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From the 1/21/2022 release of VAERS data:

Found 1,049,249 cases where Vaccine is COVID19 and Patient Did Not Die

Government Disclaimer on use of this data



Case Details (Reverse Sorted by Onset Date)

This is page 138 out of 10,493

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VAERS ID: 1981616 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ8757 / 3 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Burning sensation, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: PT had taken 25mg of benadryl 1.5 hr before arrival for vaccination. PT had also taken 0.25 of Zanax 1.5 hours before arrival for vaccination.
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: no known allergies but stated that she had hives 25 min after receiving her 2nd dose of Pfizer vaccine, given on 3.23.21
Diagnostic Lab Data:
CDC Split Type:

Write-up: PT reported hives, and burning sensation in throat approximately 5 minutes after receiving her Pfizer booster dose. EMS was called. RN administered 50mL of Benadryl to right deltoid IM. EMS arrived and took PT to local hospital. When PT left, pt was alert and oriented x3.


VAERS ID: 1981621 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: California  
Vaccinated:2021-12-26
Onset:2021-12-27
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD0809 / 3 - / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Feeling hot, Pain in extremity, Palpitations
SMQs:, Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (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: Birth control oral yaz brand taken daily
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Arm hurts really bad, woke up heart racing and really warm in the middle of the night about 10 hours after shot.


VAERS ID: 1981669 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ8757 / 3 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Dizziness, Hyperhidrosis, Nausea, Palpitations
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: UNKNOWN
Current Illness: UNK
Preexisting Conditions: UNK
Allergies: OXYCODONE CODEINE PINEAPPLE HYDROCODONE
Diagnostic Lab Data: SHE WILL BE GOING TO AN IMMEDIATE CARE FACILITY FOR EVAL AFTER SHE WAS MONITORED HERE FOR 35 MINUTES
CDC Split Type:

Write-up: UPON ARRIVAL TO THE OBSERVATION AREA PT BEGAN TO FEEL DIZZINESS, DIAPHORETIC, HEART RACING AND NAUSEA


VAERS ID: 1981675 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-12-26
Onset:2021-12-27
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 078J21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Haemoptysis
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Infective pneumonia (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:
Allergies: NONE
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient came to pharmacy on 12/26 and recieved her first dose of the moderna vaccine. Patient called the pharmacy the following day to reoprt she was coughing up blood. Patient was informed to seek emergency care.


VAERS ID: 1981717 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Wyoming  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2590 / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Needle issue, Underdose
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: Synthroid, Duloxetine, Nortryptiline, Tramadol, Gemfibrozil, Metoprolol, Vit D, Topamax,
Current Illness: N/A
Preexisting Conditions: Ideopathic polyneuropathy with demyelanation
Allergies: Zofran, Decadron, Fenofibrate, IVIG
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Gave vaccine in the left arm. Needle was loose on the syringe and some of the vaccine leaked out onto patient''s arm. Telephone call to immunization nurse consultant at the Dept of Health. Was instructed to repeat the dose as per CDC guidelines. Another dose (.3ml) given in the right arm.


VAERS ID: 1981767 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Burning sensation, Flushing, Injection site pain
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Extravasation events (injections, infusions and implants) (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
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: 10 minutes post injection, sudden of burning sensation at site of injection. Slowly spread to chest and lower body area. "Feels similar to taking a shot of whiskey". Subsided after 10 minutes. No SOB or other cardiac symptoms. Improved after lying down and drinking cold water. Shorter episode of flushing 15 minutes after first episode. Subsided within 5 minutes.


VAERS ID: 1981776 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-11-04
Onset:2021-12-27
   Days after vaccination:53
Submitted: 0000-00-00
Entered: 2021-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041C21A / 3 - / -

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

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

Write-up: covid +


VAERS ID: 1981788 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH WE0169 / 2 RA / SYR

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

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

Write-up: hearing loss/Tinnitus


VAERS ID: 1981802 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: California  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 065F211A / UNK - / -

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

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

Write-up: Facial Tingling/Numbness


VAERS ID: 1981810 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-12-22
Onset:2021-12-27
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: No adverse event, Underdose
SMQs:, Medication errors (broad)

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

Write-up: Patient had no adverse reaction to vaccination but was given the wrong dose of vaccination. Patient was injected with Pfizer vaccination designated for children 5-11 years of age due to staff error.


VAERS ID: 1981814 (history)  
Form: Version 2.0  
Age: 10.0  
Sex: Female  
Location: Mississippi  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL0007 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cyanosis, Fall, Head injury, Nausea, Syncope, Vision blurred
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Fainted, fell and hit head on ground. Possible concussion, pale blue lips, nausea, blurry vision.


VAERS ID: 1981815 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-12-26
Onset:2021-12-27
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Feeling abnormal, Headache, Immediate post-injection reaction, Pain, Somnolence
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypersensitivity (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Pfizer doses 1 and 2.
Other Medications: Omeprazole 40mg daily, Align and Culturelle alternating daily.
Current Illness: Seasonal allergies
Preexisting Conditions: GERD
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Immediately begin to feel a little off. In the middle of the night I woke up with chills, possibly a slight fever, body aches, headache. Slept in late. Feeling a little better now as of time of submission.


VAERS ID: 1981837 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 058H21A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Underdose
SMQs:, Medication errors (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Error in dosage was noted immediately, and patient was given a second injection of 0.25 ml.
CDC Split Type:

Write-up: Patient was inadvertently given a booster dose (0.25 ml) instead of a 0.5 full first dose.


VAERS ID: 1981862 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 33025BD / 3 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: triamcinolone (KENALOG) 0.5 % ointment atorvastatin (LIPITOR) 20 MG tablet albuterol 108 (90 Base) MCG/ACT inhaler chlorhexidine gluconate (PERIDEX) 0.12 % solution amLODIPine (NORVASC) 10 MG tablet Advair Diskus 100-50 MCG/DOSE inhale
Current Illness: none
Preexisting Conditions: Chronic obstructive asthma Atopic dermatitis Papular urticaria Prurigo nodularis
Allergies: Egg-products Penicillins
Diagnostic Lab Data:
CDC Split Type:

Write-up: Itching to left arm/ hand and possible rash


VAERS ID: 1981867 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-12-17
Onset:2021-12-27
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013F21A / 1 LA / IM

Administered by: Public       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: reporting vaccine error. 1st dose Moderna was given in mistake, 1st dose 12+Pfizer should have been given due to patient age.
Current Illness: N/A: reporting vaccine error. 1st dose Moderna was given in mistake, 1st dose 12+Pfizer should have been given due to patient age.
Preexisting Conditions: N/A: reporting vaccine error. 1st dose Moderna was given in mistake, 1st dose 12+Pfizer should have been given due to patient age.
Allergies: N/A: reporting vaccine error. 1st dose Moderna was given in mistake, 1st dose 12+Pfizer should have been given due to patient age.
Diagnostic Lab Data: N/A: reporting vaccine error. 1st dose Moderna was given in mistake, 1st dose 12+Pfizer should have been given due to patient age.
CDC Split Type:

Write-up: N/A: reporting vaccine error. 1st dose Moderna was given in mistake, 1st dose 12+Pfizer should have been given due to patient age.


VAERS ID: 1981876 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-10-01
Onset:2021-12-27
   Days after vaccination:87
Submitted: 0000-00-00
Entered: 2021-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / UNK - / -

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

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

Write-up: hospitalized


VAERS ID: 1981885 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 078J21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Heart rate increased, 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), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: blood pressure 125/88, pulse 165 immediately upon wakening
CDC Split Type:

Write-up: Patient was here for his 1st moderna vaccination. After 5min of receiving the vaccine patient fainted and began to seize. He came to after a few minutes, looked very pale.


VAERS ID: 1981886 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: New York  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL0007 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Underdose
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 Dose of Vaccine - Too Low-


VAERS ID: 1981887 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 059H21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Throat tightness, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: LEVOCETIRIZINE DIHYDROCHLORIDE 5MG TAB, CARBOXYMETHYLCELLULOSE NA 0.5%(PF)OP SOL,HYPROMELLOSE 0.3% OPH GEL, IPRATROPIUM BR 0.06% NASAL SPRAY, FLUTICASONE PROP 50MCG 120D NASAL INHL, TRAZODONE HCL 50MG TAB, ALBUTEROL 90MCG (CFC-F) 200D ORAL
Current Illness: ptsd, allergic rhitis, sinusitis, migraine, dysuria
Preexisting Conditions: as above
Allergies: dust mites, grass pollen
Diagnostic Lab Data: unk
CDC Split Type:

Write-up: within a few mins of receiving 1st dose of Moderna vaccine, patient started c/o throat tightness -- 25mg po benadryl given -- provider, called to area to assess/listen to patient , throat feeling tighter after 5 more mins -- 0.30mg epi-pen auto-injector administered --- 911 called for ER transport -- according to provider, patient was wheezing -- approximately 5-8 mins passed and throat still feeling tight -- 50mg IM benadryl administered -- patient transported via EMS to local Er


VAERS ID: 1981901 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 33036BD / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Condition aggravated, Dizziness, Immediate post-injection reaction, Interchange of vaccine products, Loss of consciousness, Syncope, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (narrow), Medication errors (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Fainting / Unresponsive-Medium, Additional Details: Patient announced that she was going to "pass out" prior to losing consciousness immediately after the administration of the Pfizer booster. Her first series was the single Janssen shot, and she was at the pharmacy getting her 2nd dose/Pfizer booster as well as the Flucelvax Flu Shot. The flu shot was administered first on the left arm, followed by the Pfizer COVID vaccine. The patient stated that she has a history of these type of reactions when having blood drawn, but never with a vaccine.


VAERS ID: 1981920 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Neck pain, Sleep disorder, Vascular pain
SMQs:, 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: I observed patient turning his head forcefully, asked him he has any pain, he complain he has neck pain. It looks to me he has external jugular vein pain. I took him to ER visit. It seems doctor also not sure much, expected sleeping issue.
Current Illness: NO
Preexisting Conditions: NO
Allergies: Zyrtech
Diagnostic Lab Data: No Tests are done
CDC Split Type:

Write-up: I observed patient turning his head forcefully, asked him he has any pain, he complain he has neck pain. It looks to me he has external jugular vein pain. I took him to ER visit. It seems doctor also not sure much, expected sleeping issue. Suggested to take Advil pain killer. We started to give Advil and also Zyrtech allergy medicine. after 3-4 days, he seems OK now. Now question, is it COVID vaccine side effects, or something else, he never had this kind of issue, or any know health issue, except seasonal allergy and asthma. Last two years patient did not have allergy and Asthma problem and no medicines are given. Should patient to take second dose of vaccines, it is really scary things. It seems ER doctors are helpless and we do not know the real issue of vein pain.


VAERS ID: 1981934 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: New York  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ1611 / 3 LA / SC

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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Systemic: Fainting / Unresponsive-Medium, Additional Details: Patient fainted while sitting in chair after immunization. Recovered within 1 minute.


VAERS ID: 1981944 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3594 / 4 LA / SYR

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: 1981951 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5618 / 1 LA / IM

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

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

Write-up: Patient received vaccine, was sitting there several minutes and passed out. She was coming out of it, eyes rolled back, and we talked to her to keep her awake. Patient was able to remain awake and have a small drink of water, sugar lollipop, and a cold compress was put on her head. Patient told me that she was nauseated, dizzy, and had blurry vision. I offered to call 911 several times, however the father refused. The patient''s mother was in route to pick the child up, however the father left with patient before then. The patient was in the store for 10 minutes after the incident before departing. I also assisted with escorting the patient to the car with her father. She was able to enter the car by herself as well. I told patient to go to the Emergency Room or speak with her PCP. I also told him to report back to us her condition once checked out.


VAERS ID: 1981987 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: California  
Vaccinated:2021-12-17
Onset:2021-12-27
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 067H21A / 3 LA / IM

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

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

Write-up: Excessive bleeding at injection site


VAERS ID: 1981991 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Puerto Rico  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5618 / 2 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? Yes
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: INCORRECT DOSE OF VACCINE.


VAERS ID: 1982007 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Female  
Location: New York  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3594 / 3 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Blood glucose increased, Dizziness, Fall, Headache
SMQs:, Hyperglycaemia/new onset diabetes mellitus (narrow), Anticholinergic syndrome (broad), Accidents and injuries (narrow), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Metformin, Losartan
Current Illness: Type 2 diabetes and hypertension
Preexisting Conditions: Type 2 diabetes and hypertension
Allergies: None.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Registration #11997006. Patient is a 90 year old elderly female. She came to the vaccination site for her Pfizer COVID-19 booster vaccine. Prior to having her vaccine she was in waiting area near the quiet room. When she went to sit down she felt dizzy and sat at the edge of the chair causing her to lose her balance and fall on the floor on her buttocks. No head trauma and no other body areas were hurt during the fall. Personnel was nearby which assisted in helping her get up and proceeded to sit her in a wheelchair. When MD arrived with supervisor patient was alert and oriented. No loss of consciousness. EMT arrived at the scene shortly thereafter. Patient was warm and well perfused, equal pulses. She informed us she has type 2 diabetes and is hypertensive. She is treated with Metformin and Losartan. Patient was complaining of a headache scale 3-4. She denied nausea, no abdominal pain and no weakness. Her initial BP was 152/60 and improved to 134/68 ten minutes later. Fingerstick glucose was abnormal, above standard limits read as 234 mg/dL. She had eaten an hour before. The patient was offered water which she took only a few sips and did not want more. Throughout the observation period, Patient was alert and oriented at all times. No worsening of the headache. She later received her Pfizer booster vaccine and was observed for an additional 15 minutes. She tolerated the vaccine well and there were no adverse events from the vaccine. She was taken in the wheelchair to her car. She was able to walk a few steps to the passenger side of the car assisted by Aqueduct vaccination site personnel and her daughter who proceeded to place her seat belt on and later drove away. Patient was offered a ride to the hospital via ambulance for further evaluation but she refused. Patient and her daughter were advised by the EMT and doctor to go to the nearest ER if she had worsening headache or any new symptoms such as vomiting, change in behavior, change in speech or became disoriented. Recommended to give acetaminophen for pain at home if needed. Was also advised to recheck glucose at home and if above 200 mg/dL to check for urine ketones. If ketones present was asked to go to nearest ER for further evaluation and treatment. If glucose still elevated and no urine ketones to contact her primary care provider or go to the ER for further assistance.


VAERS ID: 1982010 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL0007 / 3 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301558A / 3 LA / IM
FLU4: INFLUENZA (SEASONAL) (FLUZONE QUADRIVALENT) / SANOFI PASTEUR TG723 / N/A RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Underdose
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: ? cholecalciferol, vitamin D3, (VITAMIN D3 BY MOUTH) Take 1,000 Int''l Units by mouth daily. ? metFORMIN XR (GLUCOPHAGE-XR) 500 MG 24 hr tablet Take 1 tablet (500 mg total) by mouth daily with breakfast. Keep scheduled appt with PCP for ad
Current Illness: None
Preexisting Conditions: DM II, Asthma, former smoker
Allergies: NKA
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient arrived to clinic today for flu vaccine and Covid-19 Pfizer booster vaccine. Pfizer Pediatric vaccine was administered in error. Clinic NP, notified immediately in person. Per CDC guidelines, patient is to return for repeat of booster, in adult dose, may be administered immediately. Patient notified immediately via telephone. Patient arrived at clinic again, denied any symptoms, agreed with plan to receive adult Pfizer booster, this was administered.


VAERS ID: 1982013 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-12-26
Onset:2021-12-27
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 000014A / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Bone disorder, Dizziness, Feeling cold, Headache, Pain in extremity, Pyrexia, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Vestibular disorders (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: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data:
CDC Split Type:

Write-up: Intense headache, dizzy spells, high Temperature - 38.7. Bad ribs and pains in the legs.. Also no Energy and shaking due to being really cold. All started at 07:10 and hasn?t gone away.


VAERS ID: 1982022 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-12-24
Onset:2021-12-27
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 066H21A / 3 LA / IM

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

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

Write-up: ERYTHERMA/REDISH AND LUMPY FEEL ON THE LEFT ARM AROUND THE INJECTION SIDE


VAERS ID: 1982024 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL3197 / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Erythema, Peripheral swelling
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: about 5 minutes after getting the shot pt said her hand was red and swollen. she stayed for about 30 minutes and said it was better


VAERS ID: 1982042 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1855191 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Fall, Seizure
SMQs:, Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Vestibular disorders (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: felt faint/dizzy
Other Medications:
Current Illness:
Preexisting Conditions: siezure
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was given his first dose of J&J covid vaccine. Patient was asked to wait by pharmacy for at least 15 minutes before leaving. Almost immediately he came back in and stated he felt dizzy. I instructed him to take a seat as I grabbed juice and water. As I walked back into the room he fell onto his stomach and head. The lady with him stated he was having a seizure and I called 911 right away. EMS showed up about 5 minutes after words and assessed the patient. The patient appeared to have another siezure while EMTs were here so they took the patient to the ER to be further assesed.


VAERS ID: 1982064 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL3197 / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: age 32; pfizer vaccine 1st dose- felt a lot of pain in her arm. pfizer second dose- felt the worst headache of her life. do not
Other Medications: Not known
Current Illness: None
Preexisting Conditions: None
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Tingling in the left hand since she got the vaccine.


VAERS ID: 1982065 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-05-09
Onset:2021-12-27
   Days after vaccination:232
Submitted: 0000-00-00
Entered: 2021-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002C21A / 2 LA / SYR

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

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

Write-up: Patient received 1st dose on 5/09/2021 second dose on 12/27/2021.


VAERS ID: 1982083 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-12-22
Onset:2021-12-27
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 071F21A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: PCN
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Patient received a dose of Moderna vaccine in error. We should not have administered as he is under the age of 18 and it is not approved for this age group. It was an error due to mom working here and dad coming in to get his first dose so son came and no one caught the fact that he wasn''t proper age group.


VAERS ID: 1982084 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3594 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Ear pain, Vision blurred
SMQs:, Anticholinergic syndrome (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Covid-19 Vaccine (Pfizer-BioNTech)
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Blurry vision, pain in ears


VAERS ID: 1982095 (history)  
Form: Version 2.0  
Age: 10.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL0007 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Eye movement disorder, Fall, 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), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

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

Write-up: PT REACTION: APPROX. 10 MINUTES AFTER INJECTION, PT FELT FAINT. MOTHER STATES PT ASKEG HER TO HOLD HIM, SHE NOTICED HIS EYES ROLL BACK AND THEN FELL INTO MOTHERS ARMS. PT IMMEDIATELY REGAINED CONSCIOUSNESS. PT WAS MONITORED AT PHARMACY FOR AN ADDITIONAL 15 MINUTES AT WHICH TIME PT WAS ABLE TO STAND AND WALK ON HIS OWN. VAERS REPORT COMPLETED.


VAERS ID: 1982101 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 213D21A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: none
Preexisting Conditions: unknown
Allergies: -illin antibiotics, sulfa
Diagnostic Lab Data: oxygen saturation 97% during wheezing and 98% prior to leaving public health office. Encouraged client to seek attention at ER, if refusing EMS.
CDC Split Type:

Write-up: Client received vaccine at 3:10PM began feeling wheezy at 3:49, client consumed liquid benadryl at 3:50pm. reported feeling improved symptoms at 4:00PM. Offered to call EMS twice, refused and left clinic at 4:00pm.


VAERS ID: 1982106 (history)  
Form: Version 2.0  
Age: 10.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL0007 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cold sweat, Cyanosis, Feeling cold, Hyperhidrosis, Muscular weakness, Nausea, Tremor, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: Eggs, shellfish
Diagnostic Lab Data: Blood pressure 86/44.
CDC Split Type:

Write-up: Approximately 2 minutes after administration of COVID-19 immunization, patient began feeling weakness in knees and legs. He had nausea/vomiting and shakiness. Patient was moved back to seated area where oral fluids were administered. Patient was monitored for approximately 2 minutes longer. He began sweating, getting cold and clammy. Next, his lips began turning blue. At this point, his blood pressure was taken and we called EMS. While waiting on EMS to arrive (shortly after blood pressure was taken), patient began talking again and feeling better. Father reported the patient has some anxiety issues with needles and intense events in the past. EMS arrived and confirmed patient was okay.


VAERS ID: 1982128 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL3197 / 3 RA / IM

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

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

Write-up: Vaccine was administered undiluted.


VAERS ID: 1982141 (history)  
Form: Version 2.0  
Age: 9.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3594 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Incorrect dose administered, No adverse event
SMQs:, Medication errors (narrow)

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

Write-up: Patient received in error 0.3ml of the pf Covid-19 vaccine the 17- 12yr dose vs the 11-5yr dose. Patient tolerated the vaccine well with no adverse immediate reaction.


VAERS ID: 1982150 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1855191 / 1 LA / IM

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

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

Write-up: The patient had a vasovagal response about 10 minutes into the 15 minute holding protocol. Passed out in the chair, got pale, and very sweaty. The patient came to after about 1 minute. Stayed conscious enough to sip water and say he was ok.. He then passed out again. We called 911, an ambulance came, but the patient didn''t want to be taken to the hospital. The patient then sat for another 15 to 20 minutes. He had regained his color, and was no longer nauseous. He went home after this additional waiting period.


VAERS ID: 1982162 (history)  
Form: Version 2.0  
Age: 5.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3594 / 2 LA / IM

Administered by: Private       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: unknown .
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: none observed


VAERS ID: 1982178 (history)  
Form: Version 2.0  
Age: 9.0  
Sex: Male  
Location: New Mexico  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3594 / 2 LA / IM

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

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

Write-up: pt in error given 0.3ml pf covid vaccine for 12-17yr. mom told while waiting in car at vaccine clinic and told vaers and report will be done and apologized to. discussed concerns and gave numbers to call if concerns


VAERS ID: 1982181 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-11-26
Onset:2021-12-27
   Days after vaccination:31
Submitted: 0000-00-00
Entered: 2021-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 33030BD / 3 LA / IM

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

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

Write-up: The patient has experienced lingering arm and muscle pain in the vaccinated arm. There is also numbness/tingling in three fingers of the same hand.


VAERS ID: 1982183 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD0809 / 3 LA / IM

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

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

Write-up: Patient experienced syncope and fell down while shopping in the store following vaccination. Patient had sat in a chair for 15 minutes following her booster shot, had been jovial and in good spirits post-vaccine. When asked how she was feeling, after waiting , she said she felt fine, but was ready to go home. She was provided with a small bottle of water, not at her request, but as a courtesy. Pharmacy staff did not witness her fall, but her husband said she fell quietly and he only heard her fountain drink hit the ground. EMS was called. Her sister, who was a nurse, was with her as well. BP was taken and was 144/83 and HR was 76. Her husband reported that those values were low for her normal BP. She did not go to hospital and ambulated out of the warehouse on her own.


VAERS ID: 1982189 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 211D21A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Birth control pills, Celexa, Zyrtec,Spironolactone, Flonase
Current Illness: n/a
Preexisting Conditions: asthma
Allergies: seasonal allergies, pet allergies
Diagnostic Lab Data: none ordered
CDC Split Type:

Write-up: Needle malfunctioned while administering injection, so pharmacist estimated that appx 0.1ml may have gone into the arm and gave a 2nd shot on the same day -- pharmacist stated she gave "slightly less" than 0.5 ml on the 2nd dose. After administration, arm was very sore and has sensation of numbness in elbow & hand of same arm. Called doctor, they said to watch and wait.


VAERS ID: 1982190 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Female  
Location: Montana  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL0007 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dyskinesia, Electrocardiogram normal, Eye movement disorder, Somnolence, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Dyskinesia (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None known
Current Illness: None known
Preexisting Conditions: None known
Allergies: No known allergies
Diagnostic Lab Data: EMS checked vitals and EKG (12/27/21) with no significant findings.
CDC Split Type:

Write-up: Approximately 3-5 minutes after receiving the vaccine, while sitting down, the patient''s eyes rolled to the back of her head and she began involuntarily jerking. The episode lasted less than 5 seconds (approximately 3 seconds per the patient''s mom who witnessed the event). When she regained consciousness, she was alert and aware of her surroundings, but did report some drowsiness. She reported no difficulty breathing. EMS evaluated the patient for a potential seizure, however they deemed she likely experienced vasovagal syncope. The patient was stable and did not have to be transported to the hospital via EMS.


VAERS ID: 1982208 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: California  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL3198 / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Vision blurred, Visual impairment
SMQs:, Anticholinergic syndrome (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Rash and itching of thigh after Pfizer Covid 19 first or. Second dose.
Other Medications: Multivitamin
Current Illness: None
Preexisting Conditions: None
Allergies: Amoxicillin, keflex, erythromycin, penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Vision problem. Difficulty focusing on objects at a distance.


VAERS ID: 1982211 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: California  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 - / -

Administered by: Private       Purchased by: ?
Symptoms: Hypoaesthesia, Movement disorder, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Akathisia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (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: Dose one in series - headache and exhaustion
Other Medications: None
Current Illness: Nome
Preexisting Conditions: Obesity
Allergies: Kiwi
Diagnostic Lab Data:
CDC Split Type:

Write-up: Right hand went numb and started tingling in fingertips. Unable to properly use right hand for approx five minutes. Then it stopped.


VAERS ID: 1982218 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3594 / 3 RA / IM

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

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

Write-up: Dose given 7 minutes after expiration. No signs or symptoms of reaction at administration, parent notified and had no report of signs or symptoms of reaction. Provider notified, call placed to manufacturer , awaiting guidance.


VAERS ID: 1982219 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 213D21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood pressure decreased, Dizziness, Hyperhidrosis
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypoglycaemia (broad), Dehydration (broad)

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

Write-up: AFTER ADMINISTRATION OF J&J 1ST DOSE OF VACCINE, @1742, PT''S FELT LIGHTHEADED, SWEATY, HELPED PT''S TO SIT ON THE FLOOR WITH WALL SUPPORT ON HIS BACK, HAD WATER ~@1743. CHECKED PT''S BP DROPPED TO 86/52 MMHG, PULSE 40/MIN ~@1745. Pt''s SATRTED FEELING BETTER, CHECKED BP AGAIN ~@1755 BP 120/75 MMHG, PULSE 55/MIN. ~1804 PT''S FELT WAY BETTER AND THOUGHT HE COULD GO HOME, PT''S ASKED TO SATY ATLEAST 30 MINUTES IN OBSERVATION. PT''S LEFT ~1819 PT''S FEELING BETTER LIKE NOTHING HAPPENED. DP 12/27/2021 @1825


VAERS ID: 1982229 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-10-29
Onset:2021-12-27
   Days after vaccination:59
Submitted: 0000-00-00
Entered: 2021-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051F21A / UNK - / -

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? 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: covid post vaccination


VAERS ID: 1982233 (history)  
Form: Version 2.0  
Age: 8.0  
Sex: Male  
Location: New Mexico  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL0007 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Lip swelling, Throat irritation, Visual impairment
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Patient said his vision got weird and his throat felt funny. His lips began to swell visibly. This started about 5-10 minutes after vaccine was given. EpiPen 0.15mg administered. Symptoms began to improve within a couple of minutes. 911 was called. Paramedics called in for follow-up and monitoring.


VAERS ID: 1982234 (history)  
Form: Version 2.0  
Age: 9.0  
Sex: Male  
Location: New York  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL0007 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Body temperature increased, Headache, Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: NKA
Diagnostic Lab Data: 12/27/2021 1:51 PM - HR: 104, RR: 18, BP:102/83, O2 Sat: 99% 1:57 PM - HR: 118, RR: 18, BP: 103/80, O2 Sat: 99% 2:13 PM - HR: 123, RR: 18, BP: 96/68, O2 Sat: 99% 2:29 PM - HR: 116, RR: 18, BP: 103/64, O2 Sat: 98%
CDC Split Type:

Write-up: Observation team received client with mom in the pediatric observation area at 1:42PM. 8 minutes later, client?s mother stated that clientnis nauseous and vomitted in moderate amount. Client asked to rest back on chair, legs were elevated andnice pack was applied to back of neck. Vital signs initated. Client complained of mild headache. Temperture taken and a reading of 100.8 F was collected. Water and lolipop were given. After 30 mins of observation, client verbalized feeling better and able to stand up without feeling nauseous or dizzy. Advised mother to give more fluids to client and to call PCP if symptoms return. Client walked out of the vaccine hub with mother in stable condition without any assistance.


VAERS ID: 1982237 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8020 / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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 is 15 and boosters are only indicated for 16 and older. Patient did not report any side effect while in the store and her father said she was not having any side effects when I spoke to him.


VAERS ID: 1982239 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD7218 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Heart rate increased, 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), Dehydration (broad)

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

Write-up: pt waited her 15 minutes. walked outside then returned to take son to the restroom. said her heart started beating fast then she passed out in front of the pharmacy. we were able to wake pt within a minute or 2. Store manager called 911. pt was dizzy but after20 to 30 minutes was able to leave the pharmacy with her husband. pt did not need to go to the hospital


VAERS ID: 1982247 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: California  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ8762 / 3 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: Unknown
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Patient received a third Pfizer vaccine, the third dose was the same manufacturer as the initial 2 dose series and given greater than six months from last dose. The third dose is not approved in the patent''s age group.


VAERS ID: 1982248 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 066H21A / 2 OT / IM

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

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

Write-up: Patient previously got a single dose of Janssen. As a booster, he was supposed to received half a dose of Moderna. He was mistakenly administered a full dose of Moderna


VAERS ID: 1982251 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: California  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 33025BD / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Anaphylactic reaction, Paraesthesia oral, Pruritus, Stomatitis, Throat irritation, Throat tightness, Tongue disorder
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (narrow), Angioedema (broad), Anaphylactic/anaphylactoid shock conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Amilodipine Lisinopril-hydroclorothiazide
Current Illness: Sleep apnea HTN
Preexisting Conditions: as above
Allergies: Shellfish
Diagnostic Lab Data:
CDC Split Type:

Write-up: 1505: Pt walked to AR monitoring area after reporting that following 1st Pfizer (33025BD) pt started experiencing "symptoms like my allergy to shellfish, I am itching all over, theres tingling to my lips, my mouth feels funny and my throat is scratchy". Pt ambulated with very steady gait to gurney and placed on monitors. He is AxO x4, speaking in full and very clear sentences, RR even and unlabored. Pt denies any difficulty swallowing his own saliva. He also denies any chest pain, palpitations, dizziness, headache or SOB. LSCTA, -wheezing/stridor. Pt reports that in October 2021, pt developed a shellfish allergy where he experienced anaphylaxis which required him to seek medical care in the ER in which he experienced "my throat closed up" and he was treated and recovered. Pt denies any more episodes of those symptoms up until today. He denies having any throat closing and is very calm and cooperative. Call out to on call ER MD and verbal orders obtained for Cetirizine ODT now and pt tolerated very well. Will continue to monitor very closely. T 96.8 BP 139/87 HR 88 RR 20 SPO2 100 on Room Air 1512: Pt tolerated po Cetirizine odt and drinking water without incident. Continue to monitor. 1520: Pt reports that he feels his tongue becoming "thicker" and rated it 2/10 however he is still speaking in full and clear sentences. He continues to deny any respiratory symptoms or drooling and he is drinking the water at bedside without incident. Pt''s tongue has no rash, lips do not feel swollen as per pt and he also denies any throat closing. Pt also indicates that he feels "very relaxed" and monitoring his HR. Pt continues to deny any chest pain or palpitations. States his overall symptoms he believes is not worsening but the itching is "getting better". Will continue to monitor closely for any worsening. 152/91 55 20 100 on RA 1528: Repeat VS as charted below. Pt states his "thick" tongue is now a "1.5/10" and the generalized itching has "gotten better". Pt reports that he remains with no new other symptoms. Still calm and cooperative, no acute respiratory distress. 153/94 61 20 100 on RA 1542: Pt reports that his overall symptoms are "back to normal" and the generalized itching is "minimal". Pt continues to deny any respiratory or cardiovascular symptoms. Remains free of any rash/hives or swelling and continues to speak in full and clear sentences. -stridor or wheeze. Call out to ER MD and report given. Advised pt to seek medical attention in the ED should his symptoms return, changes, worsens or becomes life threatening. EUA, VIS and educational tools reviewed with pt who verbalizes understanding. Pt road tested and ambulated with very steady gait. He remains in no acute respiratory distress, VSS. Pt released from vaccine clinic to drive himself back to work. Ambulated with very steady gait and in no acute distress. 149/97 63 18 100 on RA


VAERS ID: 1982255 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL0007 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Underdose
SMQs:, Medication errors (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Flonase, Claritin, Ventolin inhaler
Current Illness: None
Preexisting Conditions: allergic rhinitis, sickle cell trait
Allergies: NKA
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Parent brought 2 sons together, one was 10 years old, one 12 years old to the pediatric vaccine clinic. 12 year old received pediatric 5-11yr old dose of Pfizer (10mcg) instead of 12+ dose of 30 mcg. Mother was notified, as was pediatrician.


VAERS ID: 1982437 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1855191 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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 received the shot and proceeded to sit in the chair for the 15 minutes so she can be watched. She then passed out and hit her nose on the ground. we ran out to assess the situation and she came to as soon as we went to her. Pt refused to let us call 911 to have paramedics come check her out. no allergic reaction was seen. pt said she felt better enough to sit back up on chair. once she sat in the chair she then passed out again but came to immediately after falling to the ground. manager on duty, pharmacy manager and immunizing tech were there to support. pt was asked when the last time she ate which was over 12 hours prior so we gave her a glucose tablet and some water. pt said her heart was racing but she said it was because she was nervous about getting the shot. pt called her roommate to get drive her back home and said she would call us back if anything else happened. pt was able to walk to the car herself (immunizing tech made sure she made it inside the car) and said she felt way better.


VAERS ID: 1982439 (history)  
Form: Version 2.0  
Age: 7.0  
Sex: Male  
Location: California  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL8095 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Pain in extremity
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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: NONE
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt with c/o L shin, L thigh- front and back and L calf pain that started 15 mins post 1st Pfizer vaccine. Pt had been sitting in the monitoring area for 15 minutes and upon standing to walk out of the clinic, pt reported L shin, thigh and calf pain with walking or palpation by RN. He denied any chest pain, palpitations, SOB, dizziness, or headaches. ER MD notified and monitored. Pt VSS and he was released home with mom and advised to return to the ER should his symptoms not improve, changes, worsens or becomes life threatening.


VAERS ID: 1982444 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: New York  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5618 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Underdose
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: unk
Current Illness: unk
Preexisting Conditions: unk
Allergies: unk
Diagnostic Lab Data: none
CDC Split Type:

Write-up: client presented with parent for 1st dose covid vaccine; screening completed; NP medical evaluation completed at parent request; child vaccinated after sibling ; vaccinated with a pediatric dose of Pfizer 0.2cc IM; Lead and Incident Commander notified; Clinical team aware. no additional doses needed; will need to receive COVID 19 vaccine adult 0.3cc IM dose for 2nd dose in 21 days.


VAERS ID: 1982446 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: California  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030H21B / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cold sweat, Dizziness, Feeling cold, Nausea, Pallor, Vomiting
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (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: Clindamycin topical; Ciclopirox topical; Urea topical
Current Illness: None
Preexisting Conditions: Hyperlipidemia
Allergies: NKDA
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: Pale, cool, clammy, N/V, dizzy and felt as if she was about to faint.


VAERS ID: 1982452 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: New York  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 3 LA / IM

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

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

Write-up: Gave patient 0.3mL without dilution.


VAERS ID: 1982457 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA FL3197 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Disorientation, Dizziness, Loss of consciousness, Muscle twitching
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Dyskinesia (broad), Dystonia (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), Dehydration (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: Patient had no reaction with the 1st dose but had fever and chills and body aches with 2nd. She received the Moderna booster 0f 0.25ml and was asked to sit for 15 min, her mother was with her. Within 5 min after receiving the booster shot, her mom came to the counter and told us my daughter is passing out. Her daughter was sitting on the floor and seem to have twitched a little and mom went to allow her daughters head to rest on her leg. Meanwhile we called 911 and EMS immediately sent emergency personelle while one the phone questioning if the patient has any existing heart condition or stomach issues. We were adviced by the EMS not to give patient anything to drink or eat in case she seizes. Patient came to within couple minutes but seemed disoriented. She said she feels light headed. EMS arrived and took her vitals at that time and all were within normal range. They sat and took down patient history and monitored the patient and had her sit by the pharmacy for 30 min. During questioning, they discovered patient has not had anything to eat or drink since the day before which may have contributed to her adverse reaction. They checked her vitals again and all were within normal range after 30 minutes then she was given the ok to go home.


VAERS ID: 1982460 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD7218 / 1 LA / IM

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

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

Write-up: Patient fainted


VAERS ID: 1982461 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ8757 / 3 LA / 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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: unknown
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Patient became dizzy abut 5 minutes post vaccination. She then lost consciousness. After about 10 minutes she was again fully conscious


VAERS ID: 1982462 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 330258D / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Lethargy, Malaise, Nausea, Pain in extremity
SMQs:, Acute pancreatitis (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Patient was lethargic after her first Covid (pfizer) vaccine. Generally not feeling well for a couple days.
Other Medications: Patient did not list medications on VAR and no medications are filled at this chain pharmacy.
Current Illness: No other illnesses listed.
Preexisting Conditions: No health conditions listed.
Allergies: Patient stated no allergies on VAR form and none listed in her profile in the pharmacy. Later during reaction, husband stated she is allergic to sulfa.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Her husband came to the pharmacy stating that his wife was waiting in the parking lot ,after her second covid vaccine, and wasn''t feeling well. I went to the parking lot and she was sitting in the car. She was lethargic, complaining of left arm pain, nausea, and weak. She was awake and able to communicate. I asked if she wanted me to call the ambulance and she said yes. I placed the call and they were here in about 10 minutes. The emt determined she should be taken to the hospital. At this point, she was feeling better. She stated she didn''t want to go l, but in her best interest it was determined she should be assessed at the hospital.


VAERS ID: 1982464 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ8762 / 3 RA / IM

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

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

Write-up: PT stated he fainted after the first dose of Pfizer, after administering I verified the PT felt okay, and followed him to post-vaccination chairs. Asked him to stay for 15 minutes. I administered another vaccine to another person, and then I was notified this patient had fainted. He was lying on the floor, was unconscious for less than 5 minutes, we called 911 , the EMT''s arrived, had him sit in a chair- he then fainted again after about 5 minutes of sitting up.


VAERS ID: 1982470 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Louisiana  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 060H21A / 2 LA / IM

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

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

Write-up: Patient came in for 2nd dose of Moderna. His 1st dose was 12/6/21. He 2nd dose was not due and I didn''t catch it.


VAERS ID: 1982473 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL3197 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood glucose normal, Dizziness, Hyperhidrosis, Pallor, Staring, 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ADDERALL 20MG
Current Illness: NONE, BUT GAVE BLOOD AND HAD A VAGAL RESPONSE AS WELL, BUT THEY DID NOT PUT ON THE FORM AND DID NOT DISCLOSE UNTIL AFTER THIS REACTION
Preexisting Conditions: NONE
Allergies: NONE
Diagnostic Lab Data: BLOOD PRESSURE 68/29, THEN 137/68 AFTER FLUIDS AND FOOD. BLOOD SUGAR 117 AFTER EATING CHIPS
CDC Split Type:

Write-up: within 3 minutes of vaccine patient was lightheaded and sat down. by the time I walked out to check on the patient he was pale, not responsive and eyes were wide and up to the right as if he was going to have a seizure I ran to get the emergency cart and water while the mom braced the child''s head. He was responsive and able to drink by the time I returned and was able to drink water and take 10ml of benadryl. We walked him back into the clinic room to get blood pressure and removed his shirt that was soaked in sweat. His reading was 68/29. I gave him a bottle of water and had the technicians get chips for him while I was getting his reading. We had dialed 911 in the meantime and the mom wanted the paramedics to come to check him out. His blood pressure went up to 137/68 , blood sugar was 117 and he was fine by the time the paramedics got there. He stayed another 30 minutes then left to get food with parents who decided not to take him to the ER.


VAERS ID: 1982475 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD7218 / 3 LA / IM

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

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

Write-up: Pt felt dizzy and then passed out for approx. 45 seconds then came too and complained of being very hot. EMS was called and she was checked out but refused to go to hospital. She left with her brother.


VAERS ID: 1982698 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL3197 / 3 - / IM

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

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

Write-up: Client presented to the vaccination site on 12/27/2021. The client notified RN that she received the 2nd dose of Pfizer COVID 19 vaccine on 06/30/2021 and is requesting a Pfizer booster to be given three days prior to booster eligibility. Pfizer booster eligible for 12/30/2021. Per patient leaves country on 12/30/2021 and returning on 01/15/2022. RN submitted a medical consult via text message to Vaccine Operations Leads, requesting to proceed with the COVID vaccine Pfizer booster. Per CDC guidance, approval to proceed with COVID vaccine Pfizer was obtained from medical consult team via text message from MD, Vaccine Operations Lead . Client received COVID vaccine Pfizer Lot# FL3197 on 12/27/2021. The client did not report any symptoms during the 30 minute observation period. RN educated client on possible adverse reactions and when to seek medical care. The client left the vaccination site at 4:15pm with a steady gait. VAERS and VERP completed.


VAERS ID: 1982700 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ8757 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Incorrect dose administered, Product preparation issue
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: UNKNOWN
Current Illness: UNKNOWN
Preexisting Conditions: UNKNOWN
Allergies: UNKNOWN
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: ADMINISTERED 0.3ML OF AN UNDILUTED VACCINATION


VAERS ID: 1982702 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012H21B / 3 RA / IM

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

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

Write-up: Patient 17 years of age was administered a moderna booster shot 0.25 ml (currently not authorized/approve). This error was discovered. Patient did present and adverse affected. Instructed and counsel to monitor for side effects.


VAERS ID: 1982708 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL3197 / 3 - / IM

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

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

Write-up: Client presented to the vaccination site on 12/27/2021. The client notified RN that he received the 2nd dose of Pfizer COVID 19 vaccine on 06/28/2021 and is requesting a Pfizer booster to be given one day prior to booster eligibility. Pfizer booster eligible for 12/28/2021. Per patient needs booster to be allowed in the operating room for the arrival of his baby girl. RN submitted a medical consult via text message to Vaccine Operations Leads, requesting to proceed with the COVID vaccine Pfizer booster. Per CDC guidance, approval to proceed with COVID vaccine Pfizer was obtained from medical consult team via text message from MD, Vaccine Operations Lead . Client received COVID vaccine Pfizer Lot# FL3197 on 12/27/2021. The client did not report any symptoms during the 30 minute observation period. RN educated client on possible adverse reactions and when to seek medical care. The client left the vaccination site at 5:05pm with a steady gait. VAERS and VERP completed.


VAERS ID: 1982719 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3594 / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: Technician told by the parent, patient is 16 years old. Consent form completed and signed by the parent of the patient. The booster dose of the Pfizer vaccine administered to the patient. Processing the vaccine/post administration: The date of birth of the patient showed the patient was only 15 years old, which is not recommended for a booster dose. No adverse reactions reported by the patient nor by the parent of the patient.


VAERS ID: 1982732 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 066H21A / 3 LA / IM

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

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

Write-up: Patient felt dizzy and started to sweat. I advise patient to lay down and give him cold compress. I check his blood pressure and it was low . i observe him and call 911. After while he was feeling good and EMS checked and he was doing fine. He left after 45 minutes and he was feeling fine.


VAERS ID: 1982734 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: California  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL3198 / 1 RA / IM

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

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

Write-up: pt got a rash on his chest about 15 minutes after the vaccination. His skin was a bit red but the rash subsided after a few minutes. It doesn''t bother him.


VAERS ID: 1982743 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: California  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033H21A / 3 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: A 16 year old patient and mother came in for Covid boosters. Both originally received Pfizer but they requested to switch to Moderna. My technician checked them in and provided the pharmacist with the paperwork. After verifying the dates were over 6 months the pharmacist gave the Moderna vaccine later to find out that she was only 16 and should have gotten Pfizer as booster. The parents were contacted to explain what happened and if/when to report side effects or seek medical attention.


VAERS ID: 1982751 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: New York  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 - / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: Sore arm in shot location


VAERS ID: 1982753 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: California  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Chest pain, Dizziness, Nausea
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (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:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Blood pressure, heart rate, oxygen saturation, heart sounds, lung sounds, and signs and symptoms were assessed on 12/27/2021.
CDC Split Type:

Write-up: 2 minutes after receiving the first dose of the Pfizer/BioNTech covid vaccine, patient stated, "I feel chest burning and my head." On site physician assistant was notified. PA asked the patient to further describe symptoms. Patient stated, "I feel nauseated and dizzy. I feel chest burning." Vital signs were assessed at 2:49pm. Blood pressure was 114/72, heart rate was 54 beats per minute, 99% oxygen on room air. Heart and lung sounds were clear. After being assessed, the patient was kept on site for further evaluation, but displayed no signs. Patient stated, "I feel fine" after surveillance. An interpreter was used for the entire interaction.


VAERS ID: 1982943 (history)  
Form: Version 2.0  
Age: 9.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL8095 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Somnolence
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: NONE
Diagnostic Lab Data: GENERAL CHECK UP BLOOD PRESSURE, TEMPERATURE
CDC Split Type:

Write-up: FEW MINUTES AFTER VACCINE ADMINISTRATION PATIENT STARTED SAYING HE WAS DIZZY AND SLEEPY. PHARMACIST ATTENTED THE PATIENT, PARENT WANTED TO CALL EMS SO WE DID. IN THE MEAN WHILE PATIENT, ASKED PATIENT IF HE WAS FELING SICK AND WANTED TO THROW UP OR ITCHING OR SHORTNESS OF BREATH OF ANYTHING ABNORMAL, HE JUST KEPT SAYING HE WAS SLEEPY. EMS ARRIVED WITHIN 10 MINUTES CHECKED THE PATIENT AND SAID HE WAS DOING ABSOLUTELY FINE.


VAERS ID: 1982948 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3495 / 2 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Loss of consciousness, Seizure, Syncope, Tremor
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), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (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: 1st dose of Covid vaccine on October 9th, 2021. Similar reaction, not as intense as the second dose.
Other Medications: Tegretol, Zoloft
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: Penecillin
Diagnostic Lab Data: Checked my blood pressure and sugar, and my oxygen levels. All were normal.
CDC Split Type:

Write-up: Passed out twice after receiving shot and began seizing while unconscious. Experienced uncontrollable shaking after coming to.


VAERS ID: 1982950 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013H21B / UNK - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain
SMQs:, Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

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

Write-up: complained of chest pain 45 minutes after recieving


VAERS ID: 1982951 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: California  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5618 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: overweight, BMI=93%
Allergies: none
Diagnostic Lab Data: not needed
CDC Split Type:

Write-up: When I checked the chart and found patient has turned 12 yrs. I did incidence report and educated the staff who were involved his care. I reviewed CDC Covid 19 VC for 5-11 yr protocol and called CDC and spoke with an agent who sent Email to me for how to further manage the case: plan give the second dose with covid 19 vaccine for 12 yrs and old at 21 days of interval. I called mother: pt has had no side effect so far and I told mother the administration error and scheduled the second dose with pharmacy at 1/17/2022 5PM, case reported to VAERS.


VAERS ID: 1982956 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: California  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Anaphylactic reaction
SMQs:, Anaphylactic reaction (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypersensitivity (narrow)

Life Threatening? Yes
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: Albuterol inhaler
Current Illness: none
Preexisting Conditions: asthma
Allergies: PCN
Diagnostic Lab Data: ER visit.
CDC Split Type:

Write-up: Anaphylaxis


VAERS ID: 1982965 (history)  
Form: Version 2.0  
Age: 10.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

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

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

Write-up: Patient accidentally given the Pfizer Booster adult dosage <12 hours ago. Not displaying any symptoms presently.


VAERS ID: 1984169 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 330258D / 3 LA / IM

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

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

Write-up: pt is only 15 years old and got a Pfizer booster


VAERS ID: 1984170 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: California  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032H21A / 3 LA / IM

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

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

Write-up: No adverse reaction. Administered Moderna vaccine for a 17 year old when only authorized for 18 years and older.


VAERS ID: 1984179 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: California  
Vaccinated:2021-03-29
Onset:2021-12-27
   Days after vaccination:273
Submitted: 0000-00-00
Entered: 2021-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8732 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthritis, Dizziness, Headache, Loss of employment, Memory impairment, Mobility decreased, Musculoskeletal discomfort, Pain
SMQs:, Rhabdomyolysis/myopathy (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Depression (excl suicide and self injury) (broad), Vestibular disorders (broad), Arthritis (narrow), Tendinopathies and ligament disorders (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? No
Previous Vaccinations: flu shot (egg allergy) rash whole body
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: worst...soy, msg, oats, eggs, also per testing...walnut, potato, squash, clam, crab, lobster, oyster, shrimp, tuna, all trees, all grass, all weeds, molds, dust mite, feather, horse, dog, cat, cockroach
Diagnostic Lab Data: dr appt 7-29-21; multiple physical therapy appointments. 8-23-21, 8-26-21, 8-31-21, 9-2-21, 9-07-21, 9-9-21
CDC Split Type:

Write-up: Could not turn head to left or look up , neck popping, shooting pain up into head, dizziness, forgetful (lost job), headaches 6 months. physical therapy helped (facet joint inflammation). still not 100% better


VAERS ID: 1984187 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Rashes all over the body and internal breathing issues
Current Illness: Rashes
Preexisting Conditions: None
Allergies: Not known
Diagnostic Lab Data: All allergy tests were negative
CDC Split Type:

Write-up: Rashes all over the body during night time


VAERS ID: 1984191 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Fall, Fatigue, Headache, Malaise, 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), Accidents and injuries (narrow), 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:
Current Illness:
Preexisting Conditions: headaches
Allergies: immetrex, codeine, peanutbutter
Diagnostic Lab Data:
CDC Split Type:

Write-up: So I finally caved in and got the vaccine. But, literally 12 minutes later after I got it, I remember feeling not so well, I literally say the words uh oh cause I felt sudden lightheadedness and next thing I know I wake up on the floor in store pharmacy area and didn?t even know what happened. My friend said she saw me drop my phone, slump over then she got to me just as I fell to the ground so I didn?t hit my head. She also witnessed that my eyes were wide open but I was not awake. She couldn?t get a response out of me at first. Come to find out someone had called and ambulance and there was even a nurse that was off duty that?s all it was happening and rushed over when I came to. Praise God there was an ambulance that was just across the street when someone called them and that there was a nurse that saw what happened?. Not going to going into full detail, but prayers appreciated! I didn?t end up going to the hospital, but I am very exhausted, still lightheaded, and fighting a headache. The paramedics recommended that I rest the next few days and no real physical activities. They also recommended juice and water plus protein. But its only helping some. Reason I said for outcome emergency room/department or urgent care is because there was an ambulance and paramedics that came along with an off duty nurse that saw the situation.


VAERS ID: 1984331 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 068H21A / 1 LA / IM

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

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

Write-up: Error: Patient Too Young for Vaccine Administered-


VAERS ID: 1984334 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 068H21A / 1 LA / IM

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

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

Write-up: Error: Patient Too Young for Vaccine Administered-


VAERS ID: 1984335 (history)  
Form: Version 2.0  
Age: 10.0  
Sex: Male  
Location: Oklahoma  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 33030BA / 1 AR / IM

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

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

Write-up: Error: Patient Too Young for Vaccine Administered-


VAERS ID: 1984336 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: New York  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL3198 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anxiety, Chest discomfort, Chest pain, Chills, Dizziness, Seizure, Syncope, Tachycardia, Tremor, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad), Dehydration (broad)

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

Write-up: Systemic: Chest Tightness / Heaviness / Pain-Severe, Systemic: Chills-Severe, Systemic: Dizziness / Lightheadness-Severe, Systemic: Fainting / Unresponsive-Severe, Systemic: Seizure-Medium, Systemic: Shakiness-Severe, Systemic: Tachycardia-Medium, Additional Details: patient had a 20 to 30 second seizure within 5 mins of getting the vaccine, patient reports extreme anxiety all day over vaccine and previous undiagnosed seziures that have been worsening


VAERS ID: 1984343 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: California  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 33030BD / 1 LA / IM

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

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

Write-up: Systemic: Dizziness / Lightheadness-Mild, Additional Details: Patinet inidcated feeling a little light headed/dizzy, helped patient lay down and proved OJ, no allergic reaction was observed or reported by patient, per patient has history of feeling dizzy post vaccination, after OJ patient was oberseved for 30min and was without any symptoms or complicatoins, patient said he felt back to normal after OJ.


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