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

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



Case Details (Reverse Sorted by Onset Date)

This is page 138 out of 3,524

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VAERS ID: 1333221 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-05-18
Onset:2021-05-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022B21A / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Fatigue, Nasopharyngitis, Pain in extremity
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: lightheaded, aching arm, cold, tiredness


VAERS ID: 1333246 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-16
Onset:2021-05-18
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 1 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Injection site erythema, Pain in extremity, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Patient initially had a sore arm following vaccine and up until 05/18. On the morning of 05/18, she states she experienced a "spot" on her arm where she was administered the vaccination. On the morning of 5/19, she woke up with hives all over her body. She then called her doctors office to report the hives and was told to take 50 mg of benadryl.


VAERS ID: 1333253 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-05-07
Onset:2021-05-18
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: PREGABALIN 150 MG 3x a day (lyrica) HYDROCHLOROTHIAZIDE 12.5 MG TB 1x a day (Diuretic,BP) IRBESARTAN 300 MG 1x a day (BP) JARDIANCE 25 MG 1x a day (diabetes) GLIPIZIDE 10 MG 2x a day (diabetes) LEVOTHYROXINE 200 MG 1x a day (Thyroid) ATORVA
Current Illness:
Preexisting Conditions: Diabetes, Hypothyroid, Fibromyalgia, Nerve damage
Allergies: Penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Covid arm, A rash around the injection site, started about 9 days after the shot.


VAERS ID: 1333298 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-05-18
Onset:2021-05-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Arm pain Headache Slightly high temperature Fatigue


VAERS ID: 1333303 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: New York  
Vaccinated:2021-05-17
Onset:2021-05-18
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 2 LA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Eye pruritus, Malaise, Rhinorrhoea
SMQs:, Anaphylactic reaction (broad)

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

Write-up: customer states she took her second shot of the vaccine and she has been having eye inches and running noise and not feeling well. Called her and she is ok.


VAERS ID: 1333435 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-05-18
Onset:2021-05-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034C21A / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Arthralgia, Feeling of body temperature change, Headache, Pain, Rash, Rash pruritic
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Claritin, Flonase, vitamin D, zinc, iron, vitamin E, P5P, K27, pregnenolone, fish oil
Current Illness: seasonal allergies
Preexisting Conditions: pituitary adenoma
Allergies: none known
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hot & cold, body aches, wrists hurt, headache, itchy rash all over my body


VAERS ID: 1333436 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-05-17
Onset:2021-05-18
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal discomfort, Arthralgia, Chills, Computerised tomogram head, Dizziness, Fatigue, Feeling cold, Headache, Hypotension, Loss of consciousness, Nausea, Nervousness, Pain, Peripheral coldness, Seizure, Tunnel vision, Urinary incontinence, Urinary tract infection
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (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), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Optic nerve disorders (broad), Retinal disorders (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Arthritis (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: PCOS
Allergies: None
Diagnostic Lab Data: CT angio chest PE protocol CT head without IV contrast ECG 12 Lead D Dimer POCT Pregnancy Test, Urine IP UA Micro Reflex Comprehensive Metabolic Panel
CDC Split Type:

Write-up: The morning after my vaccine (5/18/2021), I woke up with a mild headache and achiness in my joints. I took ibuprofen to alleviate the pain and my headache came back later that afternoon. I started feeling nauseous in the evening before going to bed. The following morning (5/19/2021), I woke up with the same headache and was feeling nauseous still. After about an hour, I got out of bed thinking I was going to vomit. I was sitting on the bathroom floor and became lightheaded and my stomach started hurting worse. I got tunnel vision and passed out. My boyfriend was there and said that I started seizing for about 10 seconds and was cold. He said that I started to urinate and then regained consciousness after about 15 seconds. He called 911. I felt shaky and dizzy for about 15 min after. The ambulance showed up. My blood pressure was low, blood sugar was good, heart rate was good. I was able to walk to the ambulance and they took me to the ER. They gave me anti-nausea medication and fluids via IV. At the hospital, I received a CT scan for my head and another to check for clots in my lungs. Both tests came back negative. I had chills and body aches and was extremely tired. After about a couple of hours, I started feeling nauseous again and they gave me more anti-nausea medication. They did a urine sample and said I had a UTI, but other than that there was nothing wrong. They referred me to a neurologist to follow up about the seizure. They prescribed an antibiotic for the UTI and anti-nausea medication and I was discharged after about 5 hours.


VAERS ID: 1333461 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-05-18
Onset:2021-05-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041C21A / 2 LA / IM

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

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

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


VAERS ID: 1333472 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-05-18
Onset:2021-05-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041CZ1A / 2 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Feeling abnormal, Feeling cold, Headache, Insomnia
SMQs:, Dementia (broad), Arthritis (broad)

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

Write-up: Every joint in my body ached. No fever. Couldn?t sleep. Head ache. Couldn?t get warm. Felt like a truck ran over me


VAERS ID: 1333473 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-05-18
Onset:2021-05-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

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

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

Write-up: Headache, fever, body and joint pain, nausea


VAERS ID: 1333480 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-05-18
Onset:2021-05-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 2 AR / IM

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

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

Write-up: Error: Diluent Administered Instead of Vaccine


VAERS ID: 1333515 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-05-18
Onset:2021-05-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: HEART DISEASE
Allergies: PENICILLIN
Diagnostic Lab Data: BP 82/49 AND HR 75
CDC Split Type:

Write-up: 87 YEAR OLD FEMALE EXPERIENCED CHEST PAIN AFTER VACCINATION. ON SITE EMS RESPONDED AND VITALS ARE BELOW. SHE HAS A HISTORY OF HEART DISEASE AND TRYPLE BYPASS HEART SURGERY. SHE FORGOT HER NITROGLYCERIN. HER BLOOD PRESSURE GOT BETTER AND WAS RELEASED TO HOME


VAERS ID: 1333544 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-05-18
Onset:2021-05-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 LA / IM

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

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

Write-up: Site: Swelling at Injection Site-Medium, Systemic: MUSCLE SPASMS-Medium


VAERS ID: 1333577 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-05-18
Onset:2021-05-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Muscle spasms, Seizure, Syncope, Unresponsive to stimuli, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (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), Dystonia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

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

Write-up: Systemic: Dizziness / Lightheadness-Mild, Systemic: Fainting / Unresponsive-Medium, Systemic: Seizure-Mild, Systemic: Vomiting-Mild, Additional Details: Patient passed out within 30 seconds of receiving the Pfizer COVID vaccine. She was out for about 15-20 seconds, during which time she had a couple spasms. After that, she woke up, was aware that she had passed out, then threw up once. She waited with her mom for 30 minutes after that, but felt fine during that period.


VAERS ID: 1333578 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-05-18
Onset:2021-05-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Nausea
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Escitalopram, Mirtazapine
Current Illness: Head cold
Preexisting Conditions: Asthma, IBS
Allergies: Latex, amoxicillan
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Dizziness and nausea - stayed lying down, and stayed home from school next day 5/19 - fine now 5/20


VAERS ID: 1333586 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-18
Onset:2021-05-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0164 / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Vitreous floaters
SMQs:, Retinal disorders (narrow)

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

Write-up: Client saw black dots, didn''t feel well EVMS assess. BP110/76, P71, O2Sat 99% BS 95, Had chips and Oreo cookies for lunch. Mother came to bring child home. Instruct for second vaccine needs to eat and drink liquids prior to vaccination. Let vaccinator of experience from first shot.


VAERS ID: 1333590 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-18
Onset:2021-05-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0170 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Loss of consciousness, Nausea
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? 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: blackout post vaccination; nausea; past out.


VAERS ID: 1333597 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-05-18
Onset:2021-05-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood pressure decreased, Presyncope
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: zoloft, vit d3, multivitamin
Current Illness: n/a
Preexisting Conditions: Autism, I/DD
Allergies: Allergic to Versed
Diagnostic Lab Data: BP repeated until returned to baseline
CDC Split Type:

Write-up: Vasovagal reaction with near miss syncope. 10-15 mmHg drop in BP


VAERS ID: 1333605 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-05-18
Onset:2021-05-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7533 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypotension, Nausea, Syncope, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (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), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

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

Write-up: Systemic: Fainting / Unresponsive-Severe, Systemic: Hypotension-Medium, Systemic: Nausea-Medium, Additional Details: Immunizing pharmacist checked patient''s blood pressure after syncopal episode, and again before sending patient home. He then called later to follow up and was informed of a second episode, after which he accompanied patient and mother to hospital. He remained with them until she was cleared to go home.


VAERS ID: 1333612 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-07
Onset:2021-05-18
   Days after vaccination:41
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER2613 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0162 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Exposure during pregnancy, SARS-CoV-2 test positive
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), 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: Magnesium, prenatal vitamin
Current Illness:
Preexisting Conditions:
Allergies: NKA
Diagnostic Lab Data: Novel Coronavirus PCR - SARS-COV-2 detected (5/18/2021)
CDC Split Type:

Write-up: Pt is a 31 yo female G3P0020 37w3d with an estimated delivery date of 6/5/21. She is fully vaccinated against COVID-19 with Pfizer vaccination first dose on 3/17, second dose on 4/7. On 5/18, she presents to this institution for a scheduled ECV. While admitted, she undergoes standard inpatient COVID-19 testing, which results positive. Pt was asymptomatic and vitals WNL. After extensive discussion with physician, pt chooses not to proceed with ECV on 5/18. Unclear if COVID+ diagnosis played a role in decision. Pt advised to quarantine for 10 days.


VAERS ID: 1333640 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-05-18
Onset:2021-05-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Injection site swelling, Mobility decreased, Pain in extremity
SMQs:, Parkinson-like events (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Tendinopathies and ligament disorders (broad)

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

Write-up: Patient reports swelling at the injection site. there is a small bump noted. Reports pain in the left arm and it is difficult to raise arm due to pain level.


VAERS ID: 1333665 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-05-18
Onset:2021-05-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abnormal dreams, Arthralgia, Chills, Decreased appetite, Headache, Injection site swelling, Limb discomfort, Nausea, Pyrexia, Restlessness, Toothache
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Akathisia (broad), Noninfectious encephalopathy/delirium (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Headache, fever, tooth pain, restlessness, chills, nausea, joint pain, sore/heavy feeling arm, swelling at the injection site, loss of appetite, reoccurring dreams


VAERS ID: 1333693 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-05-14
Onset:2021-05-18
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 035C21A / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Burning sensation, Feeling hot, Pruritus, Suffocation feeling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Peripheral neuropathy (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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Enalpril 20mg Proponolol 20mg
Current Illness: N/A
Preexisting Conditions: High Blood Pressure
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Intense body heat, I also feel like I am without air. As though I am suffocating. I also feel as though I?m itching and burning within. I feel it is unrelated to my menopause, for the heat is way more intense than I have ever felt before.


VAERS ID: 1333710 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-05-15
Onset:2021-05-18
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Electrocardiogram ST segment elevation, Feeling abnormal, Troponin increased
SMQs:, Myocardial infarction (narrow), Dementia (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: see above
CDC Split Type:

Write-up: Course of the Hospitalization: 05/18/2021 Today the patient was seen examined. Patient denies any chest pain, shortness breath, nausea, vomiting or diarrhea. Patient is in good spirits such time. Patient has any changes to vision/hearing/taste/smell. Patient will follow-up with his cardiologist from the hospital. Patient was told if he any discomfort in his chest, changes to vision/hearing/taste/smell go immediately to emergency room for further workup and evaluation as necessary. Patient was discharged on Pepcid 20 milligrams to be taken twice daily for next 14 days. Side effects, risks, benefits of medications discussed great length. I asked the patient to discuss with the pharmacist any questions comments or concerns he may have both this medication as well. Admitting ER Note: 23-year-old male presenting to emergency department for evaluation of chest pain. Reports pain started 2 nights ago. He received his 2nd COVID vaccine early Saturday morning, by Saturday night started having symptoms including chest pain. Other symptoms resolved the chest pain has persisted, and waxing and waning. Was seen at urgent care and found of ST elevations on EKG and sent to emergency department. While here in the ED again found to have ST elevations in anterior leads with reciprocal changes inferiorly. Troponin elevated to 11. Bedside echocardiogram performed by myself and cardiologist negative for tamponade or significant hypokinesis. Patient will require admission for further management and evaluation.


VAERS ID: 1333822 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-18
Onset:2021-05-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050C21A / 4 LA / IM

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

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

Write-up: PATIENT GOT THE VACCINE COVID 19 FIRST DOSE, SHE WAS TOLD TO SIT FOR 15 MINUTES BEFORE LEAVING! ABOUT FEW MINUTES LATER, SHE PASSED OUT AND DROP HER BODY ON THE FLOOR! WE PUT HER BACK IN THE CHAIR , GAVE HER SOME WATER. SHE FELT OK AFTER THAT, DENIED TO CALL AMBULANCE! HER VITAL SIGNS WERE OK, WE CALLED THE MOM TO PICK HER UP! FOLLOW UP CALL PATIENT IS DOING OK!


VAERS ID: 1333916 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-05-17
Onset:2021-05-18
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8735 / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Blood glucose, Blood glucose decreased, Blood uric acid, Laboratory test
SMQs:, Hypoglycaemia (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: levoythyroxine for thyroid
Current Illness: None
Preexisting Conditions: Hypothyroid and Type 1 diabetes
Allergies: None
Diagnostic Lab Data: Emergency room visit, blood tests and urine test, frequent blood sugar checks. These all occurred 05/18-05/19
CDC Split Type:

Write-up: Patient experienced ongoing and severe/disabling low blood sugar for several hours. We could not get her blood sugar to stabilize at home and had to take her to the emergency room for assistance.


VAERS ID: 1333993 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-05-17
Onset:2021-05-18
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Pain, Pain in extremity, Phlebitis
SMQs:, Thrombophlebitis (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: At about 24 hours after received Pfizer COVID vaccine #1 he started c/o pain along the cephalic vein starting at antecubital fossa and spreading distally. Yesterday mother said she could feel a ropy feel c/w phlebitis. She had him take an aspirin and put heat on it. Today it is a little better. He still has pain along that vein and it hurts to fully extend and flex his arm. Presumptive left UE phlebitis that occured within 24 hours of the first Pfizer COVID vaccine in teh sme arm, possibly reaction to vaccine. Treatment of LUE with heat, compression adn ibuprofen (avoid ASA due to age <18). If worsening pain, swelling, redness or fever; f/u and will consider US.


VAERS ID: 1334022 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-18
Onset:2021-05-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039A21A / 1 LA / IM

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

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

Write-up: Several minutes after receiving the vaccine, the patient reported an unpleasant metallic taste in her mouth. The taste remained throughout her 30 min observation period. She called back the following day to report the taste was still present.


VAERS ID: 1334031 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-18
Onset:2021-05-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 042B21-2A / 2 LA / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036A21A / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Bone pain, Dyspnoea, Ear pain, Eye irritation, Headache, Injection site pruritus, Lacrimation increased, Lymphadenopathy, Myalgia, Painful respiration, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Corneal disorders (broad), Eosinophilic pneumonia (broad), Lacrimal disorders (narrow), Osteonecrosis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: 1960- Polio-Vaccine in Kindergarden
Other Medications: metoprolol tartrate 25 mg tablet, hydrocodone 10 mg-acetaminophen 325 mg ,pregabalin 25 mg capsule,tizanidine 2 mg tablet, Wixela Inhub 250 mcg-50 mcg,Spiriva Respimat 2.5 mcg,
Current Illness:
Preexisting Conditions: CERVICAL SPONDYLOSIS, LUMBOSACRAL DISC DEGENERATION,DISPLACEMENT LUMBAR INTERVERTEBRAL DISC,ESSENTIAL HYPERTENSION,CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD)
Allergies: Aspirin, Sulfa, IV Iodine Contrast, Ibprophen, Sertraline Hydrochloride
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: Reaction to 1st- 10 days after - achy muscles & bones , swollen glands, SOB - felt like I had Covid again. Lasted 3 dsys Reaction to 2nd - super achy muscles & bones, SOB, breathing pain, swollen glands, low grade fever, headache, ears hurt, burning watery eyes, itching around injection site - felt like I had Covid again but worse


VAERS ID: 1334116 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-05-18
Onset:2021-05-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Interchange of vaccine products, No adverse event
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: loperamide HCL 2mg capsule PRN, tigan 300mg capsule QID, ibuprofen 800mg q6-8hrs PRN, promethazine 25mg/ml IM q6hrs PRN, selenium sulfide 2.5% topical solution
Current Illness: none
Preexisting Conditions: opioid use disorder
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient appeared for second Moderna COVID-19 dose. Due to paperwork and communication error, patient received Janssen COVID-19 dose instead. Patient was informed of the administration error. Documentation was corrected. Patient experienced no adverse outcomes from the vaccine as of 36 hours after vaccination.


VAERS ID: 1334145 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-05-18
Onset:2021-05-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1802070 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: same day of injection: EKG #1 sinus arrhythmia at 41 with frequent pauses, nonspecific ST-T wave changes EKG #2 normal sinus bradycardia at 36, normal interval/axis/QRS
CDC Split Type:

Write-up: Within 60-90 seconds after receiving J&J vaccine, patient became lightheaded, sat down, then subsequently passed out. Then had 2-3 jerking motions similar to seizure activity. Was lowered to the floor and called a CODE ASSIST. patient was not registered at the time, but was in a hospital. No previous reaction to injections. Patient taken to ED for workup. Patient diaphoretic and bradycardic at 36. given IV fluids and performed EKG. was later discharged from ED


VAERS ID: 1334155 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: New York  
Vaccinated:2021-02-26
Onset:2021-05-18
   Days after vaccination:81
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013L20A / 2 RA / IM

Administered by: Work       Purchased by: ?
Symptoms: Bell's palsy, Lethargy, Lymphadenopathy, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hearing impairment (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: 24 hours after 2nd dose had 103 fever, swollen lymph node, lethargy for 48 hours. almost 3 months subsequent to 2nd dose, developed Bell''s Palsey on left side of face (5/18/21)


VAERS ID: 1334186 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Utah  
Vaccinated:2021-05-17
Onset:2021-05-18
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dyspnoea, Fatigue, Injection site reaction, Myalgia, Pain
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: General seasonal allergies (pollen), but not manifest for some time prior to vaccination
Diagnostic Lab Data:
CDC Split Type:

Write-up: Moderna COVID-19 Vaccine EUA Symptoms: Muscle tenderness at vaccination site, general achiness, fatigue, occasional difficulty breathing (felt like someone squeezing on my diaphragm and made it uncomfortable breathing for short periods of time. Started in the evening time, lasted a minute max each time, and occurred around 5 times before ceasing). Symptoms ended around 9 pm the same day they began


VAERS ID: 1334238 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-18
Onset:2021-05-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Fatigue, Incorrect dose administered, Pain
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: lidocaine patch, propanolol, lasix,aldactone
Current Illness: hepatocellular carcinoma, cough
Preexisting Conditions: alcoholic cirrhosis, hepatic encephalopathy, portal hypertension, HCV infection, UGI bleed, depression, LTBI, tobacco use, vitamin A deficiency, iron deficiency anemia,
Allergies: Cephalexin, cephalosporins
Diagnostic Lab Data:
CDC Split Type:

Write-up: Was under impression that a single dose was 1.0mL not 0.5mL until after another patient was given the vaccine - did not verify with provider. Following day saw the client and she reported feeling a little fatigue and achey but otherwise no adverse reacctions noted.


VAERS ID: 1334255 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-05-18
Onset:2021-05-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 1 LA / IM

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

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

Write-up: The patient was vaccinated and then got up to walk to observation area. While waiting for her COVID vaccination card, she started leaning on mom and fainted. Mom caught her and placed her flat on the floor. A medical professional volunteering at the clinic responded to the incident and checked her O2 levels and blood pressure. Patient cam to shortly after fainting. Vitals were good and the doctor recommended she stay in observation for an additional 10 minutes. Patient left clinic with mom after waiting and without further incident.


VAERS ID: 1334301 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: New York  
Vaccinated:2021-05-18
Onset:2021-05-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / N/A RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Pyrexia, Tremor, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Adverse reaction started at approximately 1030pm about 8 hours after receiving the vaccine. I started to shake and took my temperature to find that I had 104.6 fever and took Tylenol 1000mg and tried to go to sleep. About 30 minutes later at 11pm I vomited so I went to talk to my parents. They took my temperature and it spiked to 106.7 knowing I had already taken Tylenol they grabbed ice packs and wrapped them in a towel and placed them under my armpits and behind my neck they also placed a damp cloth on my forehead and monitored my fever. At around 1145 my fever started to come down slowly to 104.2. Around 130am I ate a few crackers and took ibuprofen 600mg and the fever still slowly dropped at around 2am my fever was still at 102.4 at this time my parents went to bed knowing that my body needed to continue to fight the fever. At 530am my father checked my temperature and it was normal.


VAERS ID: 1334375 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-05-18
Onset:2021-05-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain upper, Dizziness, Nausea, Pain in extremity
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Sore arm, stomach ache/nauseous, dizzy


VAERS ID: 1334418 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-04-22
Onset:2021-05-18
   Days after vaccination:26
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 028A21A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 044B21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Bell's palsy, Dysarthria, Facial paralysis
SMQs:, Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hearing impairment (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown by pharmacy, please contact patient for information he only received the vaccines here ( both doses) on 03/25/21 and 04/22/21
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: we dont have that information
CDC Split Type:

Write-up: observed slurred speech, drooping side of face, says he was diagnosed by hospital on 5/18/21 with bells palsy


VAERS ID: 1334471 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-05-18
Onset:2021-05-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 1 LA / IM

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

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

Write-up: PATIENT CAME IN FOR SECOND DOSE OF PFIZER VACCINE, BUT WAS ADMINISTERED JASSEN


VAERS ID: 1334504 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-05-18
Onset:2021-05-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 - / IM

Administered by: Public       Purchased by: ?
Symptoms: Hyperhidrosis, Pallor, Pulse abnormal, 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: unknown
Current Illness: none stated
Preexisting Conditions: none stated
Allergies: NKA
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Dad present for vaccine, after a few minutes post vaccine, pt ws unresponsive and had a syncopal reaction, sterna rub, unresponsive to name, pale, diaphoretic., weak pulse of 40, legs raised 0947 81/43-41-12- then 107/56-77-18 responded to voice comands, oriented times 3 and transfered to cot and observation area. Parent instructed to call pediatrician and have him seen for a work up. Parent advised to have him laydown for immunization when he returns. 1015 home to the care of parent.


VAERS ID: 1334514 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-18
Onset:2021-05-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Dizziness, Headache, Nausea
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)

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

Write-up: Pt c/o weakness, HA, dizziness, and Nausea. BP 121/76, HR 112, RR 22 -- $g HR 98 -- $g 108/62, 90. Patient stable and released from vaccination site.


VAERS ID: 1334532 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-05-18
Onset:2021-05-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: 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: Parent wrote wrong DOB on our form which showed child was 12. When entering into our vaccine registry, it was determined that the patient was really born in 2009 and only 11. Family notified that they would not be receiving the second dose until child is 12.


VAERS ID: 1334534 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-05-18
Onset:2021-05-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Headache, Herpes zoster, Rash
SMQs:, Anaphylactic reaction (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Opportunistic infections (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: Ibuprofen, vitamin C, B vitamin, Calcium, magnesium, vitamin D and Zinc.
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Palms of hands red and itchy appt. an hour after vaccine. Extreme pain on side/torso area developed through the night while sleeping. Developed a head ache and the torso pain continued. Developed rash on day 2. Went to clinic and was diagnosed with Shingles. Was prescribed an antiviral medication. Valtrex.


VAERS ID: 1334551 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: New Hampshire  
Vaccinated:2021-03-06
Onset:2021-05-18
   Days after vaccination:73
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027A21A / 2 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Chest discomfort, Computerised tomogram abnormal, Intracardiac thrombus
SMQs:, Anaphylactic reaction (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Eliquis, nadolol, glucosamine, vit D, potassium, magnesium, hair skin and nails supplement, probiotic.
Current Illness: none
Preexisting Conditions: Hypertrophic cardiomyopathy, Atrial fibrillation
Allergies: none known
Diagnostic Lab Data: CT Scan
CDC Split Type:

Write-up: I was going in for a heart ablation on 5/20/2021, had a CT scan on 5/18/21 and a blood clot was found in my heart. I am a pharmacy Technician and they wanted me to stay on eliquis and added plavix to that to help dissolve clot. I spoke to the pharmacist as I had concerns about taking both and in speaking with him he asked if I had had my covid shot, I said I had, he asked which one and told him the moderna. He then stated his brother had the moderna and developed a blood clot in his lung two wks after. So I thought I should report this, I was very surprised that I had a clot as I faithfully take my eliquis daily and never miss a dose. We don''t know how long this clot has been in my heart so there is no way of knowing for sure. But I has noticed in April 2021, a heaviness in my chest, and just assumed it was the Afib.


VAERS ID: 1334634 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-18
Onset:2021-05-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 1 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Dizziness, Flushing, Hyperhidrosis, Presyncope
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Pt has a hx of "passing out" w/ shots
Allergies: amoxicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt w/ amoxicillin allergy unknown reaction. Flushing/sweating, dizziness, lightheadedness. Pt had a near syncopal episode post vaccination. Pt has a hx of "passing out" w/ shots. Pt was laid down, given juice, and stable. VSS BP 101/52, HR 74, RR 20 -- $g 99/65, 82, 20. Pt stable and released from the vaccination site.


VAERS ID: 1334646 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-18
Onset:2021-05-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Anxiety, Injection site pain, Pain, Throat irritation
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Extravasation events (injections, infusions and implants) (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: shellfish, nuts
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt c/o itchy throat and pain at injection site(left arm) PS 4/10 with throbbing pain noted. Advised pt. to keep moving arm. 5:32 pt. given benadryl 25mg 1 tab for itchy throat and sips of water given v/s monitored 5:20pm vitals 134/70 bp 18 RR P-70 99% o2 SAT pt. verbalized feeling anxious.Advised to do breathing relaxation. 5:35pm vitals 126/70 P-68 RR-18 o2 99%RA pt reported with no relief from symptoms still noted with itchy throat , no SOB pt alert and verbally responsive. patient was advised to go to urgetnt care/hospital for further eval. 6:10pm pt guardian mother will accompany the patient to hospital /urgent care


VAERS ID: 1334780 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Texas  
Vaccinated:0000-00-00
Onset:2021-05-18
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Headache, Poor quality product administered, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Medication errors (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210535199

Write-up: POOR QUALITY VACCINE ADMINISTERED; HEADACHE; FEVER; This spontaneous report received from a pharmacist concerned a patient of unspecified age and sex. The patient''s weight, height, and medical history were not reported. The patient received covid-19 vaccine (suspension for injection, route of admin not reported, batch number: 206A21A, and expiry: 23-JUN-2021) dose was not reported, administered on 18-MAY-2021 for prophylactic vaccination. No concomitant medications were reported. On 18-MAY-2021, the subject experienced poor quality vaccine administered. On 18-MAY-2021, the subject experienced headache. On 18-MAY-2021, the subject experienced fever. The action taken with covid-19 vaccine was not applicable. The outcome of the poor quality vaccine administered, headache and fever was not reported. This report was non-serious. This case, involving the same patient is linked to 20210538801.


VAERS ID: 1334788 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Female  
Location: New Jersey  
Vaccinated:0000-00-00
Onset:2021-05-18
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Diarrhoea
SMQs:, Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: The patient was not pregnant at the time of vaccination.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210535787

Write-up: DIARRHEA; This spontaneous report received from a patient concerned an 86 year old female. The patient''s weight, height, and medical history were not reported. The patient received covid-19 vaccine (suspension for injection, route of admin not reported, batch number: Unknown) dose was not reported, administered on 14-MAY-2021 for drug use for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On 18-MAY-2021, the subject experienced diarrhea. The action taken with covid-19 vaccine was not applicable. The patient had not recovered from diarrhea. This report was non-serious.


VAERS ID: 1334798 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Wisconsin  
Vaccinated:0000-00-00
Onset:2021-05-18
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821286 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Fatigue
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Abstains from alcohol; Smoker (Smokes 4 cigarettes/day.)
Preexisting Conditions: Medical History/Concurrent Conditions: Allergy; Comments: The patient had no known drug abuse or illicit drug use.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210537350

Write-up: FATIGUE; This spontaneous report received from a patient concerned a 62 year old male. The patient''s height, and weight were not reported. The patient''s concurrent conditions included smoker, non-alcoholic, and allergy, and other pre-existing medical conditions included the patient had no known drug abuse or illicit drug use. The patient received covid-19 vaccine (suspension for injection, route of admin not reported, batch number: 1821286 expiry: UNKNOWN) dose was not reported, administered on 18-MAY-2021 for prophylactic vaccination. No concomitant medications were reported. On 18-MAY-2021, the subject experienced fatigue. The action taken with covid-19 vaccine was not applicable. The patient had not recovered from fatigue. This report was non-serious.


VAERS ID: 1334804 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Texas  
Vaccinated:0000-00-00
Onset:2021-05-18
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, Asthenopia, Chills, Dizziness, Dyspnoea, Fatigue, Feeling cold, Nausea, Pain
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Corneal disorders (broad), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: METFORMIN
Current Illness: Type II diabetes mellitus
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210537708

Write-up: COULDN''T TAKE A DEEP BREATH; FELT COLD; WHOLE BODY ACHY; DIZZINESS; WEAKNESS; CHILLS; EXTREMELY TIRED; NAUSEATED; EYES GOT HEAVY; This spontaneous report received from a patient concerned a 41 year old male. The patient''s height, and weight were not reported. The patient''s concurrent conditions included type2 diabetes. The patient received covid-19 vaccine (suspension for injection, route of admin not reported, batch number: 206A21A, and batch number: 206A21A expiry: UNKNOWN) dose was not reported, administered on 18-MAY-2021 for prophylactic vaccination. Concomitant medications included metformin for type2 diabetes. On 18-MAY-2021, the subject experienced whole body achy. On 18-MAY-2021, the subject experienced dizziness. On 18-MAY-2021, the subject experienced weakness. On 18-MAY-2021, the subject experienced chills. On 18-MAY-2021, the subject experienced extremely tired. On 18-MAY-2021, the subject experienced nauseated. On 18-MAY-2021, the subject experienced eyes got heavy. On 19-MAY-2021, the subject experienced couldn''t take a deep breath. On 19-MAY-2021, the subject experienced felt cold. The action taken with covid-19 vaccine was not applicable. The patient recovered from nauseated on MAY-2021, was recovering from couldn''t take a deep breath, had not recovered from extremely tired, whole body achy, weakness, and chills, and the outcome of dizziness, eyes got heavy and felt cold was not reported. This report was non-serious.


VAERS ID: 1334861 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-05-18
Onset:2021-05-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1820095 / 1 LA / IM

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

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

Write-up: The patient received their vaccination and before my immunizing technician could apply his bandaid he fell straight back while seated in his chair. She was able to catch his fall and lie him on the ground. I went into the immunization room to assist immediately and he was apologizing for scaring. I asked him to lie there for a few minutes and take some deep breaths. He was talking and aware of his surroundings. I asked him about his medication history which was null. I asked him if he had been nervous and he said he didn''t think so. She said that he did mention he did not like needles. He had not eaten since the morning (a bagel) and it was late in the afternoon. After a few minutes I asked him if he would like to sit up so I could see how he was doing. Management arrived and observed while I went to get a cold cloth for his neck/face. Management asked him if he would like to sit in a chair. He sat in a chair and before I came back after just a few minutes, he had slumped over to the side with his eyes rolling back. Management was concerned so they immediately called 911. fire department and EMS arrived. They tested his blood pressure, etc and said they believed he had just passed out. They asked him if he wanted to go to the hospital. He declined. He called a family member to pick him up who arrived about 45 minutes after his vaccination. He was walking around and coherent when he left.


VAERS ID: 1334864 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-05-18
Onset:2021-05-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8736 / 1 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: dizziness and fever of 99.2, these symptoms lasted until 5/20/21 11:30am


VAERS ID: 1335981 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: New York  
Vaccinated:2021-05-18
Onset:2021-05-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / UNK LA / IM

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

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

Write-up: Patient called pharmacy to say he had developed a Rash and Hives the evening of his vaccine (vaccinated in the morning). Patient treating at home with hydrocortisone 1% and oral benadryl.


VAERS ID: 1336114 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-05-12
Onset:2021-05-18
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Vertigo
SMQs:, Vestibular disorders (narrow)

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

Write-up: Severe vertigo decreasing as time goes on


VAERS ID: 1336130 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-05-17
Onset:2021-05-18
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO151 / UNK LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Disorientation, Fatigue, Gait disturbance, Pain in extremity, Walking aid user
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Arthritis (broad), Tendinopathies and ligament 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: Metoprolol 25mg 1 pill am Cymbalta 60mg 1 bid Gabapentin 600mg tid Temazepam 15mg daily ha Sinemet 50/200 1 daily ha Potassium 200mg 2 pills 3 times/ week
Current Illness: None
Preexisting Conditions: Fibromyalgia High blood pressure Hypothyroidism Depression
Allergies: Sulfa Levaquin
Diagnostic Lab Data: None so far
CDC Split Type:

Write-up: I had to use my walker, from knee surgery 2 yrs ago, to get around. Still difficult- legs and knees hurt pretty bad. Husband said I was ?talking out of my head some?, was very tired. It passed after one day. *Please make note that I did have Covid in January- in my lungs. I did not report to my dr- but I will


VAERS ID: 1336145 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-05-01
Onset:2021-05-18
   Days after vaccination:17
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute kidney injury, Alanine aminotransferase increased, Anuria, Back pain, Bilevel positive airway pressure, Blood creatine phosphokinase increased, Blood lactic acid increased, Blood pH decreased, Blood urea increased, Chest X-ray abnormal, Circumoral swelling, Computerised tomogram abnormal, Dyspnoea, Endotracheal intubation, Hypocomplementaemia, Liver function test increased, Mastication disorder, Mobility decreased, Musculoskeletal stiffness, Myalgia, Myositis, Neck pain, Oropharyngeal pain, Pleural effusion, Renal replacement therapy, Rhabdomyolysis, Swelling
SMQs:, Rhabdomyolysis/myopathy (narrow), Acute renal failure (narrow), Liver related investigations, signs and symptoms (narrow), Anaphylactic reaction (narrow), Angioedema (narrow), Lactic acidosis (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Myocardial infarction (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Dystonia (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (narrow), Hypersensitivity (narrow), Arthritis (broad), Tumour lysis syndrome (broad), Respiratory failure (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? Yes
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: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: ABG showed pH of 7.15 and lactic acid of 2.7 mmol/L. CK level peaked at 744,000. CT scan suggested myositis in her masseter muscles but gluteal muscles could not be well viewed. A repeat CXR showed a progressive right pleural effusion. Other laboratories included elevated LFTs (ALT 2694 and ALT 10,885) and mild hypocomplementemia. BUN/SCr worsened to 42/4.1.
CDC Split Type:

Write-up: Patient received COVID vaccine approximately one week prior to admission. Patient developed acute rhabdomyolysis requiring hospitalization. She developed pain and stiffness in her neck which spread to her back and generalized muscles to the point where she had difficulty moving in the next 12 hours. She did not have difficulty swallowing but she did have difficulty chewing and complained of throat pain. Upon arrival to the emergency room she was unable to lift her legs to get out of the car. In the emergency room she was found to have a CK of 130,000 along with a creatinine of 1.1 and potassium of 6.8 with a calcium of 7.0. She was admitted to the hospital ward and given aggressive IVFs. The following am she was having trouble breathing and was started on BIPAP; the repeat CK level climbed to 543,500. She continued to worsen, developing increased swelling around the mouth and neck. She became anuric with acute kidney injury; and was subsequently transferred to CCC upon which she was intubated and initiated on CRRT.


VAERS ID: 1336157 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-07
Onset:2021-05-18
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Full body urticaria beginning on stomach and rapidly progressing to large area across stomach and back. Hives subsided and have resurfaced for several days across arms legs face torso . Over the counter antihistamine Allegra in combination with Benadryl at night and steroid pack initiated.


VAERS ID: 1336255 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-05-17
Onset:2021-05-18
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Injection site pain, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Extravasation events (injections, infusions and implants) (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Woke up the morning after receiving the shot & felt fine, so I went to work. As the day went on, I got muscle aches and pains all through my body (especially in my left arm - the injection site - of course) and fatigue. It continually worsened throughout the afternoon and evening, despite bedrest and proper hydration, and I could barely sleep. However, the next morning I woke up just as I did the day before - no problems, feeling fine.


VAERS ID: 1336260 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-05-01
Onset:2021-05-18
   Days after vaccination:17
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site bruising, Injection site erythema, Injection site pruritus, Injection site swelling
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

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

Write-up: Site: Bruising at Injection Site-Medium, Site: Itching at Injection Site-Medium, Site: Pain at Injection Site-Mild, Site: Redness at Injection Site-Medium, Site: Swelling at Injection Site-Medium


VAERS ID: 1336491 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-18
Onset:2021-05-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Dizziness, Dyspnoea, Fatigue, Headache, Hypersensitivity, Malaise, Nausea, Pain, Pruritus
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: Of note, pt has previous known allergies to aspirin, eggs, and shellfish (all hives).
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt began to experience an allergic reaction ~30min post vaccination. Pt devoloped dyspnea w/ itching. Pt later felt ill w/ dizziness, chill and itchiness. In several telephone visits on 5/18 and 5/19, staff recommended that the patient go to the ER for evaluation. Pt declined. On 5/19, the patient agreed to a telephone visit with a provider where the patient complained of chills, headaches with nausea with fatigue and body aches after covid 19 vaccine, also with itching occasionally. Provider reiterated that the patient can go to the ER if symptoms do not improve. On 5/20, pt indicates improvement though she still feels ill. Of note, pt has previous known allergies to aspirin, eggs, and shellfish (all hives).


VAERS ID: 1336492 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-14
Onset:2021-05-18
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 1 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Amylase increased, Dyspnoea, Lipase increased, Pancreatitis
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Type 1 diabetes mellitus.
Allergies: No known allergies.
Diagnostic Lab Data: Amylase levels of 553 and lipase levels of 3,366
CDC Split Type:

Write-up: Patient had respiratory difficulty, Pancreatitis


VAERS ID: 1336494 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-05-17
Onset:2021-05-18
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Headache, Pain
SMQs:

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

Write-up: Body aches, fatigue, headaches


VAERS ID: 1336506 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-05-18
Onset:2021-05-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal discomfort, Axillary pain, Burning sensation, Deafness, Dizziness, Dry throat, Fatigue, Headache, Hot flush, Lymphadenopathy, Neck pain, Night sweats, Pain in extremity, Pyrexia, Sleep disorder, Speech disorder, Thirst, Visual impairment
SMQs:, Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Hearing impairment (narrow), Vestibular disorders (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad)

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

Write-up: headache with visual sensitivity, headache, hard to hear for a second, speech was impaired for a second, difficult to find words for a second, felts as if she had a fever and kept coming in flashes, pain went down leg, but then quickly went away, index knuckle on left hand felt burning, but went away,2nd day- tiredness, hot flashes, thirsty, 3rd day sleep disturbances, night sweats on each day since vaccine, throat dry on second day, 3rd day throaty dry, lymph nodes swelling, tired, this morning pain in right axillary area, neck still sore, dizziness this afternoon, abdominal upset this morning, hot flashes today


VAERS ID: 1336523 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-10
Onset:2021-05-18
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Epistaxis, Exposure during pregnancy, Laboratory test, Rash, Rash erythematous, Rash pruritic
SMQs:, Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prenatal, escitalopram 10mg
Current Illness: None
Preexisting Conditions: Anxiety/Depression
Allergies: None known
Diagnostic Lab Data: OB ordered lab tests today 5/21/2021 No results yet.
CDC Split Type:

Write-up: 29 weeks pregnant at the time of vaccination, Down syndrome baby, due date July 21st but will be induced July 7th. Tuesday May 18th began having a red itchy skin reaction around the breast area around 4pm which moved to the torso and belly and hips, itchy red bumps by 12am. Took Benadryl, 2 pills every 4-6 hours, after third dose, then switched to Zyrtec, one pill. Also applied aloe vera cream. Currently my skin is beginning to clear up but still itchy. Doctor looked at rash. It is 12:50pm on May 21. Also experiencing very minor nose bleeding today, May 21st.


VAERS ID: 1336635 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-05-18
Onset:2021-05-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 1 LA / IM

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

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

Write-up: Error: Wrong Dose of Vaccine - Too High


VAERS ID: 1336641 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-05-18
Onset:2021-05-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 1 LA / IM

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

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

Write-up: Error: Wrong Dose of Vaccine - Too High


VAERS ID: 1336643 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-05-18
Onset:2021-05-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 1 LA / IM

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

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

Write-up: Error: Wrong Dose of Vaccine - Too High.


VAERS ID: 1336647 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-05-18
Onset:2021-05-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 1 LA / IM

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

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

Write-up: Error: Wrong Dose of Vaccine - Too High


VAERS ID: 1336651 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-05-18
Onset:2021-05-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 1 LA / IM

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

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

Write-up: Error: Wrong Dose of Vaccine - Too High


VAERS ID: 1336655 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-05-18
Onset:2021-05-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 1 LA / IM

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

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

Write-up: Error: Wrong Dose of Vaccine - Too High


VAERS ID: 1336659 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-05-18
Onset:2021-05-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 1 LA / IM

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

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

Write-up: Error: Wrong Dose of Vaccine - Too High


VAERS ID: 1336662 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-05-18
Onset:2021-05-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 1 LA / IM

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

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

Write-up: Error: Wrong Dose of Vaccine - Too High


VAERS ID: 1336707 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-05-18
Onset:2021-05-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 1 LA / IM

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

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

Write-up: Error: Wrong Dose of Vaccine - Too High


VAERS ID: 1336714 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-05-14
Onset:2021-05-18
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 1 UN / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Bell's palsy, Facial paralysis, Lyme disease
SMQs:, Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Hearing impairment (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: Lexapro 20mg once daily Latuda 20mg once daily
Current Illness: none
Preexisting Conditions: anxiety and depression
Allergies: none
Diagnostic Lab Data: Lyme test done on day of presentation (5/18/21) and was negative.
CDC Split Type:

Write-up: 4 days after vaccination (on 5/18/21) she presented with right facial droopiness (unable to close right eye, unable to smile on right side etc) consistent with Bell''s Palsy. Symptoms are (unsurprisingly) persistent now 3 days later


VAERS ID: 1336873 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Hawaii  
Vaccinated:2021-05-15
Onset:2021-05-18
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8735 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Oedema, Oedema peripheral
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad)

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

Write-up: bilateral pitting edema of feet and ankles 3 days after second vaccine


VAERS ID: 1336960 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-05-18
Onset:2021-05-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 1 UN / IM

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

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

Write-up: Error: Wrong Dose of Vaccine - Too High


VAERS ID: 1336964 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-05-18
Onset:2021-05-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 1 UN / IM

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

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

Write-up: Error: Wrong Dose of Vaccine - Too High


VAERS ID: 1336997 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-04-12
Onset:2021-05-18
   Days after vaccination:36
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 2031A21A / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Blood test, Catheterisation cardiac abnormal, Chest discomfort, Coronary arterial stent insertion, Coronary artery thrombosis, Dyspnoea, Electrocardiogram abnormal, Hypoaesthesia, Myocardial infarction
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Other ischaemic heart disease (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? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: EKG 5/18/21 Blood test 5/18/21 Cardiac cath 5/18/21
CDC Split Type:

Write-up: Heart attack - Sudden onset chest pressure, shortness of breath, bilateral arm numbness. Found to have clot in LAD requiring stent. No cardiac risk factors.


VAERS ID: 1337164 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-05-18
Onset:2021-05-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 1 LA / IM

Administered by: Public       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 falsified DOB when registering for vaccination. Guardian, consented to the vaccination. Department of Health verified with statistical records patients actual DOB, which made the vaccine a contraindication. No known adverse reactions noted.


VAERS ID: 1337169 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-05-13
Onset:2021-05-18
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045B21A / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Atrial fibrillation, Electrocardiogram
SMQs:, Supraventricular tachyarrhythmias (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Multi-vitamin Calcium Vitamin D3 Vitamin B-12 GABA Biotin
Current Illness: None
Preexisting Conditions: Hypoglycemia
Allergies: None
Diagnostic Lab Data: EKG on 5/18/21
CDC Split Type:

Write-up: Atrial Fibrillation with RVR


VAERS ID: 1337195 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-05-18
Onset:2021-05-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 1 UN / IM

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

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

Write-up: Error: Wrong Dose of Vaccine - Too High


VAERS ID: 1337265 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-05-18
Onset:2021-05-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Head injury, Hypotension, Loss of consciousness, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Systemic: Dizziness / Lightheadness-Severe, Systemic: Fainting / Unresponsive-Severe, Additional Details: Pt had dentist appointment the morning of vaccine. After pt got vaccine and was seated in observation area pt got dizzy and passed out and hit head. BP was taken and was 84/54. 911 was called and pt went to ER due to continuous low blood pressure.


VAERS ID: 1337304 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-18
Onset:2021-05-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041C21A / 1 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Dry mouth
SMQs:, Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Dehydration (broad)

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

Write-up: the patient complained of dry mouth with no other signs of swelling or trouble breathing hours after her 15 minute observation time. I advised her to take diphenhydramine and seek medical attention if the condition did not improve. She ended up going to the hospital. Since then division 1 has been checking in with her


VAERS ID: 1337350 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-05-17
Onset:2021-05-18
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021C21A / 2 RA / SYR

Administered by: School       Purchased by: ?
Symptoms: Exposure during pregnancy, Fatigue, Headache, Injection site pain, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Extravasation events (injections, infusions and implants) (broad), Eosinophilic pneumonia (broad), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prenatal Vitamin Fish Oil Vitamin D Tums
Current Illness: Head cold 5/7 -5/12
Preexisting Conditions: Asthma Balanced Chromosomal Translocation
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Headache - Mild (5/18 All Day) Back, shoulder, neck muscle pain - Medium (5/18 All Day) Fatigue - Medium (5/18 All Day progressing from mild to medium, peaking at 4 pm) Injection Site Pain - Mild (5/17 approx 6pm till sleep) Injection Site Pain - Medium (5/18 peak at approx 10 am) Treated with water and rest 10th pregnancy, due 8/31/21


VAERS ID: 1337559 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-05-14
Onset:2021-05-18
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Catheterisation cardiac normal, Chest pain, Echocardiogram abnormal, Ejection fraction decreased, Electrocardiogram abnormal, Myocarditis, Troponin increased, Viral test
SMQs:, Cardiac failure (narrow), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Methylphenidate HCl 54 mg po daily.
Current Illness: none
Preexisting Conditions: ADHD
Allergies: none
Diagnostic Lab Data: Troponin, Echocardiogram, Cardiac Catheterization, Multiple Viral Serologies
CDC Split Type:

Write-up: The patient was admitted to the hospital with chest pain, abnormal ECG, and elevated troponin. He underwent urgent cardiac catheterization, which showed normal coronary arteries. His left ventricular ejection fraction was reduced. His clinical picture was consistent with myocarditis.


VAERS ID: 1337632 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-05-18
Onset:2021-05-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal discomfort, Asthenia, Cold sweat, Diarrhoea, Dizziness, Hyperhidrosis, Lethargy, Pain, Tremor, Vertigo
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Parkinson-like events (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (narrow), Noninfectious diarrhoea (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Sertraline, buprenorphine, vitamin D, omeprazole, phentermine, atorvastatin
Current Illness: None
Preexisting Conditions: High cholesterol, heart burn, general anxiety
Allergies: Seasonal hay fever
Diagnostic Lab Data: Did not seek medical attention.
CDC Split Type:

Write-up: Initial symptoms started ~4 hours post vaccine and were upset stomach followed by severe diarrhea, cold sweats/dripping sweat, body trembling, weakness and overall body pain. It was so bad I considered calling 911 as it came on extremely suddenly and was very severe. After taking Immodium stomach upset/diarrhea ceased, but body soreness, lethargy, vertigo, dizziness persisted for almost 48 hours post vaccine.


VAERS ID: 1337820 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-05-18
Onset:2021-05-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 1 LA / IM

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

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

Write-up: Systemic: Fainting / Unresponsive-Medium, Systemic: Seizure-Medium


VAERS ID: 1337858 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-04-22
Onset:2021-05-18
   Days after vaccination:26
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8732 / 1 LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0171 / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Catheterisation cardiac normal, Chest pain, Echocardiogram normal, Electrocardiogram ST segment elevation
SMQs:, Myocardial infarction (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Trelegy, Omega-3 vitamins
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: EKG - Elevated ST levels, 5/18/21 Cardiac Catherization - Normal, 5/18/21 Echo - Normal, 5/18/21
CDC Split Type:

Write-up: Chest Pain for 1 week leading up to event that got worse the day after 2nd vaccination. EKG with elevated ST levels from PCP same day - sent to ER same day.


VAERS ID: 1337878 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-05-18
Onset:2021-05-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Wrong product 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: PATIENT WANTED THE PFIZER COVID-19 VACCINE NOT THE JANSSEN COVID-19 VACCINE THAT HE RECEIVED.


VAERS ID: 1337894 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-18
Onset:2021-05-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 LA / IM

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

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

Write-up: Systemic: Fainting / Unresponsive-Mild


VAERS ID: 1337930 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-19
Onset:2021-05-18
   Days after vaccination:88
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / 2 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0140 / 1 RA / IM

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

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

Write-up: Pt completed Pfizer COVID vaccine in feb 2021. Pt found COVID + on 5/18/2021 and admitted to the hospital same day for COVID treatment


VAERS ID: 1338339 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-05-18
Onset:2021-05-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cold sweat, Confusional state, Loss of consciousness, Musculoskeletal stiffness, Nervousness, Pallor, Vision blurred
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (narrow), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Arthritis (broad), Hypoglycaemia (broad)

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

Write-up: I administered the vaccine, got one side of the band-aid on and that is when her head fell back. Her eyes rolled into the back of her head; she then leaned over the right arm of the chair. Her body stiffened next. I held her head and body with the help of a colleague. This happened for about 10 seconds, then she woke up and snatched her mask off with a confused look on her face. We asked her questions to see if she was aware. She was, then she went back out falling over to the side. I called 911. When she awakened the second time after about 7-10 seconds her face turned pale. We then moved her to the floor and propped her feet up. Patient said she was nervous and felt like she had to use the restroom. Her skin was clamy; patient said clamy skin is nothing new for her. The fire truck and ambulance arrived on scene. The workers began to assess patient. Vitals were good. She did not go in the ambulance, but stated her vision were blurry. She went home with grandparents.


VAERS ID: 1338592 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-05-18
Onset:2021-05-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 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: n/a
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: n/a
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Vaccine administered to underage 11 year old.


VAERS ID: 1340233 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-05-18
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / UNK - / -

Administered by: Military       Purchased by: ?
Symptoms: Body temperature, Fatigue, Lethargy, Somnolence, Suspected COVID-19
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: COVID-19
Allergies:
Diagnostic Lab Data: Test Date: 20210519; Test Name: Body temperature; Result Unstructured Data: 103.1 F
CDC Split Type: USJNJFOC20210537559

Write-up: FELT LIKE COVID-19 SYMPTOMS; SLEEPINESS; EXTREMELY LETHARGIC; EXTREMELY FATIGUED; This spontaneous report received from a patient concerned a 53 year old male. The patient''s height, and weight were not reported. The patient''s past medical history included covid-19. The patient received covid-19 vaccine (suspension for injection, route of admin not reported, batch number: 206A21A, expiry: UNKNOWN) dose was not reported, administered on 18-MAY-2021 for prophylactic vaccination. No concomitant medications were reported. On 18-MAY-2021, the subject experienced sleepiness. On 18-MAY-2021, the subject experienced extremely lethargic. On 18-MAY-2021, the subject experienced extremely fatigued. On 19-MAY-2021, the subject experienced felt like covid-19 symptoms. Laboratory data included: Body temperature (NR: not provided) 103.1 F. The action taken with covid-19 vaccine was not applicable. The patient had not recovered from sleepiness, and extremely lethargic, and the outcome of felt like covid-19 symptoms and extremely fatigued was not reported. This report was non-serious.


VAERS ID: 1340242 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Oregon  
Vaccinated:0000-00-00
Onset:2021-05-18
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Body temperature, Chills, Dizziness, Headache, Hypoaesthesia, Pyrexia
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Abstains from alcohol; Non-smoker
Preexisting Conditions: Medical History/Concurrent Conditions: Ulcerative colitis; Comments: The patient did not have no known drug allergies.
Allergies:
Diagnostic Lab Data: Test Date: 20210518; Test Name: Body temperature; Result Unstructured Data: 101 F
CDC Split Type: USJNJFOC20210539108

Write-up: NUMBING IN THE FACE; DIZZINESS; CHILLS; HEADACHE; FEVER; This spontaneous report received from a patient concerned a 32 year old male. The patient''s height, and weight were not reported. The patient''s past medical history included ulcerative colitis, and concurrent conditions included no alcohol use, and non smoker, and other pre-existing medical conditions included the patient did not have no known drug allergies. The patient received covid-19 vaccine (suspension for injection, route of admin not reported, batch number: 203A21A, and batch number: 203A21A expiry: 23-JUN-2021) dose was not reported, administered on 17-MAY-2021 for prophylactic vaccination. No concomitant medications were reported. On 18-MAY-2021, the subject experienced chills. On 18-MAY-2021, the subject experienced headache. On 18-MAY-2021, the subject experienced fever. Laboratory data included: Body temperature (NR: not provided) 101 F. On 19-MAY-2021, the subject experienced numbing in the face. On 19-MAY-2021, the subject experienced dizziness. Treatment medications (dates unspecified) included: ibuprofen. The action taken with covid-19 vaccine was not applicable. The patient was recovering from chills, headache, and fever, and had not recovered from dizziness, and numbing in the face. This report was non-serious.


VAERS ID: 1340586 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-05-18
Onset:2021-05-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 LA / IM

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

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

Write-up: Error: Incorrect Reconstitution


VAERS ID: 1340751 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-05-18
Onset:2021-05-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / UNK LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Nausea
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)

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

Write-up: Patient became lightheaded and nauseated post vaccination, recovered and released


VAERS ID: 1340780 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-05-18
Onset:2021-05-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / UNK LA / IM

Administered by: Other       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: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: Unknown
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient became lightheadedness post vaccination, recovered and released


VAERS ID: 1340799 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Rhode Island  
Vaccinated:2021-05-18
Onset:2021-05-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 RA / IM

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

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

Write-up: Vaccine administered after vial was punctured and left at room temp for over 2 hours. Vaccine administered about 3&1/2 hours after initial puncture.


VAERS ID: 1340806 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Rhode Island  
Vaccinated:2021-05-18
Onset:2021-05-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / IM

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

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

Write-up: Vaccine administered after vaccine was punctured and left at room temp for over 2 hours. Vaccine administered about 3&3/4 hours after initial puncture.


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