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

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



Case Details (Reverse Sorted by Onset Date)

This is page 141 out of 6,867

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VAERS ID: 1554010 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-08-12
Onset:2021-08-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / UNK - / IM

Administered by: Public       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: improper storage and handing of vaccine


VAERS ID: 1554017 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-08-12
Onset:2021-08-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / UNK - / -

Administered by: Public       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: dose administered after improper temp storage. No outcome reported as of now


VAERS ID: 1554018 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-08-12
Onset:2021-08-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / -

Administered by: Other       Purchased by: ?
Symptoms: Chest discomfort, Hypoaesthesia, Joint stiffness, Muscle tightness, Muscular weakness, Pain in jaw
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Peripheral neuropathy (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Osteonecrosis (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Birth control. Blood pressure medication. Vitamins: C, B6, B12, D, Milk Thistle, Tumeric, Chromium Piccolinate, Probiotic, Collagen.
Current Illness: N/A
Preexisting Conditions: Chiari malformation.
Allergies: N/A
Diagnostic Lab Data:
CDC Split Type:

Write-up: Within minutes of injection: numbness, weakness, tightness of left wrist. Mostly resolved. Within hours of injection: chest tightness/heaviness. Mostly resolved. Morning post-injection: TMJ or tightness/pain in jaw. Persistent still.


VAERS ID: 1554024 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-08-12
Onset:2021-08-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / UNK - / -

Administered by: Public       Purchased by: ?
Symptoms: Expired product administered, 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: dose administered after improper temp storage. No outcome reported as of now


VAERS ID: 1554025 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-08-12
Onset:2021-08-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / UNK - / -

Administered by: Public       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: improper storage and handing of vaccine


VAERS ID: 1554026 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-08-12
Onset:2021-08-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / UNK - / -

Administered by: Public       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: dose administered after improper temp storage. No outcome reported as of now


VAERS ID: 1554028 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-08-12
Onset:2021-08-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / UNK - / IM

Administered by: Public       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: improper storage and handing of vaccine


VAERS ID: 1554030 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 LA / IM

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

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

Write-up: Patient passed out after receiving vaccine within about 5 minutes, face became pale and then became pink again, blood pressure dropped and came back up again, last blood pressure reading was low. Patient was in and out but was responsive when EMT arrived. The symptoms took place over a course of about 15 minutes.


VAERS ID: 1554032 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-08-12
Onset:2021-08-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / UNK - / -

Administered by: Public       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: improper storage and handing of vaccine


VAERS ID: 1554035 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-08-12
Onset:2021-08-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / UNK - / -

Administered by: Public       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: dose administered after improper temp storage. No outcome reported as of now


VAERS ID: 1554038 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-08-12
Onset:2021-08-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / UNK - / IM

Administered by: Public       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: improper storage and handing of vaccine


VAERS ID: 1554042 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-08-12
Onset:2021-08-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / UNK - / -

Administered by: Public       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: dose administered after improper temp storage. No outcome reported as of now


VAERS ID: 1554043 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-08-12
Onset:2021-08-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / UNK - / IM

Administered by: Public       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: improper storage and handing of vaccine


VAERS ID: 1554055 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040C21A / 1 LA / IM

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

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

Write-up: Patient experienced syncope after receiving the vaccine. I was able to help the patient up and brought him water and a snack. Patient reported he had not eaten yet today. After monitoring him for 15 minutes he felt he was able to stand again and had his father pick him up.


VAERS ID: 1554068 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 LA / IM

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

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

Write-up: Patient felt light headed and then passed out for 10-15 seconds, called EMS and they checked blood pressure before she left.


VAERS ID: 1554076 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-15
Onset:2021-08-13
   Days after vaccination:29
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 LA / IM

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

Write-up: Patient came in on 8-12-21 for 2nd dose of Pfizer, upon checking CAIRs noticed patient already received Janssen on 3-19-2021 at another facility. Patient failed to disclose that she had received Janssen when asked verbally & on her consent form & was given her 1st dose of Pfizer on 7-15-2021. No adverse reactions were reported


VAERS ID: 1554098 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / N/A LA / IM

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

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

Write-up: PATIENT LIED TO STAFF ABOUT NOT HAVING RECEIVED TWO DOSES OF MODERNA VACCINE PRIOR TO ADMISSION TO OUR FACILITY ON TWO SEPARATE OCCASIONS AND SIGNED VACCINATION CONSENT FORM STATING HE HAD NOT RECEIVED A DOSE OF A DIFFERENT COVID-19 VACCINE BEFORE TODAY (08/13/2021). PATIENT ARRIVED TO THIS FACILITY ON 08/09/2021 WITHOUT RECORD OF HAVING HAD THE COVID-19 VACCINATION. A RECORDS SEARCH OF THE IMMUNIZATION INFORMATION SYSTEM SHOWED THE PATIENT RECEIVED 1ST DOSE MODERNA, LOT#052C, 07/10/2021 AND 2ND DOSE MODERNA, LOT#065D21A, 08/07/2021. ALL NEW ARRIVALS TO OUR FACILITY ARE QUARANTINED FOR 14-DAYS IF THEY ARE NOT FULLY VACCINATED AGAINST COVID-19 OR IF THEY DO NOT HAVE PROOF OF VACCINATION. THIS PATIENT SAID HE LIED BECAUSE HE DID NOT HAVE PROOF OF HIS VACCINATIONS AND WAS UNAWARE WE COULD LOOK THEM UP; THEREFORE HE AGREED TO TAKE THE J&J VACCINE TO OBTAIN A CARD FOR PROOF OF VACCINATION TO AVOID A FUTURE QUARANTINE SITUATION.


VAERS ID: 1554100 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-08-12
Onset:2021-08-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Electrocardiogram normal, 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies: omnicef
Diagnostic Lab Data: ecg 8/13/2021 normal
CDC Split Type:

Write-up: Today patient had a unprovoked syncopal event at the dining room table where she was unresponsive for 1 minute, awoke to semi=consciousness and after moving to the couch became unconscious again for approximately a minute. She then slowly returned to normal mentation and was seen in our office.


VAERS ID: 1554103 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821286 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Product leakage, Wrong technique in product usage process
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: Injection needle was not inserted completely into the patient''s arm and consequently there was a moderate amount of vaccine leakage


VAERS ID: 1554106 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: West Virginia  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNKNOWN
Current Illness: HEART VALVE PROBLEMS, PROSTATE PROBLEMS
Preexisting Conditions: HEART VALVE, PROSTATE - UNSURE OF SPECIFIC NAMES OF CONDITIONS, BUT HE DOES FOLLOW UP WITH DOCTORS FOR THESE TWO
Allergies: PATIENT STATES ALLERGY TO NARCOTICS, GIVES HIM HIVES
Diagnostic Lab Data: N/A. PATIENT WAS COUNSELED ON ADVERSE EFFECTS POSSIBLE AND GIVEN DIRECTIONS TO CALL PHARMACY AND DOCTOR FOR ANY REACTION THAT MAY OCCUR.
CDC Split Type:

Write-up: PATIENT WAS GIVEN JANSSEN COVID VACCINE ON 8/13/21 AT APPROXIMATELY 12:00PM. PATIENT DID NOT DISCLOSE THAT HE HAD PREVIOUSLY RECEIVED 2 DOSES OF MODERNA COVID VACCINE IN MAY/JUNE AT ANOTHER PHARMACY, DESPITE BEING PROMPTED ABOUT PREVIOUS VACCINES -- STATED THAT HE HAD ONLY RECEIVED PNEUMONIA AND FLU IN THE LAST FEW YEARS. PATIENT WAS ASKED ABOUT PREVIOUS COVID-19 VACCINES, HE STATED THIS WAS HIS FIRST DOSE AND THAT HE WAS LOOKING FOR THE ONE SHOT VACCINE, DISCUSSED THAT THIS WAS THE JANSSEN VACCINE, AND HE WAS CONFIRMED THAT WAS WHAT HE WANTED. A DISCUSSION FOLLOWED ABOUT THE EFFICACY OF THE VACCINE COMPARED TO THE OTHERS ON THE MARKET SPECIFICALLY WITH THE DELTA VARIENT, VACCINE RATES, AND THE IMPORTANCE OF GETTING VACCINATED (APPROXIMATLY A 10 MINUTE DISCUSSION/REVIEW OF THE VACCINE AND OTHERS ON THE MARKET). AT NO TIME DID THE PATIENT DISCLOSE HE HAD PREVIOUSLY RECEVIED IT. ERROR WAS NOTED UPON LOGGING INTO THE RECORD SYSTEM. PATIENT WAS IMMEDIATELY CONTACTED, STATED THAT HE FORGOT TO MENTION IT, AND THOUGHT IT WOULDN''T BE A PROBLEM SINCE IT WAS SO LONG AGO. PATIENT COUNSELED ON THE DANGERS OF RECEIVING A VACCINE OUT OF SCHEDULE, PATIENT STATED IT WAS HIS FAULT AND ASKED IF HE COULD CALL SOMEONE TO TELL THEM HE DIDN''T REPORT IT WHEN HE WAS ASKED. PROVIDER EXPLAINED THAT THE INCIDENT WOULD HAVE TO BE LOGGED AS AN ERROR. PATIENT CONFIRMED THAT HE NEGLECTED TO DISCLOSE THE PREVIOUS VACCINE TO ME. VACCINE LOGGED IN SYSTEM WITH AN ANNOTATION. HLR 8/13/21


VAERS ID: 1554108 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-01-08
Onset:2021-08-13
   Days after vaccination:217
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3248 / 1 UN / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / 2 UN / SYR

Administered by: Senior Living       Purchased by: ?
Symptoms: SARS-CoV-2 test
SMQs:, COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Atorvastatin, Azithromycin, Desloratadine, Dorzolamide HCL, Lorazlepan, Trazodone
Current Illness:
Preexisting Conditions: dementia, hyperlipidemia
Allergies: NKA
Diagnostic Lab Data: rapid test
CDC Split Type:

Write-up: picked up on routine testing


VAERS ID: 1554113 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Rhode Island  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: COVID-19 immunisation, No adverse event
SMQs:, COVID-19 (narrow)

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

Write-up: Patient presented for second dose of vaccine. Patient wrote that he received Pfizer vaccine at his first dose but was mistaken and received Moderna. Pfizer given instead, monitored patient for any reactions, of which there were none. Patients provider aware as well as patient and patients mother.


VAERS ID: 1554119 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0169 / 1 LA / IM

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

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

Write-up: Pharmacist injected a clean empty syringe into patient''s left deltoid. He noticed the error that no vaccine was drawn up after the syringe had been injected. The second syringe was already prefilled with Pfizer vaccine and ready to go but the pharmacist did not grab this prefilled syringe that was drawn up moments before. Patient called addressing the concern with receiving an empty syringe. The same pharmacist explained what had happened and the patient is not experiencing any symptoms at this time.


VAERS ID: 1554121 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 005C21A / 1 LA / IM

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

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

Write-up: Moderna Vaccine was requested for patient by Father. Patients (older) brother had severe reaction to the Pfizer Vaccination. Injection of Moderna was given then realized patient was 16. Discussed fact with Father that Moderna not yet approved for under 18, father denies concerns, reiterated that he asked for Moderna.


VAERS ID: 1554122 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Flushing, Hyperhidrosis, Paraesthesia, Pruritus, Visual impairment
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Allergic: Itch (specify: facial area, extremeties)-Mild, Systemic: Allergic: Itch Generalized-Mild, Systemic: Dizziness / Lightheadness-Mild, Systemic: Flushed / Sweating-Mild, Systemic: Tingling (specify: facial area, extemities)-Mild, Systemic: Visual Changes/Disturbances-Mild


VAERS ID: 1554124 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002F21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: 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), 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)

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: vomiting-Medium, Systemic: Vomiting-Medium, Additional Details: pt passed out after sitting in our waiting area about 2 seconds after taking a seat. passed out for about 2 minutes. sat up and started vomiting


VAERS ID: 1554136 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-08-06
Onset:2021-08-13
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 LA / IM

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

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

Write-up: The patient''s mother lied and said the patient was 12 years old. After the vaccince was given and processed through facility, the facility sent back a message saying that the patient wasn''t 12 years old even though the mother attested that her daughter was 12.


VAERS ID: 1554142 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-12
Onset:2021-08-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 14C21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Balance disorder, Blood glucose normal
SMQs:, Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Blood sugar 101 BP 132/82 Pulse 122 02 saturation 100% on room air
CDC Split Type:

Write-up: Patient was observed for 15 minutes after receiving the vaccines patient stated that he was okay to go after patient stood up he became wobbly staff ask him to sit down patient denied any dizziness and stated "I have to go to my job". Staff observed patient leaving and still wobbly staff called patient and ask for him to come back to the clinic observe patient in the parking lot holding onto his vehicle staff brought the wheelchair out and patient stated no I can walk. Patient brought back to the clinic given water and a cold compress placed on his head blood pressure taken sitting and standing POCT Blood Sugar 101. Patient observed for additional 20 minutes.


VAERS ID: 1554148 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 035C21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Altered state of consciousness, Hyperhidrosis, Hypotension, Loss of consciousness, Muscle rigidity, Nausea, Pallor, Seizure like phenomena, Shock
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Convulsions (narrow), Parkinson-like events (narrow), 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), Hypersensitivity (narrow), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

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

Write-up: after injection pt had seizure like episode (blacked out, rigid body) - came back quickly within 30 seconds or so- but went into shock- low bp, white palor, nausea, sweating, altered consciousness- which lasted about 10-15 minutes before maintaining a steady status-


VAERS ID: 1554156 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0175 / UNK - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None at the vaccination site other than vitals, history and exam.
CDC Split Type:

Write-up: 21 y/o female who expressed significant anxiety prior to receiving the injection with no significant PMH who experienced immediate onset of right sided pleuritic chest pain across mid chest after receiving the injection into the left arm. Felt dyspnea related to pain with breathing. No itching, no urticaria, no angioedema, no wheezing, no GI or GU sx. Vital signs with 100% O2 sat on RA, BP 124/77 HR 91 and RR 22. Observed for 45 minutes without change/worsening of symptoms while awaited EMS arrival. EMS took patient to the nearest emergency room for further evaluation and treatment.


VAERS ID: 1554168 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-08-07
Onset:2021-08-13
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 9N977 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Diarrhoea, Fatigue, Nausea
SMQs:, Acute pancreatitis (broad), 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: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: Fish allergy
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Diarrhea, Fatigue, Nausea


VAERS ID: 1554178 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-08-04
Onset:2021-08-13
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: COVID-19 immunisation
SMQs:, COVID-19 (narrow)

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

Write-up: Patient received Moderna COVID vaccine from different vendor on 7/8/2021. Patient then received J+J COVID vaccine from us at Affiliated Physicians on 8/4/2021 per NYC CIR look up.


VAERS ID: 1554179 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-08-10
Onset:2021-08-13
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Baclofen, cyclobenzaprine, meloxicam
Current Illness: Herniated disc and muscle aches
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Rash on torso and underneath arms which started about 1:30am almost 4 days after vaccination. Patient also started new medication (baclofen) on 8/12/21.


VAERS ID: 1554197 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7455 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain upper, Asthenia, Dizziness, Dyspnoea, Electrocardiogram, Feeling hot, Hyperhidrosis, Nausea, Paraesthesia, Taste disorder
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

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

Write-up: Within a minute after being given the vaccine I had a metallic taste in my mouth and my body became warm and tingly. This first wave passed quickly and I thought I was fine. About 13 minutes after injection my body became extremely hot and I was dizzy. I stood up to get the pharmacists attention and fainted to the ground. Upon awakening I was profusely sweating, nauseous, had stomach cramping and weakness. I had to remove my mask and was having difficulty breathing. I was taken to the ER by ambulance where the doctor decided that I did not have an allergic reaction to the vaccine. I am convinced that I had a direct reaction to the vaccine whether or not it was anaphylactic in nature.


VAERS ID: 1554201 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-08-10
Onset:2021-08-13
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1820095 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Intermenstrual bleeding, Menstruation irregular
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Fertility disorders (broad)

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

Write-up: Spotting/menstrual bleeding irregularly 3 days post vaccination.


VAERS ID: 1554202 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Electrocardiogram normal, Hyperhidrosis, Muscle rigidity, Pallor, Seizure
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Parkinson-like events (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (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? Yes
Hospitalized? No
Previous Vaccinations: Patient passed out from meningitis vaccine, but the nurse told him it was that specific vaccine. He did not think it would happe
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: EKG at the hospital.
CDC Split Type:

Write-up: Patient was sitting in the waiting room when we heard his mother say he was having a seizure. His mother said he got rigid and slumped over. When getting to the patient, he was coming to. He was pale and sweating. We called emergency services and EMTs arrived and took patient to the hospital. Spoke to mother several hours later and she said that his heart and brain activity was normal, that the doctor said it was probably just nerves.


VAERS ID: 1554206 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006D21A / UNK RA / IM

Administered by: School       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: None known
Diagnostic Lab Data:
CDC Split Type:

Write-up: Presented to medical facility 8/13/21 for Moderna Covid-19 vaccine When asked if this was her first vaccine, she responded "yes" She also marked "no" to "Ever received a COVID-19 vaccine?" After administering the injection, she stated, "I guess you can''t take that back, right?" She then stated that this was in fact her third COVID-19 Moderna vaccine and she just received a booster and felt bad about lying about Notified Director of Health Services


VAERS ID: 1554216 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-31
Onset:2021-08-13
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 3 LA / IM

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

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

Write-up: Patient received Moderna COVID vaccine by different vendor on 4/15/2021 AND 5/13/2021. Patient then received Pfizer dose listed here on 7/31/2021 by us at.


VAERS ID: 1554223 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036C12A / 1 LA / IM

Administered by: Military       Purchased by: ?
Symptoms: Laryngospasm, Nausea, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Dystonia (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Denied on form.
Preexisting Conditions: Denied on form.
Allergies: Denied by patient.
Diagnostic Lab Data:
CDC Split Type:

Write-up: 10 minutes after vaccine administered, pt developed nausea and vomiting. 5 minutes later developed acute laryngeal spasm with stridor, no angioedema, no bronchospasm, no rash. GIven .3 mg epi IM, 100 mg Benadry IM and 125 mg Solumedrol IM with slight improvement of stridor. Given 2nd dose of epi .3 mg IM. with marked improvement of stridor. Patient transported to ER. This is second report we have submitted for this new lot in one week.


VAERS ID: 1554224 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-08-09
Onset:2021-08-13
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 088D21A / 1 LA / IM

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

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

Write-up: swollen lymp node on right side, noticed while eating


VAERS ID: 1554241 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007B21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: 0
Current Illness: 0
Preexisting Conditions: 0
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: 10 minutes after injection patient c/o itching at injection site. very slight redness at site. 1238 Benadryl 25 mg given. 1308 patient stated itching subsided. Denied adverse effects to Benadryl. Instructed to contact physician upon arrival to home to notify of event., and go to ER if itching returned.


VAERS ID: 1554245 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-08-05
Onset:2021-08-13
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FWU217 / 1 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Computerised tomogram neck, Injection site erythema, Injection site induration, Injection site inflammation, Injection site pruritus, Pain in extremity, Scan with contrast normal
SMQs:, Extravasation events (injections, infusions and implants) (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Received the first dose on 08/03/21 with no side effects other than a sore arm for a few days. On 08/13/21, I went in for a CT scan of my neck which included having an IV administered containing dye. This was uneventful, however, less than an hour later I had severe itching in my arm. I did not think much of it, but when I took off my jacket I realized it was located at my injection site, which was was severely inflamed, red, and kind of course to the touch. I left it alone and several hours later it is still red and inflamed. I contacted my doctor and she said to ice and take Benadryl. I then called the CDC hotline and was told to report.


VAERS ID: 1554253 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 091D21A / 2 LA / IM

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

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

Write-up: MAKING THIS REPORT BECAUSE THE PATIENT HAD THE INITIAL VACCINATION IN JANUARY 2021 AND IS NOW RECEIVING THE 2ND VACCINATION IN AUGUST 2021.


VAERS ID: 1554265 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-08-10
Onset:2021-08-13
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 3 LA / IM

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

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

Write-up: Patient received Pfizer COVID vaccine from different vendor on 4/11/2021 AND 5/2/2021. Patient then received J+J vaccine from us (Affiliated Physicians) as listed here on 8/10/2021.


VAERS ID: 1554266 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013A21A / 1 RA / IM

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

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

Write-up: There was no adverse reactions reported. Patient was 14 years old at the time he received the vaccine. He was monitored for 30 mins.


VAERS ID: 1554279 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Hyperhidrosis, Pallor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none reported
Current Illness: none reported
Preexisting Conditions: none reported
Allergies: none reported
Diagnostic Lab Data: VS - HR - 72, Resp. 14, BP - 91/58, 99/64, O2 98%
CDC Split Type:

Write-up: Pt. noted to be pale & diaphoretic, A&Ox4, reports to feeling "lightheaded" after receiving vaccine, which is why he laid on the ground. Pt. reports that this is his "normal" when receiving injections. Patient monitored until he reported no further symptoms.


VAERS ID: 1554282 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-30
Onset:2021-08-13
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 RA / IM

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

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

Write-up: Found out on 08/13/2021 that patient had received the Pfizer COVID-19 vaccine in April or May. No reported adverse outcomes.


VAERS ID: 1554285 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0175 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood glucose, Blood pressure decreased, Hyperhidrosis, Presyncope, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: EMS reported and took BP, blood glucose, and did physical exam. BP was unable to be determined manually but was taken by machine was was "low" per paramedic (70s/40s via manual. 80s/60s via machine) both taken 8/13/2021. Further results unknown.
CDC Split Type:

Write-up: Patient experienced vasovagal syncope approximately 5 minutes after receiving her first COVID vaccine at approximately 3:00PM. Patient received vaccine and waited for sister to get hers. She ambulated back to waiting area to sit for 15 minutes post vaccine. Within minutes of sitting down patient experienced vasovagal syncope. Father initially denied EMS as patient did hit fall from chair but passerby was able to catch her. Waited approximately 10 minutes, patient vomited and was sweaty. Did not take blood pressure yet as waiting for patient to recover. EMS did arrive as pharmacy staff called proactively at the beginning of the event. They recommended that patient report to ER for further evaluation to ensure no residual issues from vaccine or syncopal event.


VAERS ID: 1554298 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / UNK LA / IM

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

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

Write-up: Pt felt dizzy and fainted in chair within 5 minutes of vaccine administration (head tilted back, eyes closed, breathing stopped for 1 sec). Regained consciousness within 1 minute, was given glucose tabs, water, crackers and recovered by 30 minutes waiting.


VAERS ID: 1554325 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Zoloft
Current Illness: none
Preexisting Conditions: none
Allergies: None
Diagnostic Lab Data: Positive COVID test 8/13/21
CDC Split Type:

Write-up: Tested positive for COVID 8/13/21 with symptoms of cough and headache that started 8/9/21


VAERS ID: 1554327 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-01-26
Onset:2021-08-13
   Days after vaccination:199
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3248 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / 2 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Diarrhoea, Mental status changes, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Pseudomembranous colitis (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Noninfectious diarrhoea (narrow), Hypoglycaemia (broad)

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

Write-up: He presented to the ED after having a syncopal episode with altered mental status. Also reports having some loose stools earlier in the day. Denies nausea, vomiting, chest pain or shortness of breath. No prior positive COVID-19 infections.


VAERS ID: 1554332 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Feeling hot
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: patient reported his left arm was warm.


VAERS ID: 1554337 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH PC3181 / 1 RA / IM

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

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

Write-up: After the vaccination pt had seizure for about 5-7 second and perfusily sweat . immediately when saw seizure emergency services was called


VAERS ID: 1554338 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Mississippi  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006D21A / 3 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: PATIENT STATES HE DOES NOT "A GOOD MEMORY BECAUSE HE HAD A BRAIN TUMOR."
Allergies: NONE PER PATIENT
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Patient asked on online form and in person if had received a COVID Vaccination before. Patient stated on the online form and in person that he has NOT received a COVID Vaccination before. Moderna dose was then administered at 2:23 p.m. At 2:30 pm while patient was still at the pharmacy waiting the required 15 minutes, I started the state immunization registry for the patient. Then I discovered patient had already received 2 doses of Moderna Covid-19 vaccination on 03/01/2021 and 03/30/2021. I immediately call the Community Provider line which instructed me to enter the third dose in the registry and complete VAERS form.


VAERS ID: 1554342 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 1 - / IM

Administered by: Public       Purchased by: ?
Symptoms: Depressed level of consciousness, Skin discolouration, Speech disorder, Yellow skin
SMQs:, Cholestasis and jaundice of hepatic origin (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), 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: None
Current Illness: None
Preexisting Conditions: Syncopal Episode history when getting injections or blood draws
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: At 1105 patient a 40-year-old Male received an injection Pfizer Lot # 0191. Patients skin color went yellow green. Patient was able mumble incomprehensible sounds mildly arousable to sternum rub and finger nail pressure, but wouldn?t open his eyes and follow commands. Alert and Oriented 0/3. Called 911. Assisted lifting patient to wheel chair. Wheel chaired to cot assisted standing and laying patient down. First set of vitals supine at 1110 AM 110/80 Pulse 60 Respiratory Rate 18 SpO2 92% on room air. Second set of vitals at 1120 AM sitting 104/64 Pulse 73 Respiratory Rate 14 SpO2 92% on Room air. Third set of vitals at 1125 AM were standing 118/70 Pulse 73, Respiratory Rate 14, SpO2 94 % on room air. Police arrived and radioed. Response terminated At 1110 patient was Alert and Oriented four of four. Syncopal Episode history when getting injections or blood draws. A- No Known Drug Allergies. M- No medications taken. P- Syncopal Episodes from injection. L- Trail Mix an hour and a half ago. E- IM injection in left deltoid Pfizer. Clear bilateral lung sounds. At 1130 AM patient was able to ambulate without impairment. Alert and Oriented 4 of 4. Spoke with wife about contacting family physician, ER or Urgent Care. Patient assisted to car by wife and kids.


VAERS ID: 1554345 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Confusional state, Hypoaesthesia, Nausea, Paraesthesia
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypoglycaemia (broad), Sexual dysfunction (broad)

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

Write-up: Pt. states that after receiving the 1st dose of Phizer 08/13/2021, immediately after symptoms of sharp chest pain throughout the right then left rib cage, numbness through the right arm and left thigh continuing down to the feet with tingling in the left foot. Nausea associated with mild confusion, with pain in the lower left side of the head. No noted Primary visit but planned appt. shortly after.


VAERS ID: 1554355 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-08-12
Onset:2021-08-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 3 LA / IM

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

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

Write-up: Patient received and completed Pfizer COVID vaccine series by different vendor on 6/16/2021 and 7/7/2021. Patient then received another dose of Pfizer by us Physicians as listed on 8/12/2021.


VAERS ID: 1554357 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 2 LA / IM

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

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

Write-up: Patient felt dizzy just after the vaccine administration, fainted and fell. He looked pale


VAERS ID: 1554366 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006D21A / 1 LA / IM

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

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

Write-up: Facility called office reporting hives. Was sent to the ED for evaluation


VAERS ID: 1554369 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-08-11
Onset:2021-08-13
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002F21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Angiogram, Asthenia, Computerised tomogram head abnormal, Computerised tomogram head normal, Computerised tomogram neck, Dizziness, Eye pain, Gait disturbance, Headache, Leukopenia, Lymphadenopathy mediastinal, Lymphocyte count decreased, Neutrophil count decreased, Sarcoidosis, Vision blurred, White blood cell count decreased
SMQs:, Agranulocytosis (broad), Haematopoietic leukopenia (narrow), Peripheral neuropathy (broad), Interstitial lung disease (broad), Systemic lupus erythematosus (narrow), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: White blood cell count of 3.0, lymph # 0.6, and neutrophils # 1.6 were notable results.
CDC Split Type:

Write-up: Symptoms began at 0900 on 8/13/21. Patient was at home and became dizzy and weak with complaints of blurred vision. Then developed occipital headache and pain behind his right eye. Was having difficulty ambulating during this event. Patient presented to the emergency department at 0930, no neurological symptoms were noted, patient only complaining of the headache at this time. Head CT was performed to rule out hemorrhage, then head CT/neck with contrast was performed. Acute vascular findings were ruled out, but incidental findings of mediastinal lymphadenopathy as well as nodular and interstitial change at the lung apices were found. Chest CTA was then performed which found mediastinal and bilateral hilar lymphadenopathy and pulmonary findings that were strongly suggestive of sarcoidosis, or possibly lymphoma but less likely. Patient was able to discharge home with diagnosis of sarcoidosis and leukopenia.


VAERS ID: 1554372 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Auscultation, Chest pain, Depressed level of consciousness, Dyspnoea, Fatigue, Pharyngeal swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad)

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

Write-up: Father alerted this RN to patient development of extreme fatigue after approximately 13 minutes post administration. This RN administered Zyrtec 10mg solution p.o. and manual blood pressure via right arm was 132/90, HR=81-88, O2= 98% via pulse oximeter and respiratory rate=12. Patient became more difficult to arouse, transported via wheelchair to room with reclining chair and epinephrine on site. Father report patient with NKDA, and no known history of adverse reactions to past vaccines or injection. No known medical history, other than medication for attention deficit per father. Code called by non-clinical staff member. This RN re-assessed patient and patient reported new onset of sharp chest pain to center of chest- no abnormal heart sounds auscultated at that time. Emergency response team arrived concurrently, and Pediatric MD began assessment of patient at 14:03pm. Patient began to complain of swelling to throat and new difficulty breathing. This RN administered 0.3cc Epinephrine, at 14:04pm per protocol and Pediatric MD aware. Immediate response in patient noted. Patient alert and oriented to person and place. Patient stable and transported by pediatric emergency nurse via wheelchair to the Pediatric Emergency Department for further evaluation and monitoring after administration of Epinephrine. Patient accompanied by father.


VAERS ID: 1554375 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Blood pressure increased, Feeling abnormal
SMQs:, Neuroleptic malignant syndrome (broad), Dementia (broad), Hypertension (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: None
Preexisting Conditions:
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient states; "I feel like its going through me. All through my body up to my head." Nurse took vitals: Pulse 73, O2 95%, BP 168/96, Temp 98.0F, respiration 26. Monitored for 15 minutes, blood pressure was taken again it was 160/92. Patient recovered and left.


VAERS ID: 1554377 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dizziness, Pallor
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Not taking any medicine
Current Illness: I did not suffer from any disease
Preexisting Conditions: I do not suffer from any chronic disease
Allergies: I do not have any allergies
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Patient reports feeling dizzy looks pale and notifies EMT staff and supervisor. VS are taken at 12:45pm BP 100/60, P52. 12:55 VS are taken BP 110/80, P68, R20/min. 1:20pm VS are taken again BP 100/70, P68/min and R16/min. Patient looks active and reports feeling better and walks away.


VAERS ID: 1554380 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037C21A / 2 RA / IM

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

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

Write-up: First Dose: Pfizer (05/04/2021) Second Dose: Moderna (08/13/2021)


VAERS ID: 1554382 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Puerto Rico  
Vaccinated:2021-08-06
Onset:2021-08-13
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Blood glucose normal, Dizziness, Pallor
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad)

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

Write-up: Patient reports feeling dizzy and looks pale. Vital signs are taken at 1:30 pm B/P 100/60 68/ min, respiration 16, and dxt. 87mg/dl. Dr. is consulted and indicates the patient legs to be raised and the vitals are re-evaluated in the next 30 min. The new vital signs are taken spo2 99%, BP 100/80, pulse 82/min. Patient is discharge and walks out of the vaccination center.


VAERS ID: 1554383 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Presyncope
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: The patient experienced light-headedness and almost fainted. She sat down on the floor and put her head between her knees. We had her sit in pharmacy area for further observation for about 30 minutes and she covered with no problems.


VAERS ID: 1554396 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-08-11
Onset:2021-08-13
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Electrocardiogram normal, Magnetic resonance imaging abnormal, Movement disorder, Sinusitis, Vertigo positional
SMQs:, Akathisia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Vestibular disorders (narrow)

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

Write-up: Diagnosed with benign paroxysmal positional vertigo. Emergency room visit after 36 hours. After 48 hours, still unable to move.


VAERS ID: 1554406 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 053E21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Depressed level of consciousness, 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: None known
Current Illness: None reported
Preexisting Conditions: None reported
Allergies: None reported
Diagnostic Lab Data: EMT stated vitals were fine. Patient elected not to go to hospital.
CDC Split Type:

Write-up: Patient passed out approximately 5 minutes after receiving vaccine. He became more alert after about 1 minute then passed out a second time after approximately 5 minutes. EMT arrived at this time and took over monitoring the patient.


VAERS ID: 1554410 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: According to consent form client is not immunocompromised, or have a bleeding disorder
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Client present for #1 dose of COVID Pfizer vaccine only today. Client monitored for 15 minutes after receiving vaccines. Client left medical facility with wife. At approximately 1044 client returns with wife. Wife states while driving away client started feeling light headed, and appeared to have passed out. Client and wife were near local nursing home. Wife states she checked clients B/P and HR, which were within normal limits. Wife states client was pale, and sweating profusely. Client does not report having symptoms of an allergic reaction. This nurse rechecked B/P and HR at 10:46. B/P 110/68, HR 50. Wife reports to this nurse that color has returned to clients face. Client reports to this nurse he is feeling better, but does plan to take remainder of day off of work. Wife to be home with client to monitor. This nurse recommended for client to stay at clinic for another 15 minutes for monitoring. Client wife states she feels comfortable at this time to take client home. This nurse recommends for client to seek medical attention if another episode occurs this far out from vaccination. Client voiced understanding and no other questions at this time.


VAERS ID: 1554411 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 1 LA / IM

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

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

Write-up: THE PATIENT PRESENTS RASH IN THE UPPER BODY. THIS HAPPENS 15 MINUTES AFTER ADMINISTRATION OF THE VACCINE.


VAERS ID: 1554419 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051C21A / UNK LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Expired 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 was injected with an expired (past best used date) Moderna vaccine


VAERS ID: 1554421 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 2 LA / IM

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

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

Write-up: PATIENT RECEIVED 2ND DOSE PFIZER 6 DAYS BEFORE IT WAS DUE. SHE WAS MONITORED FOR EXTENDED PERIOD OF TIME AND SHE EXHIBITED NO ADVERSE REACTIONS DURING OBSERATION AND WAS DISCHARGED IN STABLE CONDITION


VAERS ID: 1554424 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041C21A / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Headache, 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: Atripla
Current Illness: N/A
Preexisting Conditions: AIDS, HBP
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: ADMINISTRATION ERROR : Pt. states that he had received the Phizer 1st dose 07/23/2021 and then for his 2nd dose received the Moderna 08/13/2021. Administrator by employee. Communations with Health Dept. Supervisor. Pt. states symptoms of a "splitting headache" continuing.


VAERS ID: 1554437 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006D21A / 2 LA / IM

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

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

Write-up: PATIENT CALLED PHARMACY WITH SHORTNESS OF BREATH AND CHEST PAIN, REPORTED 30 MIN POST VACCINE


VAERS ID: 1554440 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0175 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Flu shot, TB skin test
Other Medications: Inderal 20mg PO BID
Current Illness:
Preexisting Conditions: Migraines
Allergies: Morphine, Nitral
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient developed itching, hives was given Benadryl 50 mg and the paient left. Came back over an hour later with her mom and had similar symptoms. We administered Benadryl again. Vital signs were stable. Patient wanted to go to the ED so we provided an ED transport she was discharged on epipen and steroids


VAERS ID: 1554441 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002F21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dry skin, Pharyngeal swelling, Skin warm
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNKNOWN
Current Illness: N/A
Preexisting Conditions: ASTHMA
Allergies: SEAFOOD, PEANUTS, CYMBALTA, FASRNA - CAUSE HIVES, DOES NOT HAVE EPI-PEN, NEVER HAD ANAPHYLAXIS REACTION OR DIFFICULTY BREATHING.
Diagnostic Lab Data: 8/13/21 at 15:30 Vital signs: BP 150/92, P90, respirations - WNL, patient denied shortness of breath, skin- warm, dry
CDC Split Type:

Write-up: Patient had her 1st Moderna COVID 19 shot in left deltoid. About 25 min later, patient complained of left sided throat swelling. Vital signs: BP 150/92, P90, respirations - WNL, patient denied shortness of breath, skin- warm, dry. Pt did not want to go to hospital Pt was given Benadryl PO (suspension). Patient waited with adult children 15 more minutes. Pt reports she felt a little better, still felt like swelling was there, but wanted to go with family home. Verbalized understanding to seek medical attention if she felt worse.


VAERS ID: 1554446 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808980 / N/A UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood pressure decreased, Cold sweat, Dizziness, Nausea, Pallor, Tinnitus
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hearing impairment (narrow), Vestibular disorders (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: Adderall
Current Illness:
Preexisting Conditions:
Allergies: nkda
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt here for J&J vaccine so that she can attend school by the end of the month. At approx 4 min after the vaccine (12:41) I was called the room by the pt She was feeling light headed and had ear ringing and nausea Initial vitals: 93/60, P 81. Pox 100% 5 min (12:46) later BP 81/54- pt started to feel better with continued light headedness and nausea No pain, alert and oriented x 3 Initally pt was clammy and pale- this improved with time CV: RRR Pulm: CTA bilat 12:57 bp 101/66, 90 1:00 bp 107/63, P 80- improving but coming in waves of dizziness 1:27- pt was feeling better and able to stand and walk to car w/o difficulty Reviewed symptoms to call or go to ED for


VAERS ID: 1554448 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Patient''s mother came to the pharmacy clinic intending to get up to date shots for her child for the new school year. The vaccination record booklet was evaluated and it was understood that we were going to be giving the first dose of the COVID vaccine. The mother answered the screening questions all indicating that she had not previously vaccinated her child for COVID. The COVID vaccine was given and then the mother stated that she had gotten a COVID vaccine already at a church clinic on 08/08/2021. It was not until after the shot was given that she informed us of the initial shot and shown the vaccine card. A language barrier contributed to the miscommunication and the patient and mother went to a PCP visit where they were further evaluated and aware of the early COVID vaccine administration.


VAERS ID: 1554459 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 1 RA / IM

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

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

Write-up: IM injection given, small amount vaccine liquid on arm after injection. More than half vaccine administered. Dose not repeated.


VAERS ID: 1554490 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Erythema, Hypersensitivity, Pharyngeal erythema, Throat tightness
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), 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? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Riboflavin 400 mg every day Albuterol Inhaler prn Miralax daily Tylenol prn Ibuprophen prn
Current Illness: None
Preexisting Conditions: Esophageal reflux Allergic rhinitis Morbidly obese SOB
Allergies: Food allergy, unknown, anaphylaxis Tape-rash Donnatol-vomit
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Patient developed allergic reaction to vaccine within 8 minutes. Patient c/o of lighheadedness was given Zyrtec at 8:51 a.m. VS at 8:55 were BP 142/84, P 68 and O2 99%. Patient c/o redness in face and throat and Benadryl 25 mg IM at 8:58 a.m. Dexamethasone 4mg given IM at 8:59 a.m. Patient c/o throat tightening. EpiPen administered at 9:01 a.m. VS B/P 129/76, P 77, 02 100%. 9:11 BP 129/77, P 80, S02 100%. 9:17 BP 107/66, P72, )2 98%.


VAERS ID: 1554492 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-07-30
Onset:2021-08-13
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006D21A / 1 LA / IM

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

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

Write-up: Severe red and swollen arm, her pcp recommended for her to not get the second shot.


VAERS ID: 1554499 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037C21A / 1 LA / IM

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

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

Write-up: @1328 Post vaccination, patient started complaining of nausea. Emesis bag provided. Pt vomited about 300ml of food bolus. Pt stated that she usually vomits when she''s on her period and she is currently menstruating. Pt has a follow up visit with PMD on Aug 26th. Cooling measures provided. Effective. @1335 Pt is feeling better. Able to tolerate PO intake. VS 137/90 67RN 100%RA 18RR. Pt came in with husband and is confident of going home. ED precautions provided and encourage to message PMD about incident. Dr. made aware.


VAERS ID: 1554501 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 LA / IM

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

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

Write-up: PATIENT FAINTED


VAERS ID: 1554505 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-08-04
Onset:2021-08-13
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 928893 / 1 LA / IM

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

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

Write-up: 2 inch red lump at injection site noted 9 days after inject. Unsure of when reaction started


VAERS ID: 1554508 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dyskinesia, Eye movement disorder, Malaise, Pulse absent, Seizure, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Convulsions (narrow), Dyskinesia (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Ocular motility disorders (narrow), 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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unkown
Current Illness: No
Preexisting Conditions: No
Allergies: NKA
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: Patient received vaccine and then said she did not feel well. Within minutes she became unresponsive and starting having jerking movements indicating a seizure. Her eyes became blank and then seemed to roll back into her head. At that point it did not appear that the patient had a pulse. I laid her on the floor to start CPR and she then became responsive before CPR was administered. We had called the paramedics and they arrived and found the patients vital signs to be normal.


VAERS ID: 1554514 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: New Hampshire  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 6 LA / IM

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

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

Write-up: Patient experieced dizziness and fainting after receiving the vaccine. She continued to pass out and regain consciousness repeatedly over a half hour or so. She experienced sweating, chills, tingling in extremities, and loss of hearing. She was evaluated by EMS and cleared to go home.


VAERS ID: 1554518 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 1 LA / IM

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

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

Write-up: @1013 Pt stated that he only ate the crackers that he was given upfront. @1014 Vaccine given. Pt started to feel dizzy and nauseous. Kept pt sitting down at the vaccination site. Cooling measures provided. @1020 Pt felt better. Moved pt to observation room with supervision and mother. Upon reaching the observation clinic, pt looked pale. Placed on the gurney. Additional juice and crackers provided. @1025 Pt felt better. Denies any dizziness. SKIN WNL. VS 122/70 77HR 99% 18. Mother and pt are confident going home. Encourage to follow up with MD and ED precautions. Instructed to eat and hydrate prior to next vaccine appointment.


VAERS ID: 1554522 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052E21A / 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: Methoxsalen, Betamethasone Dipropionate, Restasis, Amlodipine/Valsartan, Nexium, Metformin, and Atorvastatin.
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Moderna vaccine that was punctured over 12 hours ago was accidentally given to patient.


VAERS ID: 1554525 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052E21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood pressure decreased, Dizziness, Hyperhidrosis, Nausea
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), 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: felt dizzy
Other Medications: Multivitamins, vitamin C, vitamin D, Zinc, turmeric
Current Illness: no
Preexisting Conditions: type II DM, seizure
Allergies: penicillin
Diagnostic Lab Data: no
CDC Split Type:

Write-up: while waiting (by himself) in the waiting area, patient felt dizzy, neauseated, and immediately returned to administration room. He was given gingerale /coke to help nausea. He was sweating heavily, BP dropped to 90/45, pulse 70 (his normal is 110/70). Pt claimed he gets nervous of needles. Pt was layed flat on the floor (no injuries). monitored his BP every 5 min. Pt was gradually improving and left store while was ensuring he was able to walk. Called pt. 2 hrs later, and he was doing well


VAERS ID: 1554530 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blindness, Eye movement disorder, Hyperhidrosis, Mydriasis, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Glaucoma (broad), Optic nerve disorders (broad), Cardiomyopathy (broad), Retinal disorders (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? 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: vasovagal syncope, sweaty, eyes dilated and rolled back, was unresponsive. He became responsive and said he couldn''t see. Lasted 10 or 15 minutes, was seated at the time. Gave him gatorade and called 911. Hadn''t consumed much food or drink. EMS walked him out and presumably checked his vitals.


VAERS ID: 1554532 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19 immunisation
SMQs:, COVID-19 (narrow)

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

Write-up: Patient signed in for 2nd vaccine and found out she had Moderna for first dose after receiving Pfizer 2nd dose today. According to CDC recommendation, notified patient that no repeat doses needed. Patient is aware of receiving incorrect vaccine. None


VAERS ID: 1554534 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cold sweat, Dizziness, Malaise, Pallor
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: atient complained of not feeling well and dizziness. Patient appears pale and clammy but remains alert and ale to answer questions. @1338 BP 80/50, HR 68, SP02 97%, sitting in chair in lobby. Patient given water and cold towel. Assisted to clinic immunization room via wheelchair, assisted to gurney, placed on supine position. @1345 BP 110/65, HR 95 SPO2 99%, states he is feeling better, no longer pale or clammy. @1350, patient assisted into a sitting position (legs up in gurney), denies dizziness, BP102/68 RR 22, HR 83, SP02 99%. @1355 patient assisted in sitting position with legs dangling down. BP 94/72, HR 83, SPO2 100%. No dizziness.@1400 Patient assisted to standing position, no dizziness and states that he feels good. Advised patient to continue hydrating well at home and contact primary if any other symptoms occur.


VAERS ID: 1554536 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006D21A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NOTHING THAT WE KNOW OF
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: NO KNOWN ALLERGIES
Diagnostic Lab Data: BLOOD PRESSURE 118/72 8/13/21 PULSE 72
CDC Split Type:

Write-up: PATIENT WAS ADMINISTERED THE MODERNA VACCINE AND ABOUT 5 MINUTES LATER PATIENT COMPLAINED THAT SHE WAS FEELING VERY DIZZY, EMOTIONAL AND FEELING LIKE SHE WILL PASS OUT. PATIENT PASSED OUT BRIEFLY (ABOUT 5 SECONDS) AND THEN CAME OUT OF IT. PATIENT WAS NERVOUS AND ANXIOUS BEFORE INJECTING VACCINE AND SAID SHE WAS FEELING NERVOUS AND ANXIOUS ALL DAY LEADING UP TO GETTING THE VACCINE. PATIENT PROBABLY EXPIERENCED SYNCOPE/DIZZINESS, WE GAVE HER WATER AND A CANDY BAR AND RECOMMEND SHE LAY DOWN BUT SHE REFUSED AND STAYED SITTING IN A CHAIR AND SHE WAS FEELING FINE. AFTER PATIENT FELT BETTER , WE TOOK HER BLOOD PRESSURE AND PULSE, BP=118/72 AND PULSE= 72, WITHIN NORMAL LIMITS. PATIENT WAS ASKED ABOUT CALLLING AMBULANCE BUT REFUSED. AFTER 30 MINUTES OF SITTING SINCE EPISODE, SHE FELT BETTER AND SHE WENT HOME WITH PERSON SHE WAS WITH.


VAERS ID: 1554546 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-12
Onset:2021-08-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

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

Write-up: Fainted twice .. once before 8 an and the 2nd one around 2:15 pm


VAERS ID: 1554557 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Mom stated after vaccine that he had fainted after a flu shot previously, but she had not indicated that on the vaccination form
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: nkda
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt received vaccine and upon walking to waiting area he fainted. This occurred about 5 minutes after the vaccine. Pt felt fine after about 20 minutes and left with his mom. He was advised to seek medical evaluation since he fainted while walking, mom declined ambulance option.


VAERS ID: 1554558 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Blood pressure decreased, Dizziness, Feeling hot, Vision blurred
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: with dose number #1, history of syncopy
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: client history of syncopy. Post administration of second dose client complained of lightheadedness, blurred vision and felt hot . Client was transferred to observation area via wheelchair. NP and EMT on site. client placed supine on mat. Vital signs obtained at 1429 HR 76, O2Sat 96% BP 92/62, @1433 HR 92, O2Sat 95% BP 109/67, Last VS @1447 HR 79 O2Sat 99%. Client feeling better able to sit up in chair. Client was provided snacks and drinks monitored in observation for 1hr before leaving. Father at his side, left without incident.


VAERS ID: 1554559 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dizziness, Limb discomfort, 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:
Current Illness:
Preexisting Conditions: High blood pressure Depression Gastritis Migraine
Allergies: Benadryl
Diagnostic Lab Data:
CDC Split Type:

Write-up: dizziness, nausea and heavy arm. After observation vitals are taken BP 140/80


VAERS ID: 1554565 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood pressure decreased, Dizziness
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular disorders (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: NA
Current Illness:
Preexisting Conditions:
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Felt faint, dizzy, blood pressure decreased......Paramedics checked him and he eventually left under own power.


VAERS ID: 1554566 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: New York  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040C21A / 1 RA / IM

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

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

Write-up: THE PATIENT FILLED OUT THE FORM SAID THAT IT WAS HER FIRST SHOT. I TALKED HER WHEN I RANG HER OUT VERIFIED AGAIN IT WAS HER FIRST SHOT AND DISCUSSED POSSIBLE SIDE EFFECTS. WE GAVE HER THE SHOT THEN I WENT TO RECORD THE SHOT AND REALIZED THAT SHE HAD GOTTEN A FULL COURSE OF PFIZER THAT STARTED IN DECEMBER OF 2020. I THEN TALKED TO HER ABOUT HOW IT SHOWED HER COMPLETED DOSES OF PFIZER AND SHE HAD TOLD ME SHE HADN''T RECEIVED ANY DOSES YET. SHE SAID THAT IT WAS HER PROBLEM AND NOT MINE. BUT I SAID NO IT WAS MY PROBLEM TOO BECAUSE NOW I HAVE TO CALL MY MANAGER AND THEN SHE WALKED AWAY. I THEN TRIED TO CALL THE PHONE NUMBER LISTED AND IT WAS NOT HER NUMBER.


VAERS ID: 1554567 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 053E21A / 1 LA / IM

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

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

Write-up: - gave moderna shot to a 17yo when vaccine is approved for 18+ - observed patient for 15min, no issues and left without complaint - instructed pt and his mother who to call if he feels unwell in next several days - told pt to come to a pharmacy in 2 months when he is 18 and to restart the vaccine series


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