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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 135 out of 6,867

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VAERS ID: 1558339 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-14
Onset:2021-08-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Montelukast 10mg : 1 tablet by mouth every day.
Current Illness: none
Preexisting Conditions: none
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: After patient got her second dose of the Pfizer vaccine, she felt light-headed and blacked out for a split -second and fell to the floor and hit her head. I put her on the side, and placed a soft cloth underneath her head and gave her a hard candy to suck on. After 5 minutes she felt better and was able to sit on the chair.


VAERS ID: 1558343 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Alabama  
Vaccinated:2021-08-14
Onset:2021-08-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 2 RA / IM

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

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

Write-up: 1 minute after patient received the vaccine he began to seize and was unresponsive for approximately 30 seconds. We laid the patient on his back and he began to respond and said he felt light-headed. Ems arrived and checked his vitals. He was released by EMS 45 minutes later.


VAERS ID: 1558344 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-08-14
Onset:2021-08-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 2 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:
CDC Split Type:

Write-up: PATIENT GOT THE FIRST DOSE OF COVID -19 MODERNA VACCINE AND CAME IN TO GET HIS SECOND DOSE OF MODERNA. PATIENT WAS GIVEN COVID - 19 PFIZER VACCINE AS THE SECOND DOSE INSTEAD.


VAERS ID: 1558347 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-13
Onset:2021-08-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Dizziness, Dyspnoea, Pain in extremity
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Vestibular disorders (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: Vitamin D, Ceylon Cinnamon
Current Illness:
Preexisting Conditions: Obesity, high blood pressure, pre-diabetes
Allergies: Penicillin, Tylenol
Diagnostic Lab Data:
CDC Split Type:

Write-up: Shortness of breath, dizziness, sore arm


VAERS ID: 1558348 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-08-14
Onset:2021-08-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 LA / -

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

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

Write-up: pt felt extremely dizzy and sweaty, 911 was called. and they determined it was just the anxiousness of the pt that was manifested


VAERS ID: 1558353 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-08-14
Onset:2021-08-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002F21A / 2 LA / IM

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

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

Write-up: during administration the syringe tip leaked vaccination. The needle was fully penetrated into arm and dose leaked out from the base of the syringe tip/ base i.e. where the needle screws onto the syringe base. Syringe was sealed and a single unit package with the tip and base already together but obviously it wasnt completly secured. Pt did not receive full 0.5ml dose as a result. No other incident/details to report


VAERS ID: 1558354 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-14
Onset:2021-08-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Dizziness, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Vestibular disorders (broad), Hypersensitivity (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE AS REPORTED BY PATIENT
Current Illness: NONE AS REPORTED BY PATIENT
Preexisting Conditions: NONE AS REPORTED BY PATIENT
Allergies: NONE AS REPORTED BY PATIENT
Diagnostic Lab Data: 10:40 AM : SYSTOLIC BP 116 DIASTOLIC BP 90 PULSE 101 10:50 AM SYSTOLIC BP 122 DIASTOLIC BP 91 PULSE 96 SO2 95
CDC Split Type:

Write-up: AT APPROXIMATELY 10:40 AM PATIENT REPORTED FEELING DIZZINESS AND TIGHTNESS IN THE THROAT. WHEN ASKED IF SHE WAS HAVING DIFFICULTY BREATHING, PATIENT STATED "NO.'' PATINET WAS CHECKED FOR BLOOD PRESSURE AND PULSE. PATIENT WAS GIVEN DIPHENHYDRAMINE 25 MG AND PREDNISONE 10 MG. PATIENT WAS LAYING DOW FOR 10 MINUTES AND PULSE AND BLOOD PRESSURE WAS RE-CHECKED. PATIENT STATED THAT SHE WAS NOT HAVING ANYMORE TIGHTNESS OF THE CHEST NOR FEELING ANY DIZZINESS. PATIENT WAS ABLE TO LEAVE FOR HOME.


VAERS ID: 1558360 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Hawaii  
Vaccinated:2021-01-29
Onset:2021-08-14
   Days after vaccination:197
Submitted: 0000-00-00
Entered: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1686 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3249 / 2 RA / IM

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

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

Write-up: Fully vaccinated and tested positive for Covid-19


VAERS ID: 1558362 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Hawaii  
Vaccinated:2021-01-20
Onset:2021-08-14
   Days after vaccination:206
Submitted: 0000-00-00
Entered: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1686 / 2 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1685 / 1 RA / IM

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

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

Write-up: tested Positive for Covid on 8/13/2021


VAERS ID: 1558367 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-14
Onset:2021-08-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Feeling abnormal, Pallor
SMQs:, Dementia (broad), Hypotonic-hyporesponsive episode (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: VASOVAGAL SYNCOPE
Preexisting Conditions: NONE
Allergies: NONE
Diagnostic Lab Data:
CDC Split Type:

Write-up: PT WAS VERY NERVOUS AND AS SOON AS I FINISH ADMINISTERING VACCINE SHE TOLD MOM NOT FEELING GOOD TURN PALE, AND MOM RESTED HER ON FLOOR WITH HER .


VAERS ID: 1558370 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Oklahoma  
Vaccinated:2021-08-14
Onset:2021-08-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 LA / IM

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

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

Write-up: patient got first covid shot, seemed fine during vaccine. 5 minutes later mom called for me and we both braced the patient as he passed out. he came to after about 10 seconds. was pale and sweaty. mom said he had passed out before during shots and finger sticks (did not inform us of this prior to vaccine). He said he felt better after 5 minutes, EMS arrived and took over from there, not sure what they did once they got him outside.


VAERS ID: 1558374 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-08-14
Onset:2021-08-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Pallor
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (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: Pfizer Covid vaccine
Other Medications: No information on file
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: NKDA
Diagnostic Lab Data: None
CDC Split Type:

Write-up: The patient mentioned she had gotten dizzy with the previous vaccine. She walked over to the bench and sat on the bench. The mom asked if we had any bottles of water we could give her but we did not. I sent my technician to get some water while I observed the patient. She turned very white and made abnormal faces. She got up to leave with her step dad and then started to kneel on the floor due to dizziness. I told her and her step dad that the 15 minutes were not up and I observed her a few more minutes until she felt better and let with her guardians.


VAERS ID: 1558376 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-14
Onset:2021-08-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Peripheral swelling
SMQs:, Cardiac failure (broad), Angioedema (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE AS REPORTED BY THE PATIENT
Current Illness: NONE AS REPORTED BY THE PATIENT
Preexisting Conditions: PATIENT STATED SHE HAS PANIC ATTACK IN THE PAST
Allergies: NONE AS REPORTED BY THE PATIENT
Diagnostic Lab Data: 12:06 SYSTOLIC BP 114 DIASTOLIC BP 82 HR 127 SO2 99 12:22 PM SYSTOLIC BP 110 DIASTOLIC BP 80 HR 97 SO2 97
CDC Split Type:

Write-up: AT APPROXIMATELY 12:03 PM PATIENT FELT DIZZINESS AND SWELLING IN BOTH HANDS. PATIENT WAS ABLE TO LAY DOWN AND BLOOD PRESSURE AND PULSE WAS CHECKED. PATIENT ALSO RECEIVED DIPHENHYDRAMINE 25 MG AND PREDNISONE 10 MG. AT 12;30 PM PATIENT WAS RE-EVALUATED AND SWELLING AND DIZZINESS HAD RESOLVED AND PATIENT WAS ABLE TO LEAVE HOME.


VAERS ID: 1558386 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-14
Onset:2021-08-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939902 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: 10ml Diphenhydramine 12.5mg/5ml orally 15 minutes after Moderna was given
Current Illness: cancer
Preexisting Conditions:
Allergies: omeprazole, codeine, allopurinol, valium
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was advised to stay at observation area for 30 minutes after the first dose of COVID19 shot. Previously she had anaphylactic reaction to oral medication that required Epi-pen. She was knowledgeable regarding the allergy reaction and what she was allergic to. She was released by her doctor to get the shot even though she was on isatuximab and carfizomib. About 15 minutes after the injection, her tongue felt funny. I gave her 10ml of diphenhydramine 12.5mg/5ml orally. She was advised to stay for another 20 minutes. She felt ok after the medicine so I released her back home.


VAERS ID: 1558387 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-08-14
Onset:2021-08-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 2 LA / IM

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

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

Write-up: Patient reported itchy inner arm about 15 minutes after shot. Her skin is red from scratching.


VAERS ID: 1558390 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-14
Onset:2021-08-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Dyspnoea, Feeling jittery, Pruritus
SMQs:, Anaphylactic reaction (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Pt is allergic to pcn. Hence I asked her to wait 30 mins after the 1 st covid vaccine. 20 mins later, pt started developing itching on her legs and body. I gave her 25 mg liquid benadryl. I asked mom to stay for longer time just to make sure it wouldnt lead to anything else.After about another 15 mins later, she started having difficulty breathing. Pt is a minor, with moms approval called 911 and also administered epipen ( pt weighs 120 lbs per mom ) . First responders came. hr was 72, bp 122/68. She was visibly jittery from the shot, but she was able to breathe


VAERS ID: 1558393 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-07-17
Onset:2021-08-14
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 0042D21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Inappropriate schedule of product administration, Interchange of vaccine products, No adverse event
SMQs:, Medication errors (narrow)

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

Write-up: Mixed vaccine series error occurred, patient received moderna 7/17/2021 however had received pfizer 4/8/21 other location, no adverse events reported


VAERS ID: 1558396 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: West Virginia  
Vaccinated:2021-08-14
Onset:2021-08-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Tinnitus, Vomiting
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hearing impairment (narrow), Vestibular disorders (broad)

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

Write-up: Patient vomited, felt light headed and had ringing in the eard


VAERS ID: 1558399 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-08-11
Onset:2021-08-14
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / IM

Administered by: Private       Purchased by: ?
Symptoms: Catheterisation cardiac normal, Chest X-ray, Echocardiogram abnormal, Electrocardiogram abnormal, Pericardial effusion, Pericarditis, Troponin
SMQs:, Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

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

Write-up: Presented to outlying hospital with presumed MI. Arrived to tertiary center with EKG changes. Echocardiogram showed pericarditis with pericardial effusion. EF is preserved. Had unremarkable Cardiac Cath


VAERS ID: 1558400 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-08-14
Onset:2021-08-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Agonal respiration, Cardio-respiratory arrest, Loss of consciousness, Malaise, Pulse absent, 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), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Respiratory failure (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: patient stated that he has fainted several times in the past when getting a vaccine or having his blood drawn
Other Medications: SINGULAIR 10MG TAB VENTOLIN HFA AER
Current Illness: NONE
Preexisting Conditions: ASTHMA SMOKER
Allergies: NONE
Diagnostic Lab Data: none
CDC Split Type:

Write-up: The patient stated in his electronic form that he faints with shots. I questioned him about it, and he acknowledged, stating that after going through chemotherapy and having multiple blood draws and shots, that it has seemed to have gotten better over the last several years. He gave the phone numbers of his grandfather and girlfriend in case they were needed. During our brief discussion, the shot was administered as the patient was talking me. He stated that having the discussion to distract him was helpful. I stayed with the patient because of knowing his history. Approximately 2 minutes later, he said he did not feel well and he passed out, sitting upright in the chair. If not for the CPR training, I think the situation could have been a lot worse. The patient was unresponsive and displayed agonal breathing. After removing his mask and unable to find a pulse (brachial or radial), I laid him on the floor, opened the door from the clinical services room, instructed call emergency then a code white. Shortly thereafter, as I was preparing to start rescue breathing and CPR, he came around and medical worker arrived promptly, along with the officer. Medical worker contacted his next of kin and EMS arrived shortly thereafter.


VAERS ID: 1558403 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: New York  
Vaccinated:2021-08-14
Onset:2021-08-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Adverse event following immunisation, Anxiety, Crying, Dyspnoea, Palpitations, Sensation of foreign body
SMQs:, Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Depression (excl suicide and self injury) (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: No known medications at time of vaccination.
Current Illness: No known illnesses within the month of getting vaccinated.
Preexisting Conditions: No known chronic conditions.
Allergies: No known allergies.
Diagnostic Lab Data: No tests were performed at the time of the adverse event while the patient was still at the vaccination facility.
CDC Split Type:

Write-up: Patient was brought to observation after receiving the first dose of the Pfizer vaccine. 15 minutes after receiving the vaccine patient stated in a clear and complete sentence, "I can''t breathe, something is in my throat." Vital signs were initiated immediately at 2:25PM. Patient denied chest pain, rash, or hives. Deep breathing techniques were initiated. Patient burped and stated she feels better. Patient noted to have palpitations, and crying spells. Continuous monitoring and deep breathing exercises were done. Patient stated she is anxious. No signs of allergic reaction were noted. EMS was called for further monitoring as per patient''s request. Patient was calm and felt better. Patient states, "I feel better, my throat is better." Patient noted to have crying spells again when EMS arrived to the site. Patient left with EMS. Steady gait noted, equal and bilateral chest rises noted throughout incident.


VAERS ID: 1558407 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-14
Onset:2021-08-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 LA / IM

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

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

Write-up: Panic, pale, fatigue, lost conciousness


VAERS ID: 1558416 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-08-14
Onset:2021-08-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 1 RA / IM

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

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

Write-up: THE NURSE VACCINATING PATIENT STATED THAT WHEN PATIENT WAS VACCINATED AT LEAST A 70% OF THE DOSE WAS LOST DUE TO MALFUNCTION OF THE RETRACTABLE NEEDLE, AS A RESULT, BASED ON THE MEDICAL TEAM DECISION AND BASED ON CDC GUIDELINES, PATIENT WAS PROVIDED WITH A FULL DOSE OF THE VACCINE IN THE OPPOSITE DELTOID. THE FIRST DOSE ADMINISTERED 08/14/2021 WAS ON LEFT DELTOID AT 1:15PM PFIZER LOT# FD8448. SECOND DOSE ADMINISTERED 08/14/2021 WAS ON RIGHT DELTOID AT 1:25 PM PFIZER LOT # FD8448.


VAERS ID: 1558426 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-08-14
Onset:2021-08-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Nausea, Palpitations
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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: she got "sick" -she said she had anxiety with vaccinations upon questioning
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: asthma/diabetes/neurologic non-epileptic events
Allergies: penicilin/mold
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt said she felt nausea/heart rate racing/dizzy she had szlasted less than a minute 911 activated she did not go with them-they checked her out and said she was going to be fine.


VAERS ID: 1558427 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-14
Onset:2021-08-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / UNK - / SC

Administered by: Unknown       Purchased by: ?
Symptoms: Balance disorder, Disorientation, Fall, Head injury
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Accidents and injuries (narrow), Vestibular disorders (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient lost consciousness, fell to the floor and hit her head, was disoriented for several minutes then was evaluated by ems and went to er for evaluation of head injury


VAERS ID: 1558431 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-08-14
Onset:2021-08-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 LA / IM

Administered by: Unknown       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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: HISTORY OF FAINTING WITH NEEDLES AND HISTORY OF SEIZURE
Preexisting Conditions: NONE
Allergies: NONE
Diagnostic Lab Data:
CDC Split Type:

Write-up: FAINTING, DIZZINESS 3 MINUTES AFTER THE DOSE WAS GIVEN, SWEATING


VAERS ID: 1558433 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-08-13
Onset:2021-08-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Headache, Pain
SMQs:

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

Write-up: Body aches, chills, headache


VAERS ID: 1558444 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-08-14
Onset:2021-08-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 2 LA / IM

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

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

Write-up: Developed slight itching about two hours later. Then increased itching with rash on trunk, face and arms. Two areas of hives


VAERS ID: 1558446 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: West Virginia  
Vaccinated:2021-08-14
Onset:2021-08-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052E21A / 3 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Emotional distress, No adverse event, Wrong product administered
SMQs:, Depression (excl suicide and self injury) (broad), Medication errors (narrow)

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

Write-up: PT HAD WANTED SHINGRIX NOT THE MODERNA VACCINE- NO EVENTS AT ADMINISTRATION EXCEPT PATIENT BEING UPSET THAT RECEIVED MODERNA INSTEAD OF SHINGRIX


VAERS ID: 1558449 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-14
Onset:2021-08-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017B21A / 3 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: No adverse event
SMQs:

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

Write-up: No symptoms on day 1


VAERS ID: 1558451 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-08-14
Onset:2021-08-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 RA / IM

Administered by: Unknown       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: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data:
CDC Split Type:

Write-up: Janssen shot administered to 17 Year old.


VAERS ID: 1558456 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-08-12
Onset:2021-08-14
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Muscle spasms, Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Dystonia (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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: Nausea, cramps, vomiting, chills


VAERS ID: 1558460 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-08-12
Onset:2021-08-14
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH BNT162B2 / 1 RA / IM

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

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

Write-up: Swollen tongue and lips, hives all over abdomen, arms, and legs


VAERS ID: 1558463 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-08-13
Onset:2021-08-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Adderrall, Lexapro, Clonaxepam, seraquil, melatonin, multi vitamin, vitamin D2, vitamin D3c, daily probiot
Current Illness: None
Preexisting Conditions: Anxiety, ADD
Allergies: Allergic to surgical tape and surgical glue
Diagnostic Lab Data:
CDC Split Type:

Write-up: Chills, fever and body aches 24 hours after receiving first dose of vaccine


VAERS ID: 1558468 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-08-13
Onset:2021-08-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A 21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Diarrhoea, Injection site pain, Malaise, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: - Sore arm at site of injection 12 hours after shot. - Diarrhea, general malaise, and fever 16 hours after shot- improved later in day.


VAERS ID: 1558469 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: New York  
Vaccinated:2021-08-13
Onset:2021-08-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Exposure during pregnancy, Neuralgia, Pain, Paraesthesia
SMQs:, Peripheral neuropathy (narrow), Guillain-Barre syndrome (broad), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (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: Iron supplements, Vitamin C supplements, Garen of life prenatal multivitamins, DHA supplements
Current Illness: No illnesses. Diagnosed with chronic seasonal asthma but I did not have any respiratory distress prior to or after the vaccination.
Preexisting Conditions: See item 11.
Allergies: None to medications, allergic to kiwi and mosquitos
Diagnostic Lab Data: None, took extra strength Tylenol 500 mg, no relief.
CDC Split Type:

Write-up: First pregnancy, vaccinated at 26 weeks. Estimate Delivery Date is November 15th. Experiencing tingling in the right arm, and extreme nerve pain in the left leg, hip, buttox, ankle, and foot. The pain began today around 24 hours after the vaccine and got progressively worse but did not experience this prior to the vaccine. It hurts to stand or walk and feels like a stabbing pain and like my left leg and skin is on fire.


VAERS ID: 1558473 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Hawaii  
Vaccinated:2021-08-14
Onset:2021-08-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Balance disorder, Crying, Emotional distress, Facial paralysis, Fatigue, Headache, Loss of consciousness, Pallor, Seizure, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Depression (excl suicide and self injury) (broad), Hearing impairment (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Patient does not take any medications per mom
Current Illness: No known disease
Preexisting Conditions: No known health conditions
Allergies: No known allergies
Diagnostic Lab Data: none available
CDC Split Type:

Write-up: Few minutes after the vaccination, patient seemed very tired and weak. Upon approaching the patient, she was crying. She seemed in distress. She started turning pale and slowly losing consciousness and balance while seating on the chair. Patient did not fall off the chair because I was holding her. It seemed like a syncope like reaction until her face started drooping and she started convulsing for few seconds. She came back to conscious within few seconds and complains her head hurts. One dose of Epipen 0.3mg was administered to the patient and EMT came and took the patient away.


VAERS ID: 1558474 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-05
Onset:2021-08-14
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Pain in extremity, Rash, Rash pruritic
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (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: Azo cranberry pill Hair, Skin and Nail supplement
Current Illness: None
Preexisting Conditions: None
Allergies: No known allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Arm was somewhat sore the following day after injection. Then extremely sore two days after injection. Less sore day three after. Eighth day after injection, I was dizzy while at the park with my child. The morning of the 9th day after injection, I woke up with a circular rash, slightly itchy and my arm sore again. It is currently the end of ninth day and still have rash.


VAERS ID: 1559242 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-14
Onset:2021-08-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Dyspnoea, Respiratory distress, Restlessness, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Dementia (broad), Akathisia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: 15 minutes after receiving the 1st dose of Pfizer covid vaccine, patient became restless, started vomiting, and complained of difficulty breathing with acute respiratory distress. Patient''s friend answered no when asked if this happened to her before stating that this is something new. RN activated anaphylaxis protocol at the mobile site, local FD on site called dispatch, RN drew and administered 0.5 mg epinephrine IM to right vastus lateralis. After 5 minutes, patient reports breathing improved, feeling much better, no more vomiting, able to sit still and talk clearly, vital signs within normal limits, breath sounds normal. EMS arrived and turned over care to them. Patient refused to go with ambulance, signed AMA, friend reassured that he is going to take her to a medical center


VAERS ID: 1559243 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-07-28
Onset:2021-08-14
   Days after vaccination:17
Submitted: 0000-00-00
Entered: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA 7485 / 1 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Pain in extremity, Vaccination site erythema, Vaccination site pain, Vaccination site swelling
SMQs:, 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: Vyvanse Lisinopril
Current Illness: None
Preexisting Conditions: None besides treatment.
Allergies: None
Diagnostic Lab Data: I can see it with my own too eyes right now. 9 days after the vaccination
CDC Split Type:

Write-up: My left arm has become red and swollen and In Pain in an area where the vaccine was administered.


VAERS ID: 1559248 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-08-14
Onset:2021-08-14
   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 - / 2 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, 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: Sprintec birth control, cetrezine allergy medication, emergency-c powder daily, elderberry gummies
Current Illness: slight sinus infection?tested negative for COVID the day before
Preexisting Conditions: Overweight but good blood pressure, sugar levels, etc. very active.
Allergies: Latex, nickel, pollen
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever, chills


VAERS ID: 1559255 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-08-13
Onset:2021-08-14
   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 - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal distension, Chest pain, Dyspnoea
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: Irritable bowel syndrome, psoriasis
Preexisting Conditions: Irritable bowel syndrome, psoriasis, spina bifida, neurogenic bladder, neurogenic bowel, obesity
Allergies: Codeine, latex
Diagnostic Lab Data:
CDC Split Type:

Write-up: Chest pain and bloating in the chest area. The underwire in my bra was digging into me because my chest was so swollen. The pain was in the front of my chest and under my ribs, but did not radiate to my back, just stayed in the front of my chest. It hurt to breathe in and I could barely move without being winded and extremely tired. My chest pain was a 6/10 on the pain scale and lasted for 4 hours before I took 1 Aleve. This was the worst chest pain I?ve ever felt. The pain went away an hour after I took the Aleve and seems to be gone now. I had my husband check my heart rate/rhythm during the event and he said it was normal.


VAERS ID: 1559259 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-08-13
Onset:2021-08-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Dyspnoea, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (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: otc multi vitamin
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Chest pain, difficulty breathing, persistent fever


VAERS ID: 1559268 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-12
Onset:2021-08-14
   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 EWO198 / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Amnesia, Computerised tomogram
SMQs:, Dementia (broad), Noninfectious encephalopathy/delirium (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: Levothyroxine
Current Illness: Cold symptoms
Preexisting Conditions: Hypothyroidism
Allergies: Sulfa drugs
Diagnostic Lab Data: CT scan performed at hospital.
CDC Split Type:

Write-up: Short-term memory loss starting in the mid-morning and not subsiding. Sought help at local hospital.


VAERS ID: 1560878 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-14
Onset:2021-08-14
   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 EW0186 / 2 - / IM

Administered by: Other       Purchased by: ?
Symptoms: Arrhythmia, Burning sensation, Chest discomfort, Dyspnoea, Feeling abnormal, Hypoaesthesia, Insomnia
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Synthroidd
Current Illness: None
Preexisting Conditions: Hypothyroidism
Allergies: Erythromycin, Sulfa, epinephrine, Z-Pack, Augmentin, Xanax
Diagnostic Lab Data: Non yet. I tried to get a rhythm report on my phone but it would not analyze my heart rhythm, it kept telling me it was inconclusive. If I continue to have this shortness of breath and tightness, arrhythmia, I will go to ED..
CDC Split Type:

Write-up: A burning strange sensation moving to my neck. Shortness of breath, numb sensation down both right and left arms, numbness in fingers on right arm especially right first digit, fourth and fifth digit. I had strange tightness in my chest, feeling very short of breath. On the way home I kept having arrhythmia and it is 1:23AM on 6/15/21a and I still feel awful and cannot sleep.


VAERS ID: 1561111 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-14
Onset:2021-08-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Headache, Pain, 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:
Other Medications: Paxil, Wellbutrin, protonix, propranolol, Enbrel (7 days prior), biotin, lysine, vitamin d
Current Illness:
Preexisting Conditions: Rheumatoid arthritis
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Shaking chills, arm pain headache, fever, body aches


VAERS ID: 1561112 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-08-05
Onset:2021-08-14
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-08-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Pericarditis
SMQs:, Systemic lupus erythematosus (broad), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: methotrexate, oxycodone, among others
Current Illness:
Preexisting Conditions: chronic inflammatory arthritis osteoarthritis diabetes mellitus type 2 Chronic pain HTN
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Admitted to the hospital 8/14/2021 with acute pericarditis


VAERS ID: 1562012 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-08-14
Onset:2021-08-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 088D21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Limb injury, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Arthritis (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: Error: Shoulder Joint Injury (prolonged pain, tingling, etc.)-


VAERS ID: 1562013 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-08-14
Onset:2021-08-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 088D21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Limb injury, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Arthritis (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: Error: Shoulder Joint Injury (prolonged pain, tingling, etc.)-


VAERS ID: 1562807 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-08-14
Onset:2021-08-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011D21A / 2 LA / IM

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

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

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


VAERS ID: 1562813 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-14
Onset:2021-08-14
   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 EW0180 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fall, Fatigue, Headache, Lethargy, 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: Exhaustion / Lethargy-Mild, Systemic: Fainting / Unresponsive-Medium, Additional Details: Pt fainted upon minutes after patient given vaccine. Pt was going by seat to sit down after getting vaccinated and brother was on deck for the vaccine. Before sitting down pt fainted and hit the floor. Patient was unresponsive for a few seconds and then recovered. Pt was complaining about headaches but reported to be okay. Asked pt and father multiple times if they were okay, they said they were fine. Pt sat for observation for 15 minutes and then left the pharmacy, fine.


VAERS ID: 1562817 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-08-14
Onset:2021-08-14
   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 FC3081 / 1 LA / SYR

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: Dizziness / Lightheadness-Medium, Systemic: Fainting / Unresponsive-Medium, Systemic: Flushed / Sweating-Medium


VAERS ID: 1562818 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-14
Onset:2021-08-14
   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 EW0182 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Wrong patient
SMQs:, Medication errors (narrow)

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

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


VAERS ID: 1562819 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-14
Onset:2021-08-14
   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: Injection site pain, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

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

Write-up: Site: Pain at Injection Site-Mild, Site: Swelling at Injection Site-Mild, Additional Details: Patient reported pain and swelling at injection site. Swelling decreased within the hour but she was concerned because it hurt more than first dose. She declined follow up with MD, although RPh recommended follow up since patient was concerned.


VAERS ID: 1562820 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-08-14
Onset:2021-08-14
   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 EW0198 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Flushed / Sweating-Mild, Systemic: Nausea-Mild


VAERS ID: 1562823 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-08-14
Onset:2021-08-14
   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 FA7485 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: 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), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Fainting / Unresponsive-Severe


VAERS ID: 1562827 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: New York  
Vaccinated:2021-08-14
Onset:2021-08-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 059E21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Feeling abnormal, Headache, Hypertension
SMQs:, Neuroleptic malignant syndrome (broad), Dementia (broad), Hypertension (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: Systemic: Chills-Severe, Systemic: Headache-Severe, Systemic: Hypertension-Severe, Additional Details: AFTER 15 MINUTES PT GOT UP AND STARTED NOT FELLING GOOD. BLOOD PRESSURE 215/182.. TAKEN AGAIN 205/180.. DAUGHTER CALLED AMBULANCE. SHE DECIDED NOT TO GO AFTER HER DAUGHTER BROUGHT HER HCTZ. WILL CALL MONDAY TO FOLLOW UP.


VAERS ID: 1562831 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-08-14
Onset:2021-08-14
   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: Hypoaesthesia, Muscle tightness, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Sexual dysfunction (broad)

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

Write-up: Systemic: jaw tightness-Mild, Systemic: Numbness (specify: facial area, extremities)-Medium, Systemic: Tingling (specify: facial area, extemities)-Medium, Additional Details: experienced numbness and tingling from left shoulder down to left hand


VAERS ID: 1562835 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: New York  
Vaccinated:2021-08-14
Onset:2021-08-14
   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 EW0198 / 2 LA / IM

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

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

Write-up: 11 hours after vaccine developed very high fever 39.3 C, chills, feeling nauseous


VAERS ID: 1562837 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-08-14
Onset:2021-08-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 088D21A / 1 LA / IM

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

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

Write-up: Systemic: Dizziness / Lightheadness-Medium, Systemic: Flushed / Sweating-Medium, Systemic: Hypotension-Mild, Systemic: Tingling (specify: facial area, extemities)-Mild, Additional Details: Tingling extremeties


VAERS ID: 1562838 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-14
Onset:2021-08-14
   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 / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site pain, Muscular weakness, Pain in extremity
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Extravasation events (injections, infusions and implants) (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Extreme soreness at site of injection. Significant weakness in both legs. Achiness in both legs, particularly from knees down.


VAERS ID: 1569054 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-08-14
Onset:2021-08-14
   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 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blindness transient, Deafness, Hyperhidrosis, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Embolic and thrombotic events, arterial (narrow), Glaucoma (broad), Optic nerve disorders (broad), Cardiomyopathy (broad), Retinal disorders (broad), Hearing impairment (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: patient reported extreme phobia of needles
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: Called EMT- took patient vitals and released. Vaso-vagal Syncope due to needle phobia
CDC Split Type:

Write-up: Had a customer yesterday who has severe needle phobia who had Vaso-vagal syncope. He reported loss of vision and hearing along with severe sweating. Had someone call 911. Code white was called however no one from management came to pharmacy. Assessed patient was alert and able to communicate. When he regained his vision which was within minutes we moved to clinical services room because the sales floor was extremely warm. Gave him a bottle of water and allowed to remain in clinical services room while the EMT checked his vitals. He was cleared to go home. They said he had Vaso-vagal syncope which happens when someone is stressed. I am going to follow up with patient today.


VAERS ID: 1569066 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-08-14
Onset:2021-08-14
   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 RA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Back pain, Dizziness, Nausea, No reaction on previous exposure to drug, Pain in extremity
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: First dose: No soreness or any other symptoms experienced. Second Dose: Sore arm, back pain, dizziness, nausea


VAERS ID: 1569069 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-14
Onset:2021-08-14
   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 RA / IM

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

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

Write-up: Patient was administered her 1st dose of Pfizer Covid Vaccine and while waiting for her 15 minutes observation, she started feeling dizziness and passed out. 911 was called and she was taken to the hospital


VAERS ID: 1569070 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: New York  
Vaccinated:2021-08-13
Onset:2021-08-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Fatigue, Lethargy, Lymphadenopathy, Pain, Palpitations, Pyrexia
SMQs:, 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), 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: Mirena IUD
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Low-grade fever (99.5) that responded to alternating Tylenol and Advil Chills Body aches Swollen lymph node in left armpit Fatigue Lethargy Heart racing


VAERS ID: 1569096 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-08-14
Onset:2021-08-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / N/A LA / IM

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

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

Write-up: Patient did not accurately complete the vaccine immunization record form prior to vaccination. Patient checked box on questionnaire incorrectly, stating that they were 18 years of age or older when in fact patient was only 17 years. Patient was given Janssen vaccine that is not approved for under 18 years.


VAERS ID: 1569100 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-08-13
Onset:2021-08-14
   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 EW0171 / 1 LA / SYR

Administered by: Military       Purchased by: ?
Symptoms: Feeling cold, Headache, Lymphadenopathy, Neck pain, Pain in extremity, Pyrexia, Skin warm
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Metformin 2000 mg a day, 1a day women?s multi vitamins, Tylenol when needed
Current Illness: Type 2 diabetes
Preexisting Conditions: Type 2 diabetes
Allergies: None
Diagnostic Lab Data: I haven?t gone to the doctor yet
CDC Split Type:

Write-up: Next day my little son woke me up at 10 am because I was making noises like whimpering. I was covered up to my neck in a blanket because I was freezing but felt hot to the touch. I have a headache still and pain on my injected arm and neck. I notice a swollen bump of the side of my collarbone/neck where I was injected. I feel tired and I?m pain. I also had a fever of 101 the day after the injection.


VAERS ID: 1569111 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-08-14
Onset:2021-08-14
   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 RA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Chills, Headache, Heart rate increased, Injection site pain, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Extravasation events (injections, infusions and implants) (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: synthroid tylenol
Current Illness: no
Preexisting Conditions: NO,.... just Thyroid disease (hypo)
Allergies: No
Diagnostic Lab Data: none
CDC Split Type:

Write-up: 102 fever, chills, headache, body and joint aches, soreness in injection site,racing pulse


VAERS ID: 1569113 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-14
Onset:2021-08-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002F21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, 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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Verapamil, Vesicare, Biotin, Magnesium, HCTZ.
Current Illness: back injury. herniated discs. recent finding.
Preexisting Conditions: HTN, menopause.
Allergies: Ace Inhibitors
Diagnostic Lab Data:
CDC Split Type:

Write-up: Developed a 102 degree fever 12 hours after vaccine. also chills and a very very sore arm.


VAERS ID: 1569118 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-07-22
Onset:2021-08-14
   Days after vaccination:23
Submitted: 0000-00-00
Entered: 2021-08-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Extra dose administered, Interchange of vaccine products
SMQs:, Medication errors (narrow)

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

Write-up: pt did not report adverse event. just wanted to report pt got Janssen prior to getting Moderna vaccine


VAERS ID: 1569124 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-08-10
Onset:2021-08-14
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-08-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 088D21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Cough, Dizziness, Dyspnoea, Fatigue, Heart rate irregular, Myoclonus, Palpitations
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow), Vestibular disorders (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: Bupropion
Current Illness: None
Preexisting Conditions: Asthma, hx of VTE, fibrinogen activator inhibitor mutation, HLRCC, chiari malformation, recurrent nephrolithiasis, rosacea
Allergies: Sulfa, glycerin, shellfish, eggs, gluten, pork, latex, adhesives, alliums, pineapple, dust mites, mold, arachnids
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Chest pain, irregular heart rate, dyspnea, palpitations, myoclonus, dizziness, fatigue & cough with sudden onset


VAERS ID: 1569130 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-07-24
Onset:2021-08-14
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-08-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 054C21A / 1 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Concerta 36mg Setraline HCL 150mg Bupropion HCL XL 150mg
Current Illness: None
Preexisting Conditions: None
Allergies: Seasonal allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Many small, itchy bumps on inside forearm of right arm. bumps had red spots on the most raised part - they looks like small blood blisters. Within the hour the same happened on left arm in the same spot, but not as severe. 19 hours later, the left arm looks normal while the right forearm looks like it has been poked in numerous spots. Not severe enough to seek medical attention.


VAERS ID: 1569141 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-08-13
Onset:2021-08-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040C21A / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood glucose abnormal, Blood glucose increased
SMQs:, Hyperglycaemia/new onset diabetes mellitus (narrow), 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: Humalog through insulin pump, Depakote for migraine, Vitamin D
Current Illness: none
Preexisting Conditions: type-one diabetes
Allergies: NKA
Diagnostic Lab Data: I normally check my sugar 4-5 times daily with a glucose monitor - now I am doing it on an hourly basis. My blood glucose has averaged over 300 mg/dl since receiving the 2nd shot
CDC Split Type:

Write-up: I am a T1D of 46 years duration, on a Medtronic insulin pump. Since receiving my 2nd dose of the vaccine 4 days ago, my blood sugars have gone high and stayed high, regardless of the amount of insulin I take. I have basically stopped eating, because it causes my bg to rise into the 400 - 500mg/dl range, even when bolusing 2 0r 3 times the amount I regularly take with meals. My last A1C, taken less than a week ago was 6.8, so I am normally well-controlled.


VAERS ID: 1569173 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Arizona  
Vaccinated:1921-08-13
Onset:2021-08-14
   Days after vaccination:36526
Submitted: 0000-00-00
Entered: 2021-08-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002F21A / 2 LA / IM

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

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

Write-up: per patient she experienced and increased heartrate of 90-100 for 8-9 hours only relieved by laying down which decreased her heart rate to 80-90bpm


VAERS ID: 1569174 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: West Virginia  
Vaccinated:2021-08-14
Onset:2021-08-14
   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 EW0182 / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: 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), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Fainting / Unresponsive-Mild


VAERS ID: 1569182 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-14
Onset:2021-08-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Ear pain, Feeling hot, Headache, Hyperhidrosis, Injection site pain, Lethargy, Musculoskeletal chest pain, Pain, Pain in extremity, Pain of skin, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: About eight hours after my vaccine, I began to have chills, fever, headache, pain/tightness in my calves. Later that night I felt hot, sweaty, intense pain at injection site, headache become worse. The next morning I had body aches, skin felt tender to touch, headache, pain in ribs, ear ache, lethargy, continued pain in calves and injection site.


VAERS ID: 1569183 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Alabama  
Vaccinated:2021-08-13
Onset:2021-08-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 049E21A / 2 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Mesalamine, Crestor, Vitamin B complex, Vitamin K2 (MK-7)
Current Illness:
Preexisting Conditions: Ulcerative Colitis, Neuropathy, Toenail fungus, Enlarged prostate, Constipation, Hiatal hernia, Hemorrhoids, Tinnitus, Sleep apnea, Vertigo, Joint pain, Headaches, Fatigue, Atherosclerosis
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Next morning injection site soreness and swelling, turning red later in the day and continues into day 2. Next day an increased level of fatigue and headache. Fever in the afternoon measured 99.5, 2 degrees over typical. At dinner a cold meal caused chills. Wet lungs late in the day and continues into day 2.


VAERS ID: 1569187 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-14
Onset:2021-08-14
   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: Dizziness, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Shortly after administering vaccine, patient said she felt dizzy and woozy. She slumped back in chair and shook her head a little bit and became unresponsive for less than a minute. Her pulse was fine and breathing was normal. At this time, I directed technician to call 911 and EMS was on scene in less than 5 minutes to evaluate patient. She walked to their stretcher on her own and the took her to their ambulance for further evaluation with her mother present


VAERS ID: 1569209 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-08-13
Onset:2021-08-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021B21A-1 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site rash, Vaccination complication
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: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Covid arm a rectangle sized rash on the left deltoid


VAERS ID: 1569217 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-08-14
Onset:2021-08-14
   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 EW0176 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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 passed out after vaccine. said she felt dizzy and her vision was a little blurry and then she fainted. Mom and patient refused for ambulance to be called and mom said she would monitor patient. called mother later in evening (7:50pm) to check on patient but had to leave voicemail and did not receive a call back with an update.


VAERS ID: 1569220 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-08-14
Onset:2021-08-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 091D21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dry mouth, Dysphagia, Lip swelling
SMQs:, Anaphylactic reaction (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 (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: ACE-Inhibitors, Blue Dye, CCBs, Cephalosporins, Macrolides, NSAIDs, Penicillins
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient reports experiencing lip swelling and a "lump sensation" in right side of throat around 30 minutes after vaccination up to around 2-2.5 hours after vaccination, as well as dry mouth/difficulty swallowing. Did not experience difficulty breathing and these symptoms had not recurred by time of report over 24 hours later (around 2:30 PM the next day) to the pharmacy. Patient was advised to call 911 if these symptoms returned or if she developed difficulty breathing.


VAERS ID: 1569225 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-08-13
Onset:2021-08-14
   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 FC3181 / 1 LA / SYR

Administered by: Work       Purchased by: ?
Symptoms: Asthenia, Headache, Hypoaesthesia, Neck pain
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Arthritis (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: Flu vaccine-fever, vomiting, body aches, chills, fatigue lasting approximately a week.
Other Medications: Bupropion Valciclovir Loratidine Vitamin D Famotidine
Current Illness:
Preexisting Conditions:
Allergies: Ciprofloxacin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Numbness of face and neck lasting an hour. Severe debilitating neck pain and headache lasting approximately 10 hours


VAERS ID: 1569231 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-08-14
Onset:2021-08-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Chills, Dyspnoea, Palpitations
SMQs:, Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

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

Write-up: Extreme rigors, shortness of breath and chest pain. Heart pounding.


VAERS ID: 1569237 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-06
Onset:2021-08-14
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-08-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Headache, Injection site rash, Nausea, Rash
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Nausea, headache, fatigue day of into the following 3 days. Rash on arm around injection site started on day 8, continued fatigue and headache


VAERS ID: 1569252 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-08-13
Onset:2021-08-14
   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 EW0196 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain, Arthralgia, Headache, Pain, Spinal pain
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Arthritis (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: allegra, b12, multi womens vitamin
Current Illness:
Preexisting Conditions:
Allergies: verapamil
Diagnostic Lab Data:
CDC Split Type:

Write-up: whole body hurt to touch, extreme stabbing joint pains in left elbow, left hip, left ankle, throbbing spine pain. extreme left sided quadrant pain. headache. symptoms lasted 24 hrs.


VAERS ID: 1569253 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-08-13
Onset:2021-08-14
   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 - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Gait disturbance, Injection site pain, Pain in extremity, Pyrexia
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Children''s Multivitamin Gummies
Current Illness: Tested positive for Covid 19 - July 28, 2021. First on set symptom was July 26, 2021.
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: On the morning of August 14, 2021, my daughter experienced injection site pain, tiredness and leg/thigh muscle pain. Her leg pain caused her to stumble while walking. That afternoon, her temperature spiked 101.6 at it''s highest. She was treated effectively with Tylenol and symptoms improved. Today, her fever was 100.1 at it''s highest and is no longer experiencing leg pain.


VAERS ID: 1569262 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-08-14
Onset:2021-08-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / N/A LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Decreased appetite, Dizziness, Fatigue, Headache, Heart rate increased, Immediate post-injection reaction, Inflammation, Myalgia, Nausea
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Arthritis (broad), Tendinopathies and ligament disorders (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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Immediately felt dizzy, elevated heart rate, extreme fatigue lasting about 10 minutes post shot instantaneously. Following day symptoms included headache, muscle aches, joint aches, loss of appetite and nausea, fatigue, inflamed hips, sore muscles.


VAERS ID: 1569267 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-08-13
Onset:2021-08-14
   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 FA7485 / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain upper, Blood test normal, Chest X-ray normal, Chest pain, Chills, Condition aggravated, Dehydration, Dyspnoea, Electrocardiogram normal, Fatigue, Feeling abnormal, Headache, Malaise, Nausea, Pain, Urine analysis normal, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Dehydration (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: sertraline,
Current Illness:
Preexisting Conditions: Congenital heart disease- pseudocoarctation and bicuspid aortic valve
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Our family had Covid in December of 2020. At that time patient tested "inconclusive" for Covid. However, an antibody test was performed in July which indicated he did have Covid antibodies. Patient received his first Covid vaccine on Friday, August 13th. By the evening of Saturday, August 14th he was feeling "off", sick, and tired. From 12:00 a.m. to 4:30/5:00 a.m. on Sunday, August 15th he vomited approximately 4/5 times. Around 7:00 a.m. he started having body aches, chills, headaches, stomach aches and nausea. Around 9:00 a.m. he complained of chest pain and difficulty breathing. At this time I took him to the ER. He has heart disease so we have to take any illness seriously. He also used to get dehydrated when he was sick with cold/strep/virus, etc. or on hot days. He had an IV of fluid to help with dehydration, Tylenol for the pain, and a nausea medication. He had an EKG, chest xray, blood work, and a urine test. I believe all results were normal/ok. He was discharged and we were told to keep an eye on his symptoms for the next few days and to follow up with his doctor.


VAERS ID: 1569280 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-14
Onset:2021-08-14
   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 / 2 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Feeling abnormal, Pallor
SMQs:, Dementia (broad), Hypotonic-hyporesponsive episode (broad)

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

Write-up: PT WAS NOT FEELING GOOD AND TURN PALE .THEN START TO FEEL BETTER IN TEN MINUTES


VAERS ID: 1569298 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-08-13
Onset:2021-08-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 088D21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Injection site erythema, Injection site warmth, Pain, Rash, Rash erythematous, Skin warm
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: My 1st COVID shot. It was reported to Vaers on 7/19/21, e-report # 590386
Other Medications: Gabapentin 1800 mg per day Aimovig 170 mg once per month
Current Illness: none
Preexisting Conditions: Chronic pain (low back)
Allergies: Codeine Morphine Hydrocodone demerol dilaudid
Diagnostic Lab Data: none at this point
CDC Split Type:

Write-up: Starting at approximately 6 am on 8/14/21 I woke up with sever body aches (felt like bones were turning into dust) and chills that lasted about 24 hrs. On 8/15/21 I discovered I have red plaque rash on both sides of my neck near my collar bone as well as my beast bone and under both breast. The rash is warmth touch but is not itchy. My injection site is also red and warm to the touch, about the size of a lemon. My injection site is also so to the touch.


VAERS ID: 1569304 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-13
Onset:2021-08-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039B21A / 2 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Condition aggravated, Fatigue, Injection site urticaria, Pain, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: COVID-19 1st dose, large hives on arm
Other Medications: Amlopine, hydrochlorthiasize, sertraline
Current Illness: N/a
Preexisting Conditions: High blood pressure
Allergies: N/a
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Large hives on left arm below injection area, low grade fever 99.4, mild body aches, tiredness


VAERS ID: 1569917 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-08-09
Onset:2021-08-14
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-08-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK LA / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lisinipril 20 mg, Dexilant 60mg, simvastatin 40mg
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: na
CDC Split Type:

Write-up: Rash, large red itchy blotches on body, medium and smaller blotches on arms and legs. They have started to subside, but still have numerous itchy red places on body and extremities.


VAERS ID: 1569927 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-08
Onset:2021-08-14
   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 FC3180 / 1 LA / IM

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

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

Write-up: Vomiting, nausea, fever, body aches, chills,


VAERS ID: 1570775 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-08-14
Onset:2021-08-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: fluticasone propionate (FLONASE) 50 MCG/ACT nasal spray loratadine (CLARITIN) 10 MG tablet
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: NKA
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Patient received the J&J vaccine on 8/14/2021, patient is 13 years old and this vaccine is not approved for persons <18 years old. No adverse reactions noted. Patient and parent educated on what to watch for and when to seek care.


VAERS ID: 1570786 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-08-13
Onset:2021-08-14
   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 FC3181 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Axillary mass, 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:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: penicillin
Diagnostic Lab Data: none
CDC Split Type:

Write-up: swollen lump under arm pit and sore arm; fever


VAERS ID: 1570793 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-08-13
Onset:2021-08-14
   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 EW0172 / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Arthralgia, Axillary mass, Back pain, Limb discomfort, Neck pain, Pain in jaw, Tenderness
SMQs:, Retroperitoneal fibrosis (broad), Osteonecrosis (broad), Arthritis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Levotyhroxine 75mcg
Current Illness: None
Preexisting Conditions: None
Allergies: Cefalexin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Woke up around 2:30am on 8/14 with severe aches in my jaw, neck, middle of back, hips, knees, ankles, pain and a feeling of fullness in my left armpit, and pain in my elbow and wrist on my left arm but not my right. When I got up I could feel a large lump in my armpit and it was very tender, and when I looked it is very visible (at least golf ball size). This continued through Saturday, I took ibuprofen and rested, keeping a pillow between my arm and my side as I could not comfortably put my arm down. When I woke up Sunday 8/15, the aches in my joints were gone, but the lump under my armpit is still there, still about the size of a golf ball. It is still a bit tender, the fullness feeling is not as much.


VAERS ID: 1571067 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: North Dakota  
Vaccinated:2021-08-12
Onset:2021-08-14
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Burning sensation, Lung disorder, Mobility decreased, Peripheral swelling, Pyrexia, Urticaria
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Patient called me at 9:00 pm 8/15/2021. She got her vaccine on Thursday and had a fever Saturday. Today she woke up with a swollen arm with a welt going up toward the shoulder 6" long and 3" wide. . Trouble moving arm. Had COVID-19 on October 31st. Lungs are burning. I told her to call the emergency room and talk to them. I told her if she needed to go to the emergency room and couldn''t get a ride that I would take her.


VAERS ID: 1571085 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-08-14
Onset:2021-08-14
   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 / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Ageusia, Anosmia, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Paracetamol
Current Illness: I arrived to with a negative test, but because of the flight I had a mild throat symptom, I generally suffer from that. I took acetaminophen and it went away.
Preexisting Conditions: No
Allergies: No
Diagnostic Lab Data:
CDC Split Type:

Write-up: I have a fever it has reached 40, I can''t smell or taste anything. More that a day has passed. Body pain.


VAERS ID: 1571212 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-08-13
Onset:2021-08-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Headache, Injection site pruritus, 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Severe chills and fever of 102. Fever would not respond to ibuprofen or tylenol. Headache and injection site itching.


VAERS ID: 1571214 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-08-14
Onset:2021-08-14
   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: Body temperature increased, Chills, Influenza like illness, Injection site pain, Myalgia, Nausea, Pain of skin, Paraesthesia
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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: Flagyl antibiotic
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pins and needles feeling in arm for about 2 hours after injection. Temperature of 99.3 remainder of day and random bands of pain around skull the rest of the day and night. Pain at injection site. Second day, temperature of 100.3 with flu like symptoms including muscle aches, nausea, and chills. Pain at injection site.


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