension And Chronic Kidney Disease Stage 2 Other Elevated White Blood Cell Count Other Specified Anemias Dermatitis Allergic Deficiency Iron Long Term Use Of Insulin Active Edema Post Traumatic Osteoarthritis Knee Bilateral Cellulitis Pain Right Upper Quadrant Lightheadedness Nodule Thyroid Hypertensive Heart Disease Without Heart Failure Hypertensive Urgency Osteoporosis Fracture Lumbar First Wedge Compression Closed Initial
Allergies:
Diagnostic Lab Data: Coronavirus 2 PCR Detect, V symptomatic POSITIVE
CDC Split Type:

Write-up: presented to ED 8/15 with following: Patient is a 86 y.o. female who presents with shortness of breath, cough, and weakness for the past 2 weeks. The patient has a past medical history notable for hypertension, hyperlipidemia, insulin-dependent type 2 diabetes mellitus, paroxysmal atrial fibrillation. The patient was in her normal state of health until about 2 weeks ago. She has unsure exactly when her symptoms started but reports that she has been coughing with scant productive yellow sputum. She developed shortness of breath over the past few days. She also endorses subjective fever and weakness, but denies chills, chest pain, palpitations.


VAERS ID: 1574087 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-08-15
Onset:2021-08-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

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

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

Write-up: Injection site pain/ soreness Fever- 103.4 Headache- moderate to severe Chills


VAERS ID: 1574157 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-08-07
Onset:2021-08-15
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 091D21A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Suboxone, advil
Current Illness: ill 2 weeks prior w/ body aches for 24 hrs.
Preexisting Conditions: chronic low back pain/neck
Allergies: codeine, chocolate, inapsine, beta blockers
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Pt experienced a rash and extreme soreness around injection site. Size of a quarter


VAERS ID: 1574194 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-04-30
Onset:2021-08-15
   Days after vaccination:107
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002C21A / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Ageusia, Anosmia, COVID-19, COVID-19 pneumonia, Cough, Diarrhoea, Dyspnoea, Hypoxia, PCO2 increased, Pyrexia, Sepsis
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Noninfectious diarrhoea (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Sepsis (narrow), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: UNKNOWN
Current Illness: UNKNOWN
Preexisting Conditions: HYPERTENSION, CORONARY ARTERY DISEASE
Allergies: IODINE, BACTRIM CIPRO, MACROBID
Diagnostic Lab Data: PATIENT REC''D MODERNA VACCINE: 4/1/21 FROM PHARMACY LOT # 020B21A 4/30/21 FROM PHARMACY LOT # 002C21A
CDC Split Type:

Write-up: 8/12/21 PT PRESENTED TO MEDICAL CENTER FOR FEVER AND SHORTNESS OF BREATH. DISCHARGED HOME ON IVERMECTIN AND ZOFRAN BUT PT DID NOT FILL MEDICATIONS. 8/13/21: PT WENT TO ER DUE TO HYPOXI, SEPSIS AND BILATERAL COVID 19 PNA. PT REPORTS SHE WAS DIAGNOSED ONE WEEK PRIOR TO PRESENTATION TO THE ER. REPORTED FEVERS, LOSS OF TASTE AND SMELL AND HAS DIARRHEA. DRY COUGH AND SHORT OF BREATH. TREATMENT INCLDUED ONE DOSE OF REGENERON AND DISCHARGED HOME 8/14/21 RETURN TO ED WITH INCREASE IN SHORTNESS OF BREATH . PCO2 = 53 REQUIRED OXYGEN 4 L. REC''D REMDESIVEIR 200MG, DECADRON 10 MG, LEVAQUIN, ALBUTEROL AND TYLENOL AND TRANSFER TO MEDICAL CENTER FOR HIGHER LEVEL OF CARE.


VAERS ID: 1574239 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-01-09
Onset:2021-08-15
   Days after vaccination:218
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK9231 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Ageusia, Anosmia, Chills, Headache, Myalgia, Nasal congestion, Pain, Pyrexia, Rhinorrhoea, SARS-CoV-2 test
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: hydrOXYzine HCl (ATARAX) 25 mg tablet PARoxetine (PAXIL) 40 mg tablet
Current Illness: None
Preexisting Conditions: Infectious/Inflammatory Warts Other Anxiety Depression, unspecified depression type Preventative health care
Allergies: No Known Allergies
Diagnostic Lab Data: COVID-19 PCR
CDC Split Type:

Write-up: Fever or Chills Muscle or body aches Headache New loss of taste or smell Congestion or running nose


VAERS ID: 1574249 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-04-01
Onset:2021-08-15
   Days after vaccination:136
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003B21A / 2 - / -

Administered by: Public       Purchased by: ?
Symptoms: Asthenia, COVID-19, COVID-19 pneumonia, Dyspnoea, Pneumonia, Respiratory failure, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: UNKNOWN
Current Illness: UNKNOWN
Preexisting Conditions: COPD
Allergies: SULFA DRUGS
Diagnostic Lab Data: 8/15/2021 COVID PCR = DETECTED.
CDC Split Type:

Write-up: PATIENT WITH CHRONIC HYPOXIC RESP FAILURE WITH HOME O2 AT 4L. HAD RECENT HOSPITALIZATION FOR COVID PNE. PRESENTED TO A MEDICAL CENTER DUE TO WORSENING SHORTNESS OF BREATH. O2 INCREASED TO 7L INCREASE WEAKNESS NOTED. EMS CALLED AND BROUGHT TO ER. PATIENT TRANSFERRED TO ANOTHER MEDICAL CENTER FOR HIGHER LEVEL OF CARE. PT DIAGNOSED WITH BILATERAL PNEUMONIA.


VAERS ID: 1574266 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-14
Onset:2021-08-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Breast pain, Lymphadenopathy
SMQs:, Lipodystrophy (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: Flu Vaccine: Developed bronchitis
Other Medications: Metformin 500 mg (once daily) Bupropion XL 100mg (once daily) Vitamin E (once daily) Milphistle 250 mg (once daily)
Current Illness: Diabetes
Preexisting Conditions: Diabetes
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Swollen glands from neck to under arm, side of breasts hurts as well


VAERS ID: 1574268 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-08-15
Onset:2021-08-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Fatigue, Nausea, Pain, Pain in extremity
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Tendinopathies and ligament disorders (broad)

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

Write-up: severe arm soreness, nausea, body aches, fatigue


VAERS ID: 1574274 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-08-15
Onset:2021-08-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 091D21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Hyperhidrosis, Product administered to patient of inappropriate age
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Medication errors (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: NKA
Current Illness: none
Preexisting Conditions: none
Allergies: NKA
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: Patient was provided a moderna covid 19 vaccination in error. Patient is 16 years of age. Mother was present at time of vaccination. Mother informed immunizer that patient has a history of fainting after vaccinations. Patient was observed for 30 minutes after vaccination. patient experienced dizziness and became sweaty. Patient was provided water and was eased to floor to lay on her back. Patient did not loose consciousness. Patient was monitored and was determined to have recovered from dizziness episode and walked with mother to car to be driven home.


VAERS ID: 1574278 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-15
Onset:2021-08-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 LA / -

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Headache, Nausea, Neck pain, Pain, Pain in extremity
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Arthritis (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: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: severe arm soreness, neck pain, body aches, nausea, headache, dizziness


VAERS ID: 1574320 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-14
Onset:2021-08-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Headache, Muscle fatigue, Myalgia, Nausea, Pain, Pyrexia, Rash, Rash papular, Urticaria
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (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:
Current Illness:
Preexisting Conditions: Mixed connective tissue disease, lupus and sjogrens antibodies, chronic migraine, raynauds
Allergies: Phenol, sulfa
Diagnostic Lab Data:
CDC Split Type:

Write-up: High fever 101-103 within 12 hours, lasting for more than 36 hours so far, complete body muscle fatigue and pain, headache, dizziness, hives/swollen rash across chest, nausea


VAERS ID: 1574347 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-08-14
Onset:2021-08-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Diarrhoea, Eye pain, Skin burning sensation
SMQs:, Peripheral neuropathy (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Noninfectious diarrhoea (narrow)

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

Write-up: Both times I got vaccinated I had/had horrible diarrhea my skin burns and my eyes hurt


VAERS ID: 1574378 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-30
Onset:2021-08-15
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 - / IM

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

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

Write-up: Pt received Pfizer vaccine x1. Admitted into the hospital for COVID on 8/16/21. Pt is currently being treated with remdesivir and dexamethasone.


VAERS ID: 1574492 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-02-19
Onset:2021-08-15
   Days after vaccination:177
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN9581 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Bacterial test, Chest X-ray, Differential white blood cell count, Fall, Full blood count, Metabolic function test, Mobility decreased, Urine analysis, X-ray, X-ray of pelvis and hip
SMQs:, Parkinson-like events (broad), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: CBC with differential, BMP, urinalysis, bacterial culture, xray of chest, knee, pelvis, sacrum,
CDC Split Type:

Write-up: fall, leg often and suddenly giving out, unable to get up on his own.


VAERS ID: 1574565 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-08-14
Onset:2021-08-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Dysstasia, Immunosuppression, Injection site pain, Myalgia, Pain in extremity, Vertigo positional
SMQs:, Rhabdomyolysis/myopathy (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Eosinophilic pneumonia (broad), Vestibular disorders (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Humalog Insulin (pump) Atorvastatin Bupropion Duloxetine Estroven Gabapentin Pantoprazole Phentermine Vitamin D Multivitamin Sulfasalazine
Current Illness: Type 1 Diabetes Ulcerative Colitis GERD Barrett?s Esophagus Fibromyalgia Recent positive ANA with Anti-dsDNA 1:640 ratio Atopic scalp dermatitis of unknown origin
Preexisting Conditions: See above
Allergies: Phenergan Peanuts
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Soreness at injection site and right arm. Muscle aches. Unable to stand or walk the next morning at 7am due to positional vertigo and dizziness. When attempted to stand also feelings of passing out until dropping to the ground and lying still. Blood sugar was 147 and stable at the time of the incident. Positional Vertigo has continued throughout 2nd day, but it slowly improving. No vertigo or dizziness with first two COVID-19 immunizations. I am immunosuppressed and take a biologic, but did not have a biologic in my system at time of vaccine as we are in the process of changing biologics.


VAERS ID: 1574636 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: New Hampshire  
Vaccinated:2021-08-08
Onset:2021-08-15
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 091D21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Erythema, Rash, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: The patient started to see a rash and some swelling on Sunday 08/15 in the morning about 7 days after the vaccine, reported the reaction, reports today that the reaction swelling has decreased as well as the redness in color but the size has increased a little.


VAERS ID: 1574876 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-12
Onset:2021-08-15
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Blood fibrinogen normal, Blood urine, Exposure during pregnancy, Full blood count normal, Sleep disorder, Urine analysis abnormal, Uterine pain, Uterine spasm, Vulvovaginal discomfort
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (narrow), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), 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: None
Current Illness: None
Preexisting Conditions: - Hx of a PE at age 18 (birth control related); was on Lovenox at the beginning of the pregnancy, but it was discontinued in June - Asthma - Cervical rediculopathy after physical abuse incident - Major depressive disorder - Migraine - Hx of polysubstance abuse (several years ago)
Allergies: Allergic to Buspar (rash) and ibuprofen (vomiting, rash)
Diagnostic Lab Data: CBC (8/16/21) normal for pregnancy Fibrinogen (8/16/21) normal for pregnancy UA (8/16/21) trace blood, otherwise normal
CDC Split Type:

Write-up: This is patients second pregnancy. Her due date is 11/19/21. She came in today complaining of intense uterine contractions that felt like tightening and period cramps and were causing intense vaginal pressure. This pain had been occurring every 2-10 minutes for almost 24 hours, it was so bad she could not sleep. According to the TOCO monitor and my assessment she was not contracting. The fetal heart rate was appropriate for the gestational age. Her cervix was not dilated or effaced. She was not bleeding or leaking fluid and the baby was active.


VAERS ID: 1574880 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-05-21
Onset:2021-08-15
   Days after vaccination:86
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory failure, COVID-19, COVID-19 pneumonia, Chills, Cough, Diarrhoea, Headache, Hepatitis acute, Hypoxia, Myalgia, Pyrexia, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Hepatitis, non-infectious (narrow), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Noninfectious diarrhoea (narrow), Respiratory failure (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Baby aspirin, cetrizine, levothyroxine
Current Illness:
Preexisting Conditions: Pre-diabetes, hypothyroidism, obesity
Allergies: NKDA
Diagnostic Lab Data: COVID status positive on 8/15/21 upon admission.
CDC Split Type:

Write-up: Patient received COVID vaccine Pfizer 2 dose series on 4/30/21 and 5/21/21. . Patient was on a cruise, returned 8/3/21. About 3-4 days after that she started having cough, headache, fevers, and mild chills. She tested positive for COVID-19 at a testing center on 8/11/21. She since then has developed some diarrhea, headache, myalgias. She continues to have subjective fevers but this is improving. She denies much of anosmia, anorexia. She started having hypoxia down to mid-80s on home pulse oximetry and was admitted to our facility on 8/15/21 for COVID-19 severe pneumonia with acute hypoxic respiratory failure and acute hepatitis. As of today (8/16), patient is still admitted.


VAERS ID: 1575065 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-08-15
Onset:2021-08-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 AR / IM

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

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

Write-up: patient received janssen on 5/4/21 however on the consent form on 8/15/21 reported that he has not received any covid shot in the past. The consent form was processed after the patient received the Pfizer shot and was rejected by insurance because he had already received janssen.


VAERS ID: 1575066 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-08-15
Onset:2021-08-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Extra dose administered, Malaise, Pain in extremity, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Tendinopathies and ligament disorders (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? Yes
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Modest sore arm and vague flu-like symptoms after dose 2
Other Medications: All generic: lexapro, fosamax, Lipitor, norvasc, vitamin d3
Current Illness:
Preexisting Conditions: I had AML leukemia 10 years ago and a haplo cord stem cell transplant in November 2011
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: High fever (102.5)and general malaise beginning this morning. Arm quite sore beginning yesterday. High fever continuing27 hrs after dose


VAERS ID: 1575088 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-14
Onset:2021-08-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 2 RA / IM

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

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

Write-up: Patient had rash on torso


VAERS ID: 1575101 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-14
Onset:2021-08-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Axillary pain, Impaired work ability, Lymphoedema, Oedema peripheral
SMQs:, Cardiac failure (broad), Angioedema (broad), Retroperitoneal fibrosis (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

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

Write-up: lymphedema in right axilla starting 1 day after second COVID vaccine. Presents to PCP for evaluation and tx. Hasn''t been to work due to swelling and pain.


VAERS ID: 1575469 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-08-05
Onset:2021-08-15
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood test, Computerised tomogram, Electrocardiogram, Urine analysis, Vertigo
SMQs:, 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:
Other Medications: Alprazolam
Current Illness: None
Preexisting Conditions: None
Allergies: Penicillin, codeine, sulfa, erythromycin
Diagnostic Lab Data: CT scan, blood work, urine test, EKG
CDC Split Type:

Write-up: Extreme vertigo on day 10 after vaccination. Had to be transferred to ER for treatment. Ongoing, debilitating vertigo since.


VAERS ID: 1575476 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-08-15
Onset:2021-08-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002F21A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: n/a
Current Illness: n/a
Preexisting Conditions: graves disease, eliquix factor 5
Allergies: nka
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: I was alerted that patient was fainting and feeling weak after giving Moderna vaccine. I had my store manager call 911 immediately. I kept talking to patient to keep her conscious. Patient breathing was fine, no anaphylactic shock persent. I placed an ice bag behind her head. I took her blood pressure, 90/48 and pulse of 60. Paramedics arrived and took over. Patient got better and refused to go to hospital.


VAERS ID: 1575618 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-08-07
Onset:2021-08-15
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052E21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site bruising, Injection site erythema, Injection site inflammation, Injection site warmth
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), 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: Sulfa
Diagnostic Lab Data:
CDC Split Type:

Write-up: On August 15, 2021, the patient noticed a red area of skin around the site of injection. She had no itching or pain. On examination from the pharmacist on August 16th, the area looked slightly inflamed and warm to the touch. The pharmacist traced the red area with a marker so the patient could evaluate whether the area was growing or shrinking. The pharmacist recommended OTC options such as ibuprofen, benadryl cream, or hydrocortisone cream. The patient also had a small bruise right at the site where the needle was inserted.


VAERS ID: 1575625 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-08-07
Onset:2021-08-15
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood glucose normal, C-reactive protein increased, Computerised tomogram abnormal, Facial paresis, Gaze palsy, Magnetic resonance imaging head normal, Metabolic function test, Pain in jaw, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Osteonecrosis (broad), Ocular motility disorders (narrow), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Emsam 12mg daily, lamotrigine ER 300mg daily, clonazepam 1mg BID
Current Illness: Generalized anxiety disorder, panic disorder
Preexisting Conditions: None
Allergies: Erythromycin
Diagnostic Lab Data: 8/16: BMP with elevated blood glucose of 118 8/16: CRP elevated at 9.4 8/16: MR Head Rapid Stroke: normal 8/16: CT Heat w/o IV contrast: disconjugate gaze
CDC Split Type:

Write-up: Acute pain in middle of night to left jaw, upper and lower. Followed by parasthesias on left side of face. Visited Hospital ED on 8/16/2021. On prednisone 60mg x5d followed by 50, 40, 30, 20, 10mg taper and acyclovir 1g BID. NSAIDS did not control pain. Left facial weakness. Left facial


VAERS ID: 1577566 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-08-15
Onset:2021-08-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939902 / 1 LA / IM

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

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

Write-up: Systemic: Fainting / Unresponsive-Medium, Systemic: Flushed / Sweating-Mild, Additional Details: 7 minutes after receiving 1st dose of Moderna covid vaccine 0.5ml in the left deltoid muscle via IM route, patient felt light head and fainted. He stated this has only happened after giving blood. He regained consciousness immediately, BP check- given orange juice, paramedics were called and on site they evaluated patient and took over care. Upon review, the patient was able to leave and did not need to go to the hospital.


VAERS ID: 1577625 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-08-15
Onset:2021-08-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 6194648 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Body temperature increased, Extra dose administered, Headache, Hyperhidrosis, Pain in extremity, Vaccine positive rechallenge
SMQs:, Neuroleptic malignant syndrome (broad), Tendinopathies and ligament disorders (broad), 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: April and May of this year other two moderna vaccinations - same reaction
Other Medications: Kevzara Methotrexate Plaquenil Citilopram Singulair Folic Acid Leucovorin Vitamin D
Current Illness: N?A
Preexisting Conditions: RA Osteoarthritis Fibromyalgia
Allergies: Aspirin Naproxen
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: After approximately 6 hours, upper arm was sore, headache started. Sweated out a temperature during the same night. Headache has continued for 2 days


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