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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 142 out of 6,867

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VAERS ID: 1554570 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
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 (MODERNA)) / MODERNA 049E21A / 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: n/a
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: n/a
Diagnostic Lab Data:
CDC Split Type:

Write-up: customer received JJ vaccine at another facility on 3/12/2021 and did not told us she had a vaccine of another manufacturer . we found out from the insurance when we try to bill . finally she admitted she had the JJ vaccine but her doctor told her to get another dose of another manufacturer .


VAERS ID: 1554571 (history)  
Form: Version 2.0  
Age: 35.0  
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 FC3180 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain upper, Abnormal dreams, Dizziness, Syncope, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), 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 known
Current Illness: none known
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Administered dose, patient was speaking and experienced syncope within 1 minute. Remained unresponsive for approximately 30 seconds. Stated he was dreaming while he was out. Stated he was dizzy upon waking. Stomach pain began about 5 minutes after awaking. Remained in vaccine area until he stated he was feeling okay (30 minutes). Stomach pain went away after about 30 seconds. Wife and sister were with him, and able to drive. Informed family to monitor him for a couple of days, and call EMS if needed.


VAERS ID: 1554575 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Louisiana  
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 088D21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Altered state of consciousness, Disorientation, Fall, 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), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad), Dehydration (broad)

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

Write-up: PATIENT BECAME DISORIENTED AND FAINTED ABOUT 1 MINUTE AFTER BEING VACCINATED. PATIENT WAS LEANING AGAINST A TABLE AND SLUMPED OVER AND WAS CAUGHT BY RPH . PATIENT DID NOT HIT OR INJURE HERSELF. PHARMACIST HELPED PATIENT LIE ON THE FLOOR. PATIENT WAS DISORIENTED, BUT BECAME AWARE OF HER SURROUNDINGS IN ABOUT 1 TO 2 MINUTES. PATIENT WAS HELPED TO A CHAIR AND GIVEN WATER TO DRINK. PATIENT WAS HELPED TO WALK AROUND THE PHARMACY ASSISTED AND UNASSISTED . SHE ATE A COOKIE, AND SAID SHE WAS OK TO DRIVE HOME. SHE CONTACTED HER HUSBAND TO INFORM HIM OF WHAT HAD HAPPENED. SHE WAS ESCORTED TO HER CAR AND DROVE AROUND THE PARKING LOT TO VERIFY HER ABILITY TO DRIVE. PATIENT WAS IN THE PHARMACY FOR 40 MINUTES AFTER SHE FAINTED. THE PATIENT CALLED THE PHARMACY WHEN SHE HAD ARRIVED SAFELY HOME


VAERS ID: 1554579 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-29
Onset:2021-08-13
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Menstrual disorder
SMQs:

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

Write-up: Menstrual period is usually regular as clockwork (26 days). However, after receiving J&J vaccine, period is late by several days. No chance of pregnancy due to no sexual activity. Also, I am not taking any contraception


VAERS ID: 1554580 (history)  
Form: Version 2.0  
Age: 54.0  
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 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / IM

Administered by: Public       Purchased by: ?
Symptoms: Product preparation 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: Vial of Pfizer was not diluted prior to administration and 0.3ml was pulled from vial and administered to patient.


VAERS ID: 1554752 (history)  
Form: Version 2.0  
Age: 20.0  
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 FA7485 / 1 LA / SYR

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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE BUT PATIENT FORGOT TO EAT.
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: FAINTING FOR 1-2 SECOND. PATIENT DID NOT EAT


VAERS ID: 1554756 (history)  
Form: Version 2.0  
Age: 12.0  
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 (MODERNA)) / MODERNA 051C21A / 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: Moderna Covid Vaccine was administered to 12 year old patient.


VAERS ID: 1554758 (history)  
Form: Version 2.0  
Age: 16.0  
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 EW0167 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Loss of consciousness, Nervousness, Pallor, Tremor
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), Parkinson-like events (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: Mother states that patient passes out with all vaccines/blood draws
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Patient''s blood pressure, heart rate and blood oxygen were taken on site by paramedics but I do not have the results. Paramedics stated the blood pressure was "low" but mother stated that is normal for patient.
CDC Split Type:

Write-up: Patient''s mother stated he passes out with any vaccine or blood draw he receives. I administered the patient''s covid vaccine and he did pass out almost immediately. His mother was holding his shoulders up so that he didn''t fall out of his chair. His mother thought he was doing ok and went to get her other son so that he could receive his Covid vaccine as well. When she left the patient clenched his fists and began shaking. His skin became pale/grayish. I asked one man standing by to call ED. I asked another man to help me get the patient out of his chair and to the floor which he did. The seizure lasted maybe 10 seconds or so but the patient lost consciousness during and didn''t regain immediately. He was unconscious for maybe 30 seconds? We had a cold paper towel on his head, fanned him and talked to him until he regained consciousness. Patient laid on the floor for awhile until he felt strong enough to sit up. When the paramedics arrived they checked blood pressure, heart rate and oxygen level. They stated his blood pressure was slightly low but mother said that is normal for him. Paramedics and parents agreed the incident was most likely due to extreme nervousness about getting the vaccine and determined he did not need to be taken to the hospital.


VAERS ID: 1554763 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
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 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient stated on form and questioned in person if she had ever received a COVID-19 vaccine. Patient answered no. Vaccine was administered at 10:03 a.m. In the afternoon while entering vaccine in state immunization system , patient records show she received 2 doses of Pfizer on 01/18/21 and 02/08/21. So the vaccination today was her 3rd dose and of a different manufacturer.


VAERS ID: 1554766 (history)  
Form: Version 2.0  
Age: 45.0  
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 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Headache, Sensation of foreign body
SMQs:, Anaphylactic reaction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: thyroid medication
Current Illness: denied any signs of illness at time of vaccination
Preexisting Conditions: thyroid condition, rheumatoid arthritis
Allergies: Anaphylaxis with Doxycycline
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Towards the end of 30min observation period, patient reported headache and lump in her throat. Vital signs initiated at 1812, WNL; was provided water and continued to monitor. Denied any difficulty breathing or respiratory symptoms. Second set of vitals taken at 1819, WNL. Patient stated symptoms still present, "it feels like when you have nasal congestion but in my throat", "the lump in my throat feels like when I had a (anaphylactic) reaction to doxycyline, but not as severe." Patient was offered IM Benadryl, accepted. Medication was administer at 1825. At 1835 patient stated symptoms of headache resolved but lump in throat was still present. At 1840 last set of vitals taken, WNL. Client requested to leave, stated that she felt comfortable to go even though symptoms had not fully resolved. Was educated to contact her primary healthcare provider, if symptoms worsen or any difficultly breathing/chest pain presents, she should seek emergency medical care. Patient verbalized understanding. Left with daughter at 1842.


VAERS ID: 1554771 (history)  
Form: Version 2.0  
Age: 24.0  
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 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 2 LA / IM

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

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

Write-up: Patient was dehydrated and did not eat the whole day before getting her vaccine. she felt dizzy and about to faint after. gave her a bottle of orange juice to drink, called the ambulance and they took her to the hospital.


VAERS ID: 1554773 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
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 939902 / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cold sweat, Feeling hot, Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), 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: Pt was hot and clammy within 5 minutes of vaccination. She was seated with husband and momentarily passed out for about 30 seconds. She came to and was back to her normal self in about 5 minutes we called emergency services and they came and checked her out and she left feeling fine.


VAERS ID: 1554776 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Oklahoma  
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 203A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blindness, Hyperhidrosis, Hypoacusis, Pallor, Presyncope
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Glaucoma (broad), Optic nerve disorders (broad), Retinal disorders (broad), Hearing impairment (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Tdap given at age 12; same vasovagal response
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Within 3 minutes of receiving vaccine a vasovagal response is noted to be occurring: loss of vision, muffled sound, pale face, diaphoretic. Normal function returned in 15 minutes.


VAERS ID: 1554777 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
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 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 LL / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Dehydration, Dizziness, Hyperhidrosis
SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypoglycaemia (broad), Dehydration (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: n/a
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: n/a
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient felt dizzy and tightness of chest after vaccination. He sweat a lot and claimed he want to lay down. gave him water and orange juice to drink. called the ambulance and they took him to hospital and found out he was dehydrated.


VAERS ID: 1554778 (history)  
Form: Version 2.0  
Age: 55.0  
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 / 2 LA / IM

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

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

Write-up: Patient stated on CDC form and questioned in person if he had received a COVID-19 vaccine. Patient stated NO. Moderna vaccine was administered at 10:03 a.m. At 4pm while entering vaccine in state immunization system (MIIX), patient had received 1 dose of Pfizer COVID_19 vaccine on 2/8/21 . I called patient at 6:30 p.m., he again denied getting a Covid-19 vaccine prior. Based on MIIX he had received a vaccine of Pfizer and then I administer Moderna on 8/13/21.


VAERS ID: 1554782 (history)  
Form: Version 2.0  
Age: 44.0  
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 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Blood pressure increased, Dyspnoea, Sensation of foreign body, Throat irritation
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Hypertension (narrow), Cardiomyopathy (broad)

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

Write-up: Patient reported throat itching, lump in throat at 1738, 20minutes into observation period after first dose of pfizer vaccine. Denied any shortness of breath or difficulty breathing. Vital signs were initiated at 1744, BP slightly elevated. Water and crackers were provided. Benadryl 25mg IM was offered, patient accepted, administered in Left deltoid at 1745. Patient reported improvement in symptoms at 1751; complete resolutions of symptoms at 1759. Last set of vital signs taken at 1800, blood pressure still slightly elevated, verbalized feeling better and ready to leave. Patient left at 1800 with daughter, stating they would take uber home together. Was educated to follow up with primary heathcare provider and if symptoms return or worsen to seek emergency medical care, patient verbalized understanding.


VAERS ID: 1554783 (history)  
Form: Version 2.0  
Age: 29.0  
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 (MODERNA)) / MODERNA 021B21A-1 / UNK - / IM

Administered by: Other       Purchased by: ?
Symptoms: Chest discomfort, Dyspnoea, Fatigue, Feeling hot, Hyperhidrosis, Pallor, Paraesthesia oral
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: After the patient received her first Moderna vaccine, patient was in observation area to be observed for any reactions. At 1515 8/13/21 patient complained about tingling of the lips and stated that she had a hard time breathing with pressure on her chest, and felt hot and diaphoretic. Patient was placed on bed in semi fowlers position, patient was instructed to drink water and juice, ice packs were placed on her back. Blood pressure was taken at 1520, BP 126/88 and heart rate was 93, O2 100%. Patient was then placed in side lying position with support on back, RN supervisor then called 911 because patient was not improving and looked pale and fatigued. A second blood pressure was taken at 1545, BP 101/58 HR 97. Paramedics arrived at 1553 and took patient to hospital. Patient reported being over 8 months pregnant with recent history of adverse reaction to Tdap vaccine 6/24/21.


VAERS ID: 1554784 (history)  
Form: Version 2.0  
Age: 31.0  
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 (MODERNA)) / MODERNA 037C21A / 2 LA / 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:
Current Illness:
Preexisting Conditions:
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: First covid vaccine Pfizer and second dose vaccine Moderna


VAERS ID: 1554785 (history)  
Form: Version 2.0  
Age: 11.0  
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 FC3180 / 2 LA / IM

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

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

Write-up: No adverse event, patient was not 12 years old yet. Actual age is 11 years and 11 months old


VAERS ID: 1554794 (history)  
Form: Version 2.0  
Age: 80.0  
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 040C21A / 3 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: n/a
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: n/a
Diagnostic Lab Data:
CDC Split Type:

Write-up: patient lied on intake form and said he had never received any moderna doses. after administration and checking cairs it shows he received in jan and feb 2021. no reaction at this time.


VAERS ID: 1554799 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: Louisiana  
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 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Haemorrhage, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemodynamic oedema, effusions and fluid overload (narrow)

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

Write-up: bleeding and swelling outside of normal reaction to vaccine


VAERS ID: 1554800 (history)  
Form: Version 2.0  
Age: 70.0  
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 040C21A / 3 LA / 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: na
Current Illness: na
Preexisting Conditions: na
Allergies: na
Diagnostic Lab Data:
CDC Split Type:

Write-up: patient lied on intake form and said he had never received any moderna doses. after administration and checking cairs it shows she received in jan and feb 2021. no reaction at this time and wasn''t eligible for 3rd dose when administered.


VAERS ID: 1554967 (history)  
Form: Version 2.0  
Age: 49.0  
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 040C21A / UNK - / -

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

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

Write-up: patient falsified immunization paperwork to say she had never received any doses of moderna but had received in early 2021. at the time of administration she was not eligible for 3 rd booster and wasn''t caught on cairs until after.


VAERS ID: 1554968 (history)  
Form: Version 2.0  
Age: 25.0  
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 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypoaesthesia, Limb discomfort, Malaise, Paraesthesia, Thirst
SMQs:, Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Dehydration (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Patient mentioned after she received the vaccine, that she takes blood pressure, and thryroid medications.
Current Illness: Patient has sinus tachycardia and wears a monitor for this.
Preexisting Conditions: Sinus tachycardia and thyroid condition.
Allergies: None
Diagnostic Lab Data: Pulse oximeter showed her heart rate to be at 151bpm.
CDC Split Type:

Write-up: Patient received 1st dose pfizer vaccine. About 10 minutes later, patient said she was feeling unwell. Pharmacist went over to check her vitals. Pulse oximeter showed her to be at 151bpm. She complained that she was not feeling well. Looked distressed. She complained that her left arm where she received the injection, was feeling numb/heavy and tingling. Patient also complained that she was feeling very thirsty and asked for water, which we refused to give her in the fear of her choking if she was to pass out. Paramedics were called to the scene and she was taken to hospital by ambulance.


VAERS ID: 1554973 (history)  
Form: Version 2.0  
Age: 25.0  
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: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Feeling of body temperature change, Nausea, Somnolence
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypoglycaemia (broad)

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

Write-up: come on for a Pfizer Covid 19 IMZ. I gave the IMZ at roughly 9:30 am in her right Deltoid. She was ask along with her husband to stay for 15 minutes to observer and make sure there was no reaction before leaving. In a few minutes waiting she rushed to the restroom feeling hot/cold and nauseated. She returned from the restroom and sat in one of the waiting area chairs. I immediately came out and ask her to come back into the IMZ room and lay down on the floor and I propped up her feet on a ABC plastic container and put a few sacs underneath her head. She complained about feeling hot/cold and woozy. I ask if she had any breathing difficulties and she said no and that she could breath fine. I began taking her blood pressure at around roughly 9:40. It was 123/82 and HR 63. I continued to monitor her BP and HR every few minutes. At roughly 9:50 I ask and then gave her 15ml of diphenhydramine oral solution 12.5mg/5ml to help with any allergic reaction and nausea the might have. She was sleepy but alert and talking. At 10:10 she was talking on the phone to someone while still lying down. She ask at one point if she could sit in the chair but I said for her safety for her to continue to lie on the floor until she felt very stable and she agreed. In roughly another 15 minutes I ask her if she felt like she was improving and she said not really and still felt hot/cold and woozy. I spoke to both of them and suggested calling 911 just to be on the safe side and they agreed. I called 911 and was transferred to the medical center where I gave my name, reason for calling, our address and patient''s condition, IMZ received and was requesting EMS to come. While continuing to check BP and HR we waited for EMS to arrive. After 15 to 20 minutes, I believe roughly, they arrived and took over care of patient. They told her that the symptoms she was experiencing were not too unusual with the Pfizer Covid IMZ and that she might have had some anxiety that contributed to her symptoms. The assisted her into a chair at her request and again took her vitals and BS. They ask all routine questions while filling out computer visit questions. After discussing with her the options she had as to go to the hospital for observation or just monitoring herself and calling them back if needed. She decided to not go to the hospital. She signed the computer AMA about going to the hospital. She was still a little woozy and sleepy but as I had told her the EMS techs did also that the generic Benadryl might maker her feel sleepy and sluggish also. She and her husband left on there own power walking out of the clinical service room next to the pharmacy . BP and HR readings 9:40 - 123/82 HR 63 9:50 - 120/86 HR 63 9:54 - 121-82 HR 59 9:56 - 124-86 HR 62 10:00 - 127/83 HR 60 10:07 - 126/89 HR 68 10:11 - 127/94 HR 64 10:16 - 129/92 HR 67 10:21 - 127/93 HR 67 10:28 - 126/90 HR 65


VAERS ID: 1554981 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Missouri  
Vaccinated:2020-12-17
Onset:2021-08-13
   Days after vaccination:239
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Ageusia, Anosmia, COVID-19, SARS-CoV-2 test positive
SMQs:, Taste and smell disorders (narrow), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

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

Write-up: Lost sense of taste and smell . Tested positive via PCR . Healthcare worker and vaccinated


VAERS ID: 1554983 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
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 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 1 RA / 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? 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: FAINTING


VAERS ID: 1554989 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
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 FC3181 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Condition aggravated, Depressed level of consciousness, Dizziness, Heart rate decreased, Hypotension, Loss of consciousness, Somnolence
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad), Dehydration (broad), 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: The patient passed out after both of his Gardasil vaccines about 6 years ago.
Other Medications: Unknown
Current Illness: None
Preexisting Conditions: None
Allergies: Penicillins
Diagnostic Lab Data: First BP reading: 90/38, pulse 44 Second BP reading: 92/54, pulse 53
CDC Split Type:

Write-up: I administered the vaccine and the patient left the booth to sit in the waiting area. About a minute later, someone called that he had passed out. I found him in the chair, and his mother was holding him and trying to wake him up. He woke up briefly but then passed out again. She again tried to wake him up but he was still only semi-conscious. We took his blood pressure and it and his pulse were very low. He kept saying that he felt like he was going to pass out again. A few minutes later we took his BP again and it was still low. His mother and I at that point decided to call for an ambulance. By the time they arrived, the patient was feeling better and his blood pressure had gone up slightly, so he decided not to go to the hospital.


VAERS ID: 1554993 (history)  
Form: Version 2.0  
Age: 44.0  
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 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hyperhidrosis, Pallor
SMQs:, Neuroleptic malignant syndrome (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
Current Illness: unknown
Preexisting Conditions: vasovagal syncope/response to needles
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was ok immediately after vaccine, but experienced sweating and paleness about 15- 20 minutes later.


VAERS ID: 1554995 (history)  
Form: Version 2.0  
Age: 64.0  
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 FC3180 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Headache, Nasal congestion, Pain in extremity
SMQs:, Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Shingrix for herpes zoster
Other Medications: Vitamins D, C and Zinc, Desloratadine, Metformin
Current Illness: None
Preexisting Conditions: Diabetes Mellitus
Allergies: Allergic to raw strawberries, and allergic to pollen, dust, dogs and cats
Diagnostic Lab Data:
CDC Split Type:

Write-up: Congested headache, stuffy nose and arm pain onset at 5 hours post injection


VAERS ID: 1555207 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Nevada  
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 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Arthralgia, Asthenia, Back pain, Balance disorder, Chills, Diarrhoea, Dizziness, Dry mouth, Headache, Hyperhidrosis, Nausea, Pain, Palpitations, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Arthritis (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad)

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

Write-up: Fever 102F checked at 6:30am. Woke up in sweats. Chills and aches all over the body, especially the back and joints. Heart palpitation, Headache, Nausea, Diarrhea, Dry Mouth, Weak, Light headed. Loss of balance. I did not reach out to my doctor yet. I am hoping all these symptoms will subside by this evening or tomorrow.


VAERS ID: 1555209 (history)  
Form: Version 2.0  
Age: 59.0  
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 FA7484 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cold sweat, Dizziness, Dyspnoea, Hyperventilation
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness:
Preexisting Conditions: claims to be diabetic with a collapse left lung
Allergies:
Diagnostic Lab Data: EMS came after 15 minutes all vital signs were normal, blood pressure taken to be normal and blood sugar as well . Pharmacist on duty did auscultatation and no wheezing noted .
CDC Split Type:

Write-up: Patient felt he was about to faint , hyperventilated , complaints of shortness of breath , cold clammy skin after the shot


VAERS ID: 1555213 (history)  
Form: Version 2.0  
Age: 45.0  
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 (MODERNA)) / MODERNA 002F21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dysphagia, Dysphonia, Erythema, Feeling jittery, Pruritus, Taste disorder, Throat irritation
SMQs:, Anaphylactic reaction (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Albuterol
Current Illness: none
Preexisting Conditions: Asthma allergies
Allergies: Sulfa, Codeine, morphine, robitussin, pepper
Diagnostic Lab Data: none
CDC Split Type:

Write-up: A few minutes after receiving her 1st moderna shot, patient complained of an itchy throat and bad taste in her mouth. She had visible redness all over her face, neck and shoulders. She stated she had intense itching all on her neck and face and her voice was sounding a little hoarse. She did tell me that she had experienced something like this with her asthma allergies but not with a vaccine. She had her albuterol inhaler with her and took t 2 puffs. She did state that it was a little hard to swallow, but did not feel like her throat was closing up. She stated she did not feel like she was having shortness of breath, but was felt jittery and didn''t know if was from the inhaler or her nerves. I had her lie on the floor. The intense itching did not seem to be subsiding for her. Aske her if she would like me to call the EMTs to asses her and she said yes. I called the EMTs. Once they arrived , they took an assessment and her vitals. After about 20 minutes , she decided she was feeling a little better. She did not go to the ER , they did wheel her out in a wheel chair and advised her to take some Benadryl.


VAERS ID: 1555422 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
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 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Write-up: Rash on body


VAERS ID: 1555427 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Washington  
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 / N/A AR / IM

Administered by: Public       Purchased by: ?
Symptoms: Eye movement disorder, Fatigue, Hypotonia, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Peripheral neuropathy (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: none at time of vaccination or 14 days prior
Preexisting Conditions: N/A
Allergies: no
Diagnostic Lab Data:
CDC Split Type:

Write-up: Client received J&J vaccine at 1:29pm. In post-vaccination observation area at 1:31pm, client''s eyes rolled back in head and body went limp as he leaned back in chair (prevented from falling out of chair by employee). Lead observation nurse rushed over and attempted to give epinephrine pen into right thigh at 1:32pm. Nurse accidentally forgot to remove safety cap off the Epi-pen, so dose was not administered. Client was then arousable and started to talk, apologizing for fainting. No respiratory distress, pain, hives, rash, swelling, or any other signs of adverse reaction. At 1:37pm, vital signs were: pulse 65, blood pressure 96/67, and O2sats 97%. Client stated he had not ate or drank much at all today and complained of fatigue (temperature outside over 90 degrees with Unhealthy air quality due to wildfire smoke). Client drank 32oz water while resting on cot. By 1:59pm, client sitting up on cot and stating he feels much better. At 2:10pm, vital signs were: pulse 58, blood pressure 118/72, O2sats 97%. All questions answered and client verbalized understanding of when to seek further medical care. At 2:14pm, client stated he felt back to his baseline, was able to stand up independently without dizziness, and left without assistance.


VAERS ID: 1555430 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: Washington  
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 / N/A AR / IM

Administered by: Public       Purchased by: ?
Symptoms: Dizziness, Dysarthria, Hyperhidrosis, Movement disorder, Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Akathisia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: none at time of vaccination or 14 days prior, per client report
Preexisting Conditions: none reported
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Client received J&J vaccine at 3:45pm. In post-vaccination observation area, client started to rock back and forth in chair with eyes closed. No signs of distress. At 3:50pm, client became diaphoretic and complained of dizziness. Denied ability to stand up or assist in moving to cot approx. 6 feet away. At 3:55pm, speech noted to be somewhat slurred and Lead observation nurse activated Rapid Response. Client complained of nausea and vomited in trash can moderate amount one time. Clinic rapid response team arrived at approx 3:57pm. Client already reporting feeling significantly better, opening eyes, and speaking coherently. Client reported having nothing to eat/drink in last 3-4 hours and working as landscaper outside all day prior to arrival (in 90-95 degree heat with Unhealthy air quality due to wildfire smoke). Client in no distress; Vital signs at 4:00pm were: pulse 66, blood pressure 87/57, O2sat 98%. Attending provider assessed client; determined client was most likely experiencing heat intolerance & dehydration, and recommended we push oral fluids and monitor client until returned to baseline. Client given 32 oz water, 8oz juice, and 2 granola bars; which he tolerated well with no nausea. Family joined client in observation area and wife updated on what happened. Both client & wife given education (including heat-illness related care) and verbalized understanding of when to seek further medical care. Vital signs at 4:19pm were: pulse 66, blood pressure 108/71, O2sat 98%. Client still in no distress, no longer diaphoretic or pale, able to stand independently without dizziness. Discharged home with family.


VAERS ID: 1555433 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
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 (MODERNA)) / MODERNA 050C21A / 2 LA / IM

Administered by: Pharmacy       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: NA
Current Illness: NA
Preexisting Conditions: NA
Allergies: NA
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: Patient came in for a second COVID vaccine. He did not have his vaccination card but reported that he had received Moderna for his first vaccination. He was given a second vaccination of Moderna. After a while, the patient came back and said that he had actually gotten Pfizer for the first dose.


VAERS ID: 1555589 (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 FC3181 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Pain in extremity, Pruritus
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: One hour after shot, I had stabbing pains in my feet. It lasted about 45 minutes. An hour and a half after the shot I had extreme itching on my neck and scalp. Then it spread to my palms and then feet. As of 8:45pm, it is still extremely itchy on my feet and palms.


VAERS ID: 1555592 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 1 - / IM

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

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

Write-up: Patient entered facility indecisive about which vaccine to take. Patient then decided to receive the Pfizer vaccine . An appointment was made for the patient to receive the Pfizer vaccine. Patient was escorted into the vaccination waiting area. I called, "next for Pfizer" then the patient answered and came to the vaccinating table. The patient only spoke Spanish, so I asked her to wait until the next Spanish speaking clinician was available. She was seen by the next available Pfizer vaccinating team who spoke Spanish. She received her Pfizer vaccine. After receiving the vaccine, the patient stated she did not want Pfizer, then stated she wanted Janssen.


VAERS ID: 1555595 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-08-12
Onset:2021-08-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002F21A / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Chills, Hyperhidrosis, Lip swelling, Pain, Pyrexia
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: B12, Vitamin D and Iron
Current Illness: None
Preexisting Conditions: Asthma, anemia
Allergies: Cantaloupe & Honeydew
Diagnostic Lab Data:
CDC Split Type:

Write-up: 8/12 12:30pm sweating 8/12 6:00pm body aches 8/12 fever and chills start over night 8/13 fever and chills continue and moderate joint pain through lout day 8/13 3:30pm Swollen bottom lip starts 8/13 9:30pm swelling of bottom lip increases and fever and chills and moderate joint pain


VAERS ID: 1555600 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-08-10
Onset:2021-08-13
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052EZ1A / 1 LA / SYR

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

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

Write-up: Severe chest pain


VAERS ID: 1555602 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: Hawaii  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Fatigue, Feeling abnormal, Headache, Pain, Peripheral coldness
SMQs:, Dementia (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: Trivalent flu vaccine
Other Medications: Zoloft
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Body muscle aches, headache, fatigue and tiredness, body rush/pulsating feeling, cold legs feet.


VAERS ID: 1555606 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

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

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

Write-up: Extreme soreness at injection site, headache


VAERS ID: 1557022 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-11
Onset:2021-08-13
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Chills, Injection site erythema, Injection site pain, Injection site swelling, Injection site warmth, Myalgia, Neutrophil count decreased, Pain, Pyrexia, White blood cell count increased
SMQs:, Rhabdomyolysis/myopathy (broad), Agranulocytosis (broad), Haematopoietic leukopenia (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin D, turmeric, Zinc, Vitamin C, Calcium, Magnesium
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: 8/13/2021 -- WBC 2.4, ANC 0.7 No history of chronic or acute diseases
CDC Split Type:

Write-up: 12 hours after injection, experienced fever 100.8F, chills, generalized muscle soreness and ache, injection sight tenderness. 24 hours after injection, fever/chills/body ache resolved, but injection sight pain worsened, reddened, hot to touch, and swelling. 48 hours after injection, no systemic symptoms, but injection sight more swollen, painful, hot to touch, redness expanding. Also 48 hours after injection, developed NEUTROPENIA as evidence by WBC 2.4 and ANC 0.7. Repeat labs at approximately 12 hours resulted WBC 2.9 and ANC 1.2.


VAERS ID: 1557023 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 054C21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Fatigue, Headache, Injection site pain, Vomiting
SMQs:, Acute pancreatitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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: Zyrtec allergy medicine otc
Current Illness: None
Preexisting Conditions: GERD
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Severe pain in arm of injection. Fatigue. Headache. Vomiting.


VAERS ID: 1557749 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Dizziness, Headache, Hyperhidrosis, Motion sickness, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? 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: Shivering, chills, extreme headache, dizziness, motion sickness, fever, extreme sweating.


VAERS ID: 1558038 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017E21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anxiety, Seizure, Seizure cluster
SMQs:, 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Systemic: Seizure-Mild, Additional Details: Patient got the vaccine and was waiting in the waiting area for observation for 15 minutes after shot her friend came and adressed that patient is having seizures. Patient has history of seizures upon asking her last seizure was couple weeks ago and had 2 cluster seizure at that time. Her max cluster seizure she has had is 5. Patient said she was very anxious about vaccine and she had worked up on the axiety all day long and that caused seizure. Patient said she does not take any med for seizure


VAERS ID: 1558041 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017E21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Condition aggravated, Seizure
SMQs:, 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Systemic: Seizure-Mild, Additional Details: Patient got vaccine and after sometime during 15 minute wait her friend came and let us know she is having seizures. Me and minute clinic nurse ran to patient to help. She was having seizures after her recovery from seizure I asked her questions and she let me know anxiety usually causes seizures and she was very anxious with vaccine and she got it because of that. her last seizure was 2 weeks ago and in past she has had about 5 cluster seizures at a time. She is not on any meds for seizure.


VAERS ID: 1558050 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017E21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Condition aggravated, Seizure
SMQs:, 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Systemic: Seizure-Mild, Additional Details: Patient got vaccine and after sometime during 15 minute wait her friend came and let us know she is having seizures. Me and minute clinic nurse ran to patient to help. She was having seizures after her recovery from seizure I asked her questions and she let me know anxiety usually causes seizures and she was very anxious with vaccine and she got it because of that. her last seizure was 2 weeks ago and in past she has had about 5 cluster seizures at a time. She is not on any meds for seizure.


VAERS ID: 1558052 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 LA / IM

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

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

Write-up: Error: Improper Storage (temperature)-


VAERS ID: 1558055 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-08-12
Onset:2021-08-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 1 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Exposure during pregnancy, Injection site erythema, Injection site mass, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow)

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

Write-up: Hard lump at injection site and small red circle. Sore to touch. Pregnancy delivery date is expected to be 3/9/2022


VAERS ID: 1558058 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-08-11
Onset:2021-08-13
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 088D21A / 1 RA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Site: Bruising at Injection Site-Mild, Site: Pain at Injection Site-Medium, Site: Redness at Injection Site-Medium, Site: Swelling at Injection Site-Severe, Systemic: Body Aches Generalized-Severe, Systemic: Headache-Mild, Additional Details: Reports baseball sized knot on injection site arm 2 days after injection. Also reported severe fatigue


VAERS ID: 1558061 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 3 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Error: Booster Given Too Early-


VAERS ID: 1558065 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 RA / IM

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

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

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


VAERS ID: 1558066 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 LA / IM

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

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

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


VAERS ID: 1558067 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 LA / IM

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

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

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


VAERS ID: 1558070 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site pruritus, Nausea, Nervousness
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Site: Itching at Injection Site-Mild, Systemic: Nausea-Mild, Additional Details: Patient wanted us to call 911 to check. Paramedics came and everything is normal. We gave pt ice on the injected arm and asked mom if she wanted us to give her daughter benadryl but refuse, instead just wait for the paramedic to come. Patients mom was advised to just observe daughter and call pediatrician. My observation was the patient was just nervous.


VAERS ID: 1558072 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Rhode Island  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 2 LA / IM

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

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

Write-up: Error: Booster Given Too Early-


VAERS ID: 1558075 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site pruritus, Nausea
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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: Site: Itching at Injection Site-Mild, Systemic: Nausea-Mild, Additional Details: We called 911 per patient''s request. All her vitals were normal. Mom was advised to observe the daughter and communicate with the pediatrician. Before 911 came we offered to administer benadryl, but the mother refused and wanted to wait for 911. We gave water and ice around the injection area. Patient looks okay.


VAERS ID: 1558076 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Public       Purchased by: ?
Symptoms: Arthralgia, Headache, Malaise, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Headache, fatigue, 20 years old, 07.02.2021, COVID-19 Pfizer first shot
Other Medications: Vitamin D
Current Illness: Vertigo
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Headache, fever, pain around the shoulder, malaise


VAERS ID: 1558077 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0170 / 2 LA / IM

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

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

Write-up: Systemic: Dizziness / Lightheadness-Mild, Systemic: Tingling (specify: facial area, extemities)-Mild, Additional Details: Patient said she was lightheaded 15 minutes after vaccine. I had her sit in chair head between her legs and she drank Gatorade while fan blew on her. Started feeling tingling as well from knees down. Took BP and pulse both were normal. Called paramedics she chose not to go with them.


VAERS ID: 1558079 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Delaware  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011D21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain, Anxiety, Blood pressure increased, Cardiac disorder, Dyspnoea, Feeling abnormal, Flushing, Heart rate increased, Hyperhidrosis, Hypertension, Injection site erythema, Tachycardia
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (narrow), Cardiomyopathy (broad), Hypersensitivity (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Site: Redness at Injection Site-Medium, Systemic: Allergic: Difficulty Breathing-Medium, Systemic: Abdominal Pain-Medium, Systemic: Flushed / Sweating-Medium, Systemic: Hypertension-Severe, Systemic: Tachycardia-Severe, Additional Details: ALMOST IMMEDIATELY AFTER INJECTION PATIENT STARTED TO FLUSH AND SAY SHE WASN''T FEELING GOOD. 911 WAS CALLED. PARAMEDICS ARRIVED. PATIENT COMPLAINED OF SPIKE IN BP/HR, DIFFICULTY BREATHING, AND ABDOMINAL PAIN. ALSO HAD SOME ANXIETY WITH GETTING THE VACCINE. PATIENT ALSO HAS HEART CONDITIONS. LEFT WITH PARAMEDICS BUT DID NOT GO TO ER/URGENT CARE. PATIENT CAME BACK WITHIN A COUPLE OF HOURS FOR HER CARD AND EXPLAINED SHE WAS FEELING BETTER BUT IS GOING TO FOLLOW UP WITH HER CARDIOLOGIST


VAERS ID: 1558080 (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: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 LA / IM

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

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

Write-up: Systemic: Dizziness / Lightheadness-Medium, Systemic: Fainting / Unresponsive-Mild, Systemic: Flushed / Sweating-Medium, Systemic: Weakness-Medium


VAERS ID: 1558084 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 2 LA / IM

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

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

Write-up: Error: Incorrect Reconstitution-


VAERS ID: 1558085 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 2 LA / IM

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

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

Write-up: Error: Incorrect Reconstitution-


VAERS ID: 1558086 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 005C21A / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Anxiety, Condition aggravated, Hypoaesthesia, Paraesthesia, Tachycardia
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Hypoglycaemia (broad), Dehydration (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None reported
Current Illness: Anxiety -Nervous
Preexisting Conditions: Anxiety and Tachycardia
Allergies: NKA
Diagnostic Lab Data: Vital signs monitored.
CDC Split Type:

Write-up: Patient was anxious on arrival. History of tachycardia. 610pm reports tachycardia. Vital signs: RR 22, o2 Sat % 99, HR 185, BP 140/92. No diaphoresis or SOB noted. Talkative. Tachycardia resolving. At 630pm she reported tingling and numbness allover, states she remains anxious and would like to go to ED. ED adjacent to Medical Office Building- transpoted by PVT by spouse. LPN to ED with Patient. No distress noted at time of transport or on arrival. 620pm Vital Signs BP 120/84, HR 115 O2 Sat 99% and RR 17.


VAERS ID: 1558092 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Fatigue, Flushing
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypersensitivity (broad)

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

Write-up: After about 10 minutes after the vaccine, patient started to feel faint. She got very tired and flushed. She acted like she was going to pass out but did not. I got her a drink. It lasted about 10 minutes.


VAERS ID: 1558097 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

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

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

Write-up: Fever, chills, weakness, nausea


VAERS ID: 1558107 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK RA / IM

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

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

Write-up: Shaking head to toe like Parkinson''s, teeth chattering, vomiting, headache, dizziness, bone pain, fever


VAERS ID: 1558109 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA MODERNA / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Burning sensation, Chills, Dysgeusia, Injected limb mobility decreased, Pain, Pyrexia
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Right arm can barely move, burning in right arm, chemical taste in mouth, body aches, chills, fever , joint pain


VAERS ID: 1558130 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-08-12
Onset:2021-08-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Headache, Injection site abscess, Myalgia, Nausea
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (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: Mirtazipine abilify trazodone atenolol potassium ativan nexium
Current Illness:
Preexisting Conditions:
Allergies: Metoprolol influenza vaccine reglan keflex cipro penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Muscle aches fatigue nausea headache injections site pain


VAERS ID: 1558140 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Maine  
Vaccinated:2021-08-03
Onset:2021-08-13
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Penicillin childhood
Other Medications: 81 mg aspirin Ramipril 10mg Simvastatin20mg D3 50mcg
Current Illness: None
Preexisting Conditions: None
Allergies: Penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Administered on 8/3. Red itchy rash appeared on 8/13. No treatment plan due to no returned phone call from dr office. Received this report info from local pharmacy.


VAERS ID: 1558142 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Dysgeusia, Pain in extremity
SMQs:, Taste and smell disorders (narrow), Tendinopathies and ligament disorders (broad)

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

Write-up: Within 30 minutes, odd metallic taste in mouth. Is still present next day. Sore arm worsening. No treatment needed.


VAERS ID: 1558148 (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: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: PER DAD , CHILD TEND TO PASS OUT AFTER GETTTING SHOTS
Other Medications: NO KNOWN
Current Illness: NO KNOWN
Preexisting Conditions: NO KNOWN
Allergies: NO KNOWN
Diagnostic Lab Data: NO TESTS NEEDED
CDC Split Type:

Write-up: PATEINT WAS GIVEN PFIZER VACCINE ON 08/13/21 AND PASSDED OUT WHILE IN WAITING AREA FOR 15 MINUTES OBSERVATION. PER HIS FATHER , CHILD IS TEND TO PASS OUT AFTER GETTING SHOTS .. FOLLOW CALL WAS MADE ON 8/13/21 AT 4 PM TO MAKE SURE THE CHILD WAS OK.. PER DAD HE WAS DOING OK WITH NO ISSUES.


VAERS ID: 1558149 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 2 LA / IM

Administered by: Pharmacy       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: Lamictal Nexium
Current Illness: No
Preexisting Conditions: Non alcoholic fatty liver disease GERD Chronic gastritis
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Enlarged and tender Supraclavicle lymph nodes on left side. I expect enlargement of lymph nodes but not the supraclavicle.


VAERS ID: 1558159 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injected limb mobility decreased, Pain in extremity
SMQs:, Tendinopathies and ligament disorders (broad)

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

Write-up: 2 hours post vaccine arm started getting sore a little swollen 8 hours post arm very painful can''t move the arm very good can''t lift anything can''t raise the arm at all pretty much have to keep it by my side. 20 hours post vaccine after waking up in the morning the symptoms are not worse but they are not better they are the same painful can''t use right arm and that''s my dominant arm


VAERS ID: 1558161 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-06
Onset:2021-08-13
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 091D21A / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Back pain, Headache, Injection site erythema, Injection site pruritus, Injection site swelling, Injection site warmth, Pain in extremity, Palpitations, Vaccination complication
SMQs:, Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Sore arm: 1-4 days after vacccination Headache: 1 day after vaccination Lower back pain: 1-3 days after vaccination Palpitations: 2-3 days after vaccination (could be anxiety or WPW, not related to vaccine) COVID arm (itchy, swelling, redness, warm): occurred 1 week after vaccination


VAERS ID: 1558166 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 0988D21A / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (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: letrozole, Eliquis, atorvastatin, Cardizem, digoxin, famotindine, furosemide, losartan, metroprolol, potassium chloride,
Current Illness: Breast Cancer
Preexisting Conditions: AFIB, Cancer
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Starting a few hours after injection, general muscle pain and fatigue.


VAERS ID: 1558170 (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: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dyspnoea, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (broad)

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

Write-up: 15 minutes after vaccine was administered, patient experienced tightness and closing up of the throat and difficulty breathing. Symptoms worsened in the next 5 to 10 minutes. Pharmacist administered Epipen 0.3mg 1 syringe to the left thigh, Patient immediately gasped for air and said he felt much better. Paramedics were called, and they came to examine both the patients. They were stable and doing well. They gave their mother the choice to have them taken to the hospital or for them to go home. The mother chose to have them be taken to the emergency room hospital, so the paramedics took them from the premises.


VAERS ID: 1558172 (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: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dyspnoea, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (broad)

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

Write-up: 15 minutes after vaccine was administered, patient experienced tightness and closing up of the throat and difficulty breathing. Symptoms worsened in the next 5 to 10 minutes. Pharmacist administered Epipen 0.3mg 1 syringe to the left thigh, Patient immediately gasped for air and said he felt much better. Paramedics were called, and they came to examine both the patients. They were stable and doing well. They gave their mother the choice to have them taken to the hospital or for them to go home. The mother chose to have them be taken to the emergency room hospital, so the paramedics took them from the premises.


VAERS ID: 1558176 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-08-12
Onset:2021-08-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Decreased appetite, Feeling cold, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Seasonal influenza, yearly, fevers, body aches, and fatigue
Other Medications: None
Current Illness: None
Preexisting Conditions: No smell, insomnia, and restless leg syndrome since having Covid 19 in November 2020.
Allergies: Eggs and Aleve
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fevers up to 103, chills, fatigue, and loss of appetite. With Tylenol and ibuprofen, fevers stated 101-102 degrees.


VAERS ID: 1558188 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-08-12
Onset:2021-08-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Oxycarbazepine 300mg, Ziprasidone 80mg, Buspirone 10mg, Venlafaxine 50mg, Alprazolam 0.5mg, Carisoprodol 350mg, Hydrocodone APAP 7.5/325mg, Rosuvastatin 20mg, Trazodone 50mg, Albuterol Inhaler, Breo Ellipta, Hydroxyzine 50mg
Current Illness: Unknown
Preexisting Conditions: Asthma, Chronic pain, Depression
Allergies: Sulfer
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: Nausea Fever Vomiting Patient said it was moving into her lungs


VAERS ID: 1558202 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-08-12
Onset:2021-08-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Injection site pain, Injection site swelling, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Carvedilol
Current Illness: 00
Preexisting Conditions: 0
Allergies: 0
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever of 101.7, soreness and swelling at site of ?? injection. Left arm.


VAERS ID: 1558203 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-12
Onset:2021-08-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052E21A / UNK LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Hypoaesthesia, Injection site erythema, Injection site induration, Injection site swelling, Injection site warmth, Myalgia, Pain
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (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? 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:
CDC Split Type:

Write-up: Full body pain in joints and muscles to the point of not being able to move without pain. The injection site is swollen red, hot to touch and hard 5inches around site. My fingers and feet feel numb like they are cold but arent cold.


VAERS ID: 1558205 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017E21A / UNK - / -

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

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

Write-up: Patient got dizzy a couple minutes after the shot, got up from chair and seemed to lose consciousness and stumbled to the ground. Pharmacist ran over and checked on patient. patient was responsive immediately after fall but was still confused, etc. 911 was called and patient walked out with the paramedic.


VAERS ID: 1558219 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC31818 / 2 AR / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain, Asthenia, Fatigue, Lethargy, Nausea, Pain, Vomiting
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Systemic: Abdominal Pain-Medium, Systemic: Body Aches Generalized-Severe, Systemic: Exhaustion / Lethargy-Severe, Systemic: Nausea-Severe, Systemic: Vomiting-Severe, Systemic: Weakness-Severe, Additional Details: Patient unable to keep any food down, feeling very weak. Drinking plenty of fluids calling PCP and seeking care if no improvement


VAERS ID: 1558223 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-11
Onset:2021-08-13
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 3003604 / 2 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Back pain, Chest pain, Chills, Diarrhoea, Dyspnoea, Headache, Nausea, Paraesthesia, Pyrexia
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Tax ( the pill ) took Ibuprofen for knee pain on the 12&13th
Current Illness: n/a
Preexisting Conditions: Iron, Vitamin B12 and Folicacid deficiency
Allergies: n/a
Diagnostic Lab Data:
CDC Split Type:

Write-up: after the vaccination i had chills, fever, nausea, diarrhoea, and a headache for the first two days three days after i started developing difficulty breathing with a lot of chest pain, pain at the back of my back, also pins and needles in my lower legs and feet


VAERS ID: 1558225 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Herpes zoster, Maternal exposure during breast feeding
SMQs:, Neonatal exposures via breast milk (narrow), Opportunistic infections (broad)

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

Write-up: Shingles left L1 dermatome developed evening of COVID 19 second dose vaccine. Patient is currently breastfeeding.


VAERS ID: 1558234 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-08-12
Onset:2021-08-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

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

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

Write-up: Red raised warm swollen area at injection site and around site measuring approx 4.2 cm in diameter. Extreme pain at injection site.


VAERS ID: 1558244 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-12
Onset:2021-08-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Asthenia, Back pain, Bradykinesia, Fatigue, Muscular weakness
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Retroperitoneal fibrosis (broad), Parkinson-like events (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Arthritis (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: Nothing
Current Illness: The next morning after vaccine,, weakness in overall muscles in the entire body, left knee pain, and lower back pain L 4-5, No energy , feeling tired and slowly walking to bathroom, so I remained in bed with lots of fluids.
Preexisting Conditions: None
Allergies: Shrimp
Diagnostic Lab Data: None
CDC Split Type:

Write-up: The next morning after vaccine,, weakness in overall muscles in the entire body, left knee pain, and lower back pain L 4-5, No energy , feeling tired and slowly walking to bathroom, so I remained in bed with lots of fluids. The next day the pain had all but gone and I was able to move around with out pain or weakness.


VAERS ID: 1558269 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 2 LA / IM

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

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

Write-up: PATIENT SAID THAT HE HAD SWELLING IN LOWER JAW HOURS AFTER VACCINATION. PATIENT WAS OUTSIDE AND MOWING LAWN AND ADVERSE REACTION OCCURED, SO UNKNOWN IF DUE TO GRASS ALLERGY RELATION.


VAERS ID: 1558296 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain upper, Arthralgia, Chills, Dizziness, Headache, Hyperhidrosis, Hypoaesthesia, Muscle tightness, Pain, Pain in extremity
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Metformin, Glimepride, Jardiance, Megesterol, Lisinopril, Simvastatin, women''s multi vitamin.
Current Illness: Recent diagnosis of grade 1 endometrial cancer, stung by wasp day before
Preexisting Conditions: Type 2 diabetes, PCOS
Allergies: None
Diagnostic Lab Data: not applicable
CDC Split Type:

Write-up: 5 minutes after injection my left arm and hand went numb. I broke out in a sweat. 3 hours after injection my left leg developed numb spots and toes went numb. My muscles felt tight. Numbness subsided hours after. My entire shoulder joint and arm felt like it was on fire, extreme pain, could not move without pain. That night I had chills, stomach pains, headache and some dizziness that has continued into the next day.


VAERS ID: 1558298 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-08-12
Onset:2021-08-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abnormal dreams, Sleep terror
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Kolopin .5mg as needed 500mg naproxen as needed (usually daily)
Current Illness: N/a
Preexisting Conditions:
Allergies: Large doses of red food dye and any ant bites or stings.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Extremely vivid night terrors..when I don''t ever remember dreams at all and these are extreme and some flash backs of PTSD related inncendents. Started after 1 dose once but after second dose 08/12/2021 extreme Everytime I fall asleep


VAERS ID: 1558309 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-08-05
Onset:2021-08-13
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Hypoaesthesia, Injection site erythema, Injection site warmth, Lymphadenopathy, Sinus operation, Throat irritation
SMQs:, Peripheral neuropathy (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin c, vitamin d, magnesium
Current Illness: None
Preexisting Conditions: None
Allergies: Peppers
Diagnostic Lab Data: None, I don''t have a primary care physician and don''t want to add to urgent care burden.
CDC Split Type:

Write-up: Sudden extreme swollen lymph under jaw, side neck and base of skull, and left arm pit. Intermittent Numbness follows same path from injection to elbow through forearm to thumb. New Slight redness and heat at injection site. Mild throat irritation and drainage (I suspect from wildfire smoke, but could be related to lymph, so including.)


VAERS ID: 1558315 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017C21A / 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? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Melatonin, Depo Provera
Current Illness: none
Preexisting Conditions: none
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was given Modena vaccine at age 15/No adverse reaction reported to this


VAERS ID: 1558317 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-12
Onset:2021-08-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939902 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Balance disorder, Constipation, Dizziness, Headache
SMQs:, Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)

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

Write-up: HEADACHE, DIZZINESS, OFF BALANCE, CONSTIPATED, INCREASED BLOOD PRESSURE, EMERGENCY ROOM


VAERS ID: 1558337 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002F21A / 2 LA / IM

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

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

Write-up: Pain at injection site, mild fever (100F), treating with Ibprofen.


VAERS ID: 1558377 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-08-12
Onset:2021-08-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204AZIA / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Headache, Hyperhidrosis, Myalgia, Nausea, Pyrexia, Urticaria
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Concerta Dexilant
Current Illness:
Preexisting Conditions:
Allergies: Penicillin
Diagnostic Lab Data: August 14 urgent care for ahota of toradol and sotradecol.
CDC Split Type:

Write-up: Severe headaches, Nausea, severe muscle aches & joint aching, fever, sweating through clothes in bed, significant hives on day 2 post vaccine causing need for shots of toradol and sotradecol.


VAERS ID: 1558379 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-06
Onset:2021-08-13
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

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

Write-up: Small rash in the site where the shot was given, itchy and red. One week after the vaccination


VAERS ID: 1558395 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Presyncope, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anticholinergic syndrome (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: fainting, vaccine information unknown
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient experienced a vasovagal response post-vaccination (fainting). She was lowered to the floor in time to prevent any damage to herself or others. She did not experience any further reactions or need any further medical attention after the reaction. EMS was called to the scene as a precaution, and also in response to her mother''s fainting (who was not immunized - just in response to the patient''s reaction).


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