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

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



Case Details (Reverse Sorted by Onset Date)

This is page 142 out of 3,524

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VAERS ID: 1385175 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-01-23
Onset:2021-05-18
   Days after vaccination:115
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3249 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9264 / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, COVID-19, Cough, Dyspnoea, Pain, Respiratory symptom, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Infective pneumonia (broad), Opportunistic infections (broad), 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? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: albuterol inhaler, aspirin 81mg, Vitamin D3 1000 unit, Vitamin B12 1000mcg, Breo inhaler, Synthroid 88mcg, losartan 25mg, pravastatin 20mg, pregabalin 150mg, Spiriva inhaler.
Current Illness: No acute illnesses at time of vaccination.
Preexisting Conditions: History of COPD, HTN, hypothyroidism, hyperlipidemia and idiopathic neuropathy.
Allergies: No known food or drug allergies.
Diagnostic Lab Data: Patient had positive COVID19 test at unrelated urgent care 5/18/21. During hospitalization, on 5/24/21, patient again tested positive for COVID19,
CDC Split Type:

Write-up: Patient admit to Hospital 5/23/21 for cough, weakness and SOB x 4 days. Pt had completed COVID19 vaccines earlier in the year and attended a family wedding 5/14/21 and developed respiratory symptoms within 3 to 4 days thereafter. Several family members now COVID19 positive, including patient (positive test approximately 5/18). Patient with history of COPD (on 2L 02 at home), and decision made to admit patient for close monitoring. Vaccination History: 1/23/21 Pfizer EL3249 2/13/21 Pfizer EL9264 Hospital Course: Patient admitted to COVID19 general unit, and started on IV dexamethasone (6mg IV daily) and remdesivir (200mg IV x 1, then 100mg IV daily). COVID19 test 5/24 was positive, and was to be sent to ODH for genotyping. Patient required 02 at 4L NC initially, then was able to tolerate 2L NC thereafter. Patient improved with less body aches and no SOB by 5/25. Patient continued to improve and was discharged home with HHC 5/28 with remdesivir course complete and home going med of dexamethasone 6mg daily x 5 more days.


VAERS ID: 1385260 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-04
Onset:2021-05-18
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL 8982 / 2 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK 5730 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood test abnormal, Chest X-ray normal, Computerised tomogram abnormal, Dyspnoea, Electrocardiogram normal, Fibrin D dimer increased, Pulmonary thrombosis
SMQs:, Anaphylactic reaction (broad), Haemorrhage laboratory terms (broad), Embolic and thrombotic events, venous (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Atorvastatin 20 mg daily
Current Illness: None
Preexisting Conditions: None
Allergies: Sensitivity to codeine (makes me very weak and drowsy)
Diagnostic Lab Data: Blood work, all normal except for D-Dimer, which was out of normal range. Chest x-ray did not show any adverse conditions, nor did ECG. CT scan, however, revealed clotting in both lungs. All tests were done on 6/5/21.
CDC Split Type:

Write-up: Shortness of breath, gradually progressed over two weeks time to become more pronounced. Doctor visit on 6-5-21 and lab tests showed elevated D-Dimer results, indicating presence of a blood clot, where CT scan showed presence of "extensive" clotting, primarily in lower lobes. Was prescribed blood thinner medication (Xarelto). Remained in E.D. overnight under observation. Results over the past four days are that breathing is getting better.


VAERS ID: 1385274 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-05-15
Onset:2021-05-18
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest discomfort, Electrocardiogram ST segment elevation, Palpitations, Pericarditis, Troponin increased
SMQs:, Anaphylactic reaction (broad), Systemic lupus erythematosus (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None prior to cardiac event.
Current Illness: None
Preexisting Conditions: None
Allergies: N/A
Diagnostic Lab Data: +EKG ST elevation, +troponin elevation; echo did not show pericardial effusion.
CDC Split Type:

Write-up: Patient developed chest tightness, pressure, palpitations and had +EKG changes and troponin elevation. He was admitted to hospital 5/18/21-5/20/21 for studies and treatment, final diagnosis was pericarditis.


VAERS ID: 1385460 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Nebraska  
Vaccinated:2021-05-18
Onset:2021-05-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026B21A / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dysphagia, Hypoaesthesia oral
SMQs:, Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad)

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

Write-up: Complaints of numbness in lips, and hard to swallow; Treated in OP setting withIV Normal Saline at 125 ml/hr; Famotidine 20 mg IV push; Benadryl 25 mg IV Push; Solumedrol 125 mg IV push; Ofirmev 100 mg IV piggyback.


VAERS ID: 1385906 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-05-18
Onset:2021-05-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037B21A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Isosorbide Dinitrate, Amlodipine,,Atrovastatin Calcium,,Flonase,,Ferrous Sulfate, Loratadine, NTG, Humalog Kwli pen, hydralazine, Basaglar, VitaminD, Hydroxyzine, ProAir HFA, Furosemide, Minoxidil, ASA
Current Illness: None
Preexisting Conditions: Diabetes, HTN,CKD, CHF
Allergies: None known
Diagnostic Lab Data:
CDC Split Type:

Write-up: Within 5-10 minutes after administration patient bagan vomiting. Refused Zofran. Came the next day with the same symptoms in addition to diarrhea. Went to the ER the next day. Non admit. Returned to the clinic after the ER.


VAERS ID: 1385977 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-31
Onset:2021-05-18
   Days after vaccination:48
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6208 / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7533 / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Acute kidney injury
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

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

Write-up: Acute kidney failure, unspecified Personal history of covid-19


VAERS ID: 1386367 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2021-03-30
Onset:2021-05-18
   Days after vaccination:49
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Angiogram, Aphasia, Blood test, Coagulation test, Computerised tomogram head, Echocardiogram, Headache, Hypoaesthesia, Ischaemic stroke, Magnetic resonance imaging head abnormal, Muscular weakness, Rheumatological examination, Ultrasound scan, Venogram, Vision blurred
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), Dementia (broad), Embolic and thrombotic events, arterial (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (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? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Tacrolimus, Mycophenolic acid, Jardiance, Ezetimibe, Insulin, Labetalol, Nifedipine
Current Illness:
Preexisting Conditions: HTN, DM, MRKH, HLD, SHPT ESRD 2/2 DM s/p DDKT
Allergies: bydureon, glipizide, ibuprofen, lisinopril, metformin
Diagnostic Lab Data: . Initial CT head was negative for hemorrhage and pt was within window so Alteplase was given. CTA Head/Neck did not show LVO. MRI brain showing left thalamus and hippocampus infarcts and subacute infarct of right insula. A TTE was completed and essentially normal. TCD was done showing 4 late bubbles without Valsalva so TEE was completed by cardiology and also negative for shunt with normal results. An MRV pelvis was completed and showed some narrowing of left common iliac vein but no occlusion. Hypercoagulable panel was sent as well as rheumatology labs which have been negative thus far
CDC Split Type:

Write-up: patient started having headache a week after vaccination. Within 6 weeks, patient was found to have headache on the left side of her head, and then developed right sided blurry vision and RUE numbness/weakness. Per EMS, patient was having word-finding difficulty. Last known normal: 19:10 5/17/21. Patient got diagnosed with acute ischemic stroke that required tPA.


VAERS ID: 1387381 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-05-17
Onset:2021-05-18
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033021A / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Full blood count, Heavy menstrual bleeding, Menstruation irregular, Metabolic function test, Ultrasound pelvis, Urine analysis
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Fertility disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: on 6/9/2021 I went to the ER and submitted to CBC, CMP, Urine lab test and US pelvic imaging testing
CDC Split Type:

Write-up: post-vaccination menstrual irregularities, including vaginal haemorrhages. experiencing heavy bleeding since the vaccine.


VAERS ID: 1387719 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-05-02
Onset:2021-05-18
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Bell's palsy, Blood test
SMQs:, Hearing impairment (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Blood pressure high; Diabetes; Neuropathy; Sleep apnea
Allergies:
Diagnostic Lab Data: Test Date: 20210518; Test Name: blood work; Result Unstructured Data: Test Result:Bell''s Palsy; Comments: Primary Care Physician she did blood work and it was determined I have Bell''s Palsy.
CDC Split Type: USPFIZER INC2021599219

Write-up: it was determined I have Bell''s Palsy; This is a spontaneous report received from a contactable consumer (patient). A 44-year-old female patient received the first dose of bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE), via an unspecified route of administration, administered in Arm Left on 02May2021 13:00 (Lot number: EW0172) as single dose for (at the age of 44-years-old) COVID-19 immunization. Medical history included diabetes, sleep apnea, high blood pressure, neuropathy. The patient was not pregnant at the time of vaccination. No allergies. Unspecified concomitant medications were taken ("Yes my prescribed medications"). The patient reported that, "My face started getting droopy, my speech slurred and started having extreme facial pain. I went to my Primary Care Physician she did blood work and it was determined I have Bell''s Palsy." Date of start of reaction was on 18May2021 07:15. The adverse event resulted in any Doctor or other healthcare professional office/clinic visit. Hospitalization not Prolonged. The outcome of event was not recovered. The event is serious (medically significant). Another dose of bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE) was administered via an unspecified route of administration on 23May2021 03:00 PM, administered in Arm Left (Lot number: EW0172) as single dose for COVID-19 immunization (pending clarification). Facility where the most recent COVID-19 vaccine was administered was in Pharmacy or Drug Store. The patient did not receive any other vaccines within 4 weeks prior to the COVID vaccine. Prior to vaccination, the patient was not diagnosed with COVID-19. Since the vaccination, the patient has not been tested for COVID-19. Additional information has been requested.


VAERS ID: 1387861 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-05-12
Onset:2021-05-18
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Cold sweat, Confusional state, Dyspnoea, Heart rate increased, Hypertension, Hypoaesthesia, Injection site swelling, Panic reaction, Syncope, Ultrasound scan, Urticaria
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Angioedema (narrow), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypertension (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (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? 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: Possibility of allergic reaction to penicillin, Bactrim, latex.
Diagnostic Lab Data: No bloodwork done, Ultrasound was done on left arm no blood clot.
CDC Split Type:

Write-up: Injection site swollen around my back arm and armpit, small hive left inner elbow, increased heart rate, blood pressure was 183/110. Was hard to breathe, clammy, faint, confused, and panicky. Left arm went numb. I went to hospital twice, and clinic twice due to the symptoms coming and going.


VAERS ID: 1387950 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-05-18
Onset:2021-05-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Dyspnoea, Limb discomfort, Nasal congestion
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)

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

Write-up: Systemic: Allergic: Difficulty Breathing-Medium, Systemic: Chest Tightness / Heaviness / Pain-Medium, Additional Details: Pt stated that 1&1/2 hours after first dose she felt a stuffiness of the nose (nasal congestion) along with tightness of the chest which made it difficult to get in a deep breath. Symptoms persisted for 5-6 hours. Pt did not seek medical attention. Pt came for second dose 6/8/21, informed patient to seek medical attention if symptoms reoccur.


VAERS ID: 1387955 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-05-04
Onset:2021-05-18
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9810 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Herpes zoster, Lethargy, Nervous system disorder
SMQs:, Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypoglycaemia (broad), Opportunistic infections (broad)

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

Write-up: Systemic: Exhaustion / Lethargy-Severe, Systemic: SHINGLES-Severe, Systemic: Neurological Disorder (diagnosed by MD)-Severe


VAERS ID: 1388153 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-05-18
Onset:2021-05-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0171 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Extra dose administered, Interchange of vaccine products, No adverse event
SMQs:, Medication errors (narrow)

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

Write-up: NO ADVERSE EVENT. IMMUNIZATION INFORMATION SHOWS PATIENT RECEIVED 2 DOSES OF MODERNA FROM ANOTHER FACILITY AND RECEIVED A PFIZER DOSE FROM US.


VAERS ID: 1388530 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-05-18
Onset:2021-05-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Angiogram, Asthenia, Blindness unilateral, Computerised tomogram head, Electrocardiogram, Full blood count, Lethargy, Magnetic resonance imaging head, Metabolic function test, Paraesthesia, Prothrombin time
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Glaucoma (broad), Optic nerve disorders (broad), Retinal disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: sertraline
Current Illness: none
Preexisting Conditions: Von-Willebrands Disease Type 2M
Allergies: NSAIDS
Diagnostic Lab Data: basic metabolic panel CBC without auto differential PT INR CT head without contrast CTA Head and neck stroke set EKG 12 Lead MRI Brain/Head with & without contrast
CDC Split Type:

Write-up: parasthesia in injected arm, blindness in right eye, intense weakness and lethargy.


VAERS ID: 1388582 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-05
Onset:2021-05-18
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8737 / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8729 / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Encephalitis, Encephalomyelitis, Speech disorder
SMQs:, Dementia (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (narrow), Noninfectious encephalopathy/delirium (broad), Demyelination (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

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

Write-up: Other encephalitis and encephalomyelitis Speech abnormality


VAERS ID: 1389024 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-18
Onset:2021-05-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041C21A / 1 LA / 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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: no
Current Illness: no
Preexisting Conditions: no
Allergies: no
Diagnostic Lab Data: no
CDC Split Type:

Write-up: 17 year old patient presented to clinic with parent for his first Covid vaccine, patient was administered Moderna instead of Phizer. Parent was notified and no additional adverse signs and symptoms reported by parent.


VAERS ID: 1389037 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-05-18
Onset:2021-05-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Dizziness, Fall, Loss of consciousness, Pain in jaw
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Osteonecrosis (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: Adverse effects began 3 to 4 hours after vaccination. Patient reports arm soreness with pain moving down arm and into chest, back and top of jaw. Patient got up and felt dizzy. Fell over and blacked out with eyes open for a few seconds. She does not remember falling over.


VAERS ID: 1389333 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-05-17
Onset:2021-05-18
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016C21A / UNK LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: A cold that ended 19 days before vaccination.
Preexisting Conditions: Bronchitis throughout life
Allergies: Allergic to codeine
Diagnostic Lab Data: None
CDC Split Type:

Write-up: I woke up the next morning after the shot on 5/18/21 with a fever and bad headache. The fever went away within a few hours but the headache has been continuous for the past 24 days straight, including today. I have had no relief from varying levels of head pain since the shot. The headache varies in intensity throughout the day, but has not let up. In the past I rarely have experienced headaches, maybe a few every year, so having chronic headaches is not typical for me. Unfortunately, my chronic headaches are a direct result of receiving the first Moderna vaccine.


VAERS ID: 1389346 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-05-18
Onset:2021-05-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 3 LA / IM

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

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

Write-up: Client reported this was their second dose but after vaccine was given, it was found that there were 2 previous Pfizer doses already given, so this would be client''s third dose.


VAERS ID: 1390956 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-15
Onset:2021-05-18
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-06-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Cardiac failure congestive
SMQs:, Cardiac failure (narrow), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021612447

Write-up: Shortness of breath started getting severe/ diagnosed with CHF/ unable to breathe when laying back in a chair; This is a spontaneous report from a contactable consumer (patient himself). A 61-year-old male patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE), via an unspecified route of administration on 15May2021 (Batch/Lot number was not reported) as 2nd dose, single for COVID-19 immunisation. The patient''s medical history and concomitant medications were not reported. The patient previously received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE), via an unspecified route of administration on 24Apr2021 (Batch/Lot number was not reported) as 1st dose, single for COVID-19 immunization and experienced intermittent SOB 5 days after. He received the second dose on Saturday, 15May2021. Shortness of breath started getting severe on the following Monday (18May2021), worsened on Tuesday, and went to ED on Wednesday. He was diagnosed with CHF. He has experienced being unable to breathe when laying back in a chair and having to stop 5-6 times during a 1 mile walk due to the shortness of breath. He has been referred to a Cardiologist. Outcome of the event was unknown. Information on the lot/batch number has been requested.


VAERS ID: 1391274 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: New York  
Vaccinated:2021-03-12
Onset:2021-05-18
   Days after vaccination:67
Submitted: 0000-00-00
Entered: 2021-06-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032M20A / 2 UN / IM

Administered by: Public       Purchased by: ?
Symptoms: Adult failure to thrive, Blood thyroid stimulating hormone normal, Chest X-ray normal, Computerised tomogram head normal, Full blood count normal, Gait disturbance, General physical health deterioration, Metabolic function test normal, SARS-CoV-2 test negative, Subarachnoid haemorrhage, Urine analysis normal
SMQs:, Peripheral neuropathy (broad), Haemorrhage terms (excl laboratory terms) (narrow), Anticholinergic syndrome (broad), Haemorrhagic central nervous system vascular conditions (narrow), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Hypoglycaemia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: flomax, norvasc, aricept, omeprazole, lipitor
Current Illness: Pt had covid 19 infection in dec 2020 treated with antibiotics, steroids and remdesivir and went to rehab on 1/6/21
Preexisting Conditions: dementia, HTN, BPH
Allergies: cats claw, ace inhibitors, cat dander
Diagnostic Lab Data: as above
CDC Split Type:

Write-up: Pt had covid 19 infection in dec 2020 and recovered and was sent to rehab facility on 1/6/21 and ultimately discharged home with his family. He received his 1st and 2nd covid 19 vaccines on 2/10 and 3/12/21 and was admitted on 5/18 and shipped to another hospital after coming to the er with a non traumatic subarachnoid hemorrhage. He was discharged home on 5/20 and his daily aspirin was discontined. He returned back to the ER on 6/1/21 with the family c/o the pt not thriving , difficulty ambulating and progressive decline. Head CT and chest x ray were negative. cbc was normal, tsh normal. covid 19 negative. urinalysis was negative, cmp was normal, cbc was at his baseline. He was ultimately discharged to a nursing home on 6/4/21.


VAERS ID: 1391318 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-05-13
Onset:2021-05-18
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-06-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0158 / UNK - / IM

Administered by: Private       Purchased by: ?
Symptoms: Head discomfort, Headache, Hypoaesthesia, Immediate post-injection reaction, Magnetic resonance imaging head, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Hypersensitivity (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: Doxicicline was stopped day prior to vaccine. Havent taken again
Current Illness: N/a
Preexisting Conditions: Rosacea, inappropriate sinus tacchycardia
Allergies: Na
Diagnostic Lab Data: MRI Brain WO done
CDC Split Type:

Write-up: Left foot went numb immediately after vaccine. 5 days later i got a headache with throbbing and pressure and tingling that has lasted 3 weeks and 4 days. No medication helps the headache


VAERS ID: 1391350 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-05-14
Onset:2021-05-18
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-06-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003C21A / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site rash, Pruritus
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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prilosect
Current Illness: None
Preexisting Conditions: Breast cancer
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Large rash on injection site, extreme itching for 11 days


VAERS ID: 1391481 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-05-12
Onset:2021-05-18
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-06-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048B21A / 1 LA / IM

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

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

Write-up: Patient states onset of tinnitus and loss of hearing approx 6-7 days after receipt of Moderna dose 1 on 5/12/2021.


VAERS ID: 1391506 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-03-16
Onset:2021-05-18
   Days after vaccination:63
Submitted: 0000-00-00
Entered: 2021-06-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER2613 / 1 LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0162 / 2 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Condition aggravated, Dyspnoea, Facial paralysis, Fatigue, Headache
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hearing impairment (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Nexplenon
Current Illness:
Preexisting Conditions: Fatigue, migraines, panic attacks, stroke like symptoms
Allergies:
Diagnostic Lab Data: 05/18 please contact doctor for them
CDC Split Type:

Write-up: Stroke like symptoms: fatigue, headache, facial droop, shortness of breath


VAERS ID: 1391824 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-17
Onset:2021-05-18
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8727 / 2 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Dyspnoea, Fatigue
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad)

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

Write-up: SOB, weakness, fatigue for 3wks


VAERS ID: 1391951 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-05-16
Onset:2021-05-18
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041C21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Alopecia areata
SMQs:, Immune-mediated/autoimmune disorders (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: multivitamin
Current Illness: none
Preexisting Conditions: none
Allergies: penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Developed Alopecia Areta with two bald spots on the scalp following the vaccination. No prior history of alopecia areata or any other auto-immune disorders.


VAERS ID: 1347146 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-05-18
Onset:2021-05-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Haemorrhoids, Limb discomfort, Pyrexia, Vasodilatation
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: On the night after the vaccine I felt myself very very tired (which is not normal), fever (up to 101.5?F), my legs tired, my vains were much more visible than usual and also a big external hemorrhoid appeared the day after the vaccine (I never had hemorrhoids before). For the fever I took paracetamol 1g every 6 to 8 hours and after 2 days the fever symptoms disappeared. About the legs, the veins are not that visible but still more than before. Also feel my left lower leg like it is tired and the area around my left knee also. Regarding the hemorrhoid, I was applying a lotion and now is almost recovered.


VAERS ID: 1365324 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-04-29
Onset:2021-05-18
   Days after vaccination:19
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0151 / 1 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Angiogram, Computerised tomogram head, Condition aggravated, Erythema, Feeling cold, Hypoacusis, Hypoaesthesia, Magnetic resonance imaging head abnormal, Nystagmus, Tinnitus, Vertebral artery occlusion, Vertebral artery stenosis, Vertigo, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Ischaemic central nervous system vascular conditions (narrow), Embolic and thrombotic events, arterial (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hearing impairment (narrow), Vestibular disorders (narrow), Ocular motility disorders (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Asthma
Allergies: None known
Diagnostic Lab Data: CT brain 5-19-21: unremarkable. MRI brain 5-19-21: normal but distal narrowing of the right vertebral. CT angiogram on 5-20-21: right vertebral distally tapered or occluded MRI angiogram pending
CDC Split Type:

Write-up: Three weeks following vaccination, the patient suddenly developed painless right-sided muffled hearing, followed by right-sided facial heaviness or numbness, then by a sense of spinning vertigo. Vertigo was severe and intermittently accompanied by vomiting. When seen in the ER the following day, the symptoms persisted. She was extremely sensitive to any movement and had obvious horizontal nystagmus with right-beating fast phases, with amplitude larger in left gaze. Facial sensation was subjectively mildly reduced on the right to cold, but not to touch. No motor asymmetry. Hearing was mildly reduced on the right and worsened with movement. Slight redness of the auditory canal but no rash. Remainder of neurological exam was normal. She was seen the following day by neurology. Vertigo was much improved, with transient nystagmus, but hearing was worse on the right, and she described tinnitus. The next day, she was seen by ENT, with further improvement of the vertigo and minimal nystagmus. On Romberg, she fell to the front and right. Subjective right facial hypoesthesia persisted. Otoscopy was normal. Hearing test showed profound sensorineural hearing loss on the right.


VAERS ID: 1273717 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-03-30
Onset:2021-05-17
   Days after vaccination:48
Submitted: 0000-00-00
Entered: 2021-04-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Menstruation irregular, Ultrasound scan vagina, Vaginal haemorrhage
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Fertility disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Active Outpatient Medications Status ========================================================================= 1) ACETAMINOPHEN 250/ASA 250/CAFF 65MG TAB TAKE 2 ACTIVE TABLETS BY MOUTH TWICE A DAY A
Current Illness:
Preexisting Conditions: chronic diarrhea/ constipation, hyperlipidemia, joint pain, and bipolar disorder
Allergies: morphine
Diagnostic Lab Data: Vaginal ultrasound.
CDC Split Type:

Write-up: irregular periods: after having the COVID19 vaccine, she read about this happening to other women, vet reports having 2 weeks of vaginal bleeding, despite having the Nuvaring in, she reports having a normal period 3 weeks ago, but had started bleeding again and not normal spotting but having what she describes as a full period. Vet reports she had always had random spotting between periods, that was light and not every cycle. Vet reports that she would sometimes keep the nuvaring in for 4 weeks to skip periods, sometimes. She was advised she May replace immediately with new ring after 21 days, to skip period for up to 3-4 months at a time, but she will have increased spotting risk when attempting to skip periods. Vet wants to continue the Nuva ring. Vet agrees to vaginal ultrasound and will report any problems with ongoing bleeding, or if she had pain, so that gyn referral could be placed.


VAERS ID: 1322509 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-05-15
Onset:2021-05-17
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / UN

Administered by: Pharmacy       Purchased by: ?
Symptoms: Back pain, Chills, Headache, Lymphadenopathy, Malaise, Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (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: Lisinoprl
Current Illness:
Preexisting Conditions: High blood pressure
Allergies: Effixor
Diagnostic Lab Data:
CDC Split Type:

Write-up: Covid rash, sick with headaches, fever horrible chills ,back pain ,glands swollen. Everything except for rash within 10 hrs period of vacation. Rash about a day later


VAERS ID: 1322527 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-16
Onset:2021-05-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / IM

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

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

Write-up: Swelling and soreness at site. Tiredness/fatigue.


VAERS ID: 1322620 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-05-16
Onset:2021-05-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lexapro, red yeast rice, vitamin c, zinc, flaxseed oil, multivitamin.
Current Illness: N/a
Preexisting Conditions: No
Allergies: Shellfish
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever, chills, body aches.


VAERS ID: 1322867 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: D.C.  
Vaccinated:2021-05-15
Onset:2021-05-17
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

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

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

Write-up: On the morning of May 17, approx 40 hours after vaccine dose 1, patient developed stomach pain, nausea and vomiting.


VAERS ID: 1322918 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 1 RA / SYR

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

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

Write-up: Tongue swelled up and her throat felt tight, itchy, and closed up. I have a dose of Benadryl within minutes, it didn?t seem to help. I gave a second dose of Benadryl and increased the amount and that helped. I also called the nurse line.


VAERS ID: 1323089 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Eye pruritus, Skin warm, Throat tightness
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies: Allergy to peanuts & dairy in the past with prior anaphylaxis events. Mother and patient carry EpiPens.
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Slight throat tightness and itchy eyes about 15 minutes after vaccination. Slight cheek warmth without rash or hives. Benadryl 50 mg PO administered with mother''s consent. Symptoms did not progress and slowly resolved over a 1 hour observation time at CVC. No SOB, wheezes, tongue thickness, or hives at any time. BP, pulse, O2 sats were all normal. Initial BP - 118/78, pulse-84, O2 sat - 99%. No orthostasis at dismissal. Home with mother with precautionary instructions.


VAERS ID: 1323095 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821286 / 1 LA / IM

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

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

Write-up: Post vaccination seizure and loss of consciousness


VAERS ID: 1323134 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / UNK LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Patient stated he has had similar reactions to prior vaccinations
Other Medications: not stated on vaccination form
Current Illness: not stated on vaccination form
Preexisting Conditions: not stated on vaccination form
Allergies: not stated on vaccination form
Diagnostic Lab Data: Not known
CDC Split Type:

Write-up: Patient fainted after receiving Janssen Covid 19 vaccination while sitted for the mandatory 15 minutes observation time. Patient slumped on the chair. Patient was helped to the floor, wet paper towel placed on his head and he became conscious. We immediately dialed 911 for emergency help. Ambulance arrived shortly after and he was transported to the hospital .


VAERS ID: 1323185 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8735 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Erythema, Injection site mass, Pruritus
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Small raised, red bump that appeared immediately after injection at injection site. Patient also experienced itching and small red dots that started to appear around injection site seconds after injection. Administered 50mg po Diphenhydramine following injection. Itching subsided and no additional redness or swelling occurred.


VAERS ID: 1323203 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / UNK - / -

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

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

Write-up: Patient complaints of dizziness and anxiety which resolved over time. Patient was given water to hydrate. EMS evaluated patient. Patient felt better after hydration.


VAERS ID: 1323246 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-15
Onset:2021-05-17
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 043A21A / 1 LA / IM

Administered by: School       Purchased by: ?
Symptoms: Pain in extremity, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Tendinopathies and ligament disorders (broad)

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

Write-up: Pain and swelling under left arm and towards left breast.


VAERS ID: 1323265 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001C21A / 1 RA / SC

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: n/a
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: unknown
Diagnostic Lab Data: Pt was observed double the standard length of time
CDC Split Type:

Write-up: A medical assistant at our facility provided Moderna vaccine to a 12 y/o minor child


VAERS ID: 1323290 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-08
Onset:2021-05-17
   Days after vaccination:39
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006M20A / 1 LA / IM

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

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

Write-up: Vaccine administered to person <18 years of age.


VAERS ID: 1323308 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821286 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cold sweat, Feeling hot, Headache, Hyperhidrosis, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), 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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: pt received shot at 1107am at 1110am pt started feeling sweaty/claimy an severe headache, pt asked to wait a few before calling 911, we gave pt a wet paper towel and boyfriend purchased a water to possible give benadryl, at 1112am pt started feeling hot, and felt like throat closing, we called 911 at that time and monitored symptoms pt wasnt running a fever and no rash around injection site, ems and fire arrived and checked vitals all checked out ok we advised we could give a benadryl pt said they had some at home and would just take at home, pt refused to be transfered to hospital so we all signed off on ems sheet and pt left with parent and boyfriend.


VAERS ID: 1323378 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: New Mexico  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 - / IM

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

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

Write-up: 5 minutes after receiving vaccine, patient stated he didn''t feel so good. Lost color in face and then fainted. Pt layed on floor for 5 minutes. A wet cloth was placed in forehead. Pt came back to feeling better then sat up on floor for a few minutes then sat in chair. Pt drank a bottle of water and called his brother for a ride.


VAERS ID: 1323415 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022C21A / 1 LA / IM

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

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

Write-up: While the patient was sitting in the waiting area, she passed out and began displaying signs of seizing, making nonverbal noises and convulsing. She quickly regained consciousness after approximately 1 minute of lost consciousness. The pharmacist on duty then asked the patient if she had eaten and drank today, to which she responded that she had not. The pharmacist then provided a granola bar and water. The pharmacist also took the patient''s blood pressure, measuring 92/58 mmHg with a pulse of 60 bpm. She then took a second reading 5 minutes later, measuring 112/68 mmHg. The patient quickly recovered and was able to leave without further medical attention.


VAERS ID: 1323471 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / SYR

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

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

Write-up: I haven?t had my period in well over a year with absolutely no spotting. I received my vaccine this morning around 6/6:30 am. I have no idea the name of the clinic we were at. When I came back to my room around 12 pm I noticed I had started my period which is highly unlikely it would happen on its own as I?ve had my iud for over a year and it has completely stopped my period until the day I received my vaccine.


VAERS ID: 1323473 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dyspnoea, Pharyngeal paraesthesia, Throat irritation
SMQs:, Anaphylactic reaction (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad)

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

Write-up: Parent mother reported to staff, patient experiencing throat tingling, itchiness and mild SOB while in the observation area around 0909. Per patient symptoms started approx 15-20 post vaccine administration. Patient was brought back to triage area. 0910: VS BP 110/80, HR 63, Temporal temp 98.3 F, 100% RA. Monitoring continued, MD and mother at bedside. Patient given benadryl 25mg per MD order and water. Patient reported symptoms improved after medication administration. 0920: Vitals BP 111/74 HR 57 Temporal temp 98F, 98% RA. Per patient SOB resolved. Throat itchiness and tingling improving. Leader discussed with mother regarding second dose. MD continued to monitor and patient discharged from triage at 0940 with mother per MD.


VAERS ID: 1323522 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-05-13
Onset:2021-05-17
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Oropharyngeal pain
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (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: Pt''s mom says he has had fatigue, sore throat, since receiving the vaccine, has been given tylenol but says it has not helped
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: sore throat, fatigue starting the day after administration, still ongoing


VAERS ID: 1323544 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 RA / IM

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

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

Write-up: Patient friend called out the nurse, upon the nurse arrival patient was already unconscious. Ammonia placed under the nose by the nurse and patient regained consciousness. Paramedic is assessing patient at this time. Patient is now alert and oriented.


VAERS ID: 1323607 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 1 LA / IM

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

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

Write-up: Pt had an episode of vomitting while sitting down in the observation hall. She was taken to a cubicle inside the hall for further observation. The stomach content w as mainly water and undigested food particles. Pt. remained A&O x4 and verbal. She c/o no pain, dizziness or respiratory distress. V/S obtained was b/p 121/81, rr16, Hr. 97, temp 96.9, O2 98% RA.At 12:50 p m Pt.said she felt well and ready to go home. She left unassisted in the company of her mom.


VAERS ID: 1323647 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0165 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Chest pain, Dysphagia, Syncope, Throat tightness, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Angioedema (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (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), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Allergic: Difficulty Swallowing, Throat Tightness-Mild, Systemic: Chest Tightness / Heaviness / Pain-Mild, Systemic: Fainting / Unresponsive-Medium, Additional Details: Patient waited 15 minutes after receiveing vaccine and felt fine, on the drive home the patient says she had some difficulty swallowing water that caused pain in her chest, then passed out momentarily, patient returned to the pharmacy where we checked her BP which was 107-67, patient mom was on the phone with her physician, monitored the patient for additional 10 minutes and patient said she felt well enough to return home. Gave patient chocolate bar since she had not eaten anything.


VAERS ID: 1323676 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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 she had a rapid onset of feeling dizzy and Nausious. The patient was laid supine on the floor and assisted py paramedics. Responded, Patients father signed AMA via hospital. Patient released to father.


VAERS ID: 1323678 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-16
Onset:2021-05-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 1 LA / SYR

Administered by: School       Purchased by: ?
Symptoms: Chest discomfort, Nausea
SMQs:, Anaphylactic reaction (broad), 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: None known
Current Illness: None
Preexisting Conditions: None
Allergies: None known
Diagnostic Lab Data:
CDC Split Type:

Write-up: Nausea and tightness in chest next day. Tightness is felt when relaxing and worsens when breathing deeper.


VAERS ID: 1323714 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-04-07
Onset:2021-05-17
   Days after vaccination:40
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Exposure during pregnancy
SMQs:, 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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Allegra, prenatal vitamins
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: 05/17/2021
CDC Split Type:

Write-up: 2 months pregnant at the time of vaccine. Babies brain is not developing properly and miscarriage is expected.


VAERS ID: 1323730 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 1 RA / IM

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

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

Write-up: NAUSEA/VOMIT


VAERS ID: 1323760 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-04-06
Onset:2021-05-17
   Days after vaccination:41
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 AR / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Anembryonic gestation, Exposure during pregnancy
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Termination of pregnancy and risk of abortion (narrow)

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

Write-up: Pregnancy that ended in blighted ovum. Vaccine given right about time of fertilization.


VAERS ID: 1323767 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: West Virginia  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 LA / IM

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

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

Write-up: Patient was walking in the store, said she started feeling anxious and light headed and began to feel like she was going to pass out. The manager came and got me and we went to her. She was seated and I gave her water. After about 10 minutes she said she felt better and said she wanted to leave. I walked her to her car, helped her load her groceries in the car and she left with her sister. An incident report was written by store management


VAERS ID: 1323768 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Oklahoma  
Vaccinated:2021-05-16
Onset:2021-05-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7534 / 1 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Chest discomfort
SMQs:, Anaphylactic reaction (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: Cymbalta 30mg, Flonase OTC
Current Illness: Inpatient treatment for mental health - depression/anxiety/suicidal ideation
Preexisting Conditions: No
Allergies: None known
Diagnostic Lab Data:
CDC Split Type:

Write-up: Woke up and said it felt like an elephant on his chest, still had heavy pressure at 11.. Went to pediatrician - spirometry and heart basics, BP and pulse ox okay. Prescribed albuterol in hopes it would help in a few days. Took first dose at 1pm and feels slightly better.


VAERS ID: 1323785 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 1 LA / IM

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

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

Write-up: Post vaccine pt became dizzy and lightheaded. Pt transferred to med obs via wc. Pt reports immediately feeling better after sitting down on litter. Vitals obtained and monitored. Pt had no complaint of chest pain. Pt had no complaint of SOB. Pt released at 14:10. Vitals as follows: 1359 SITTING BP 116/67 HR 62 RR 16 SpO2 98% 1410 STANDING BP 119/79 HR 62 RR 16 SpO2 98%


VAERS ID: 1323792 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Levetiracetam 500mg one tablet twice a day
Current Illness: none
Preexisting Conditions: seizures
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: PATIENT HAD BEEN ON CHAIR MONITORING FOR 14 MINUTES WHEN SHE FAINTED. NOT CERTAIN IF SHE HAD A SEIZURE. HOSPITAL WAS CALLED TO THE SCENE AND SHE WAS TRANSFERRED TO HOSPITAL FOR OBSERVATION. PHARMACIST SPOKE TO PATIENT''S MOM THIRTY MINUTES LATER AND SHE WAS ENROUTE. MOM STATED SHE WAS DOING OKAY.


VAERS ID: 1323799 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-01-23
Onset:2021-05-17
   Days after vaccination:114
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029L20A / 1 UN / IM

Administered by: Public       Purchased by: ?
Symptoms: Acute myocardial infarction, Cardiac failure congestive, Dyspnoea
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (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? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Admitted CHF and NSTEMI, CC SOB


VAERS ID: 1323841 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 023C21A / 1 - / IM

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

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

Write-up: Given to pt who is 16 years old. No adverse side effects noted. Pt received counseling from RN and Pharmacist.


VAERS ID: 1323859 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007C21A / 1 RA / IM

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

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

Write-up: Patient is 16 years old and received Moderna COVID vaccine, which is only approved for ages 18 and above. I have contacted the manufacturer who states: If the patient received the 1st dose between 16-17 years of age, it will be considered off-label use and the patient can still receive the 2nd dose 28 days later. If the patient is below 16 years of age, the patient cannot receive the second dose. Case # is MOD21-091150. No reaction noted as of today. Doctor on site notified.


VAERS ID: 1323861 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-05-01
Onset:2021-05-17
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 1 - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: Patient did not have any breakfast
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient said she had no breakfast today, felt dizzy and nauseous


VAERS ID: 1323908 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014C21A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: NA
CDC Split Type:

Write-up: Patient presented to off-site vaccine clinic with parent. Had signed consent to receive Moderna vaccine. RN administered Moderna vaccine (1st dose) before verifying patient was over 18 years of age. Patient is only 17 years old. Contacted Moderna and they deemed this as off-label use and advised patient could get second dose at routine interval. Patient waited for 15 minutes after administration without any adverse reactions noted.


VAERS ID: 1323930 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0117 / 1 LA / SYR

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

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

Write-up: client received first dose of pfizer covid 19 vaccine. walked over to recovery area and passed out.


VAERS ID: 1323933 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood pressure decreased
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Benadryl 25mg
Current Illness: none
Preexisting Conditions: none
Allergies: Unknown
Diagnostic Lab Data: None available
CDC Split Type:

Write-up: Patient''s blood pressure dropped to 60/40 with a pulse of 50 initially, then she was given Benadryl 25mg ie 1 tab with half a glass of water, she rested for a few minutes and we checked her blood pressure a second time which read 70/49 with a pulse of 55. We offered the Patient EpiPen and to call 911, but she refused. However, we provided the Patient an EpiPen 0.3mg to take home and instructed Patient''s father on how to use it. We confirmed with Patient that her breathing was fine, she had no difficulty in breathing. Patient was fine when they left to go home.


VAERS ID: 1323943 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039B21A / 1 LA / IM

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

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

Write-up: 16yo F was vaccinated. No adverse reaction related to this event.


VAERS ID: 1323957 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 LA / IM

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

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

Write-up: Patient received the Janssen COVID vaccine on 5/17/2021 around 1513. Prior to vaccine administration during prescreening questions, the client reported "I have a history of passing out after vaccines because I have to have monthly vaccines in my leg for headaches and I hate them" Client was taken to another room with a reclining seat to lay down during vaccine administration. She remained in the supine position for several minutes afterwards and after reporting she felt fine was changed to the sitting position for several minutes and again reported feeling fine. Patient was then changed to standing, reported she felt fine and ambulated to the waiting area, escorted by an RN assistant to be observed for 15 minutes by the EMS provider on site. Soon after, patient appeared to be having a syncopal episode. EMS provider on site called 911 to transport patient to the nearest hospital.


VAERS ID: 1323977 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0158 / 2 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Anticoagulant therapy, Chest pain, Computerised tomogram thorax abnormal, Deep vein thrombosis, Intensive care, Pulmonary embolism, Ultrasound Doppler abnormal
SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: norgestimate-ethinyl estradiol, ferrous sulfate
Current Illness: none
Preexisting Conditions: iron deficiency anemia, prolonged uterine bleeding
Allergies: none known
Diagnostic Lab Data: ultrasound of R leg with DVT Chest CT with bilateral pulmonary emboli
CDC Split Type:

Write-up: Presented with acute onset chest pain, found to have right lower extremity DVT and bilateral PEs. Required short stay in ICU for close monitoring given clot burden in her lungs. Required heparin infusion and then transitioned to lovenox for home-going therapy.


VAERS ID: 1324006 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Throat irritation
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow)

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

Write-up: The patient received her vaccine at 12:06pm. At around 12:40-12:45 she came back to the pharmacy complaining of her throat feeling strange. She was talking fine with no physical symptoms other than that complaint. She was given 2 teaspoonfuls of Benadryl and was monitored for 30 minutes. At her time of departure she said she was feeling better and was okay to go home. Her mom bought more Benadryl prior to leaving.


VAERS ID: 1324008 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-05-16
Onset:2021-05-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Balance disorder
SMQs:, 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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Zyrtec, Fluticasone Propionate Nasal Spray, EpiPen, Albuterol
Current Illness:
Preexisting Conditions: Asthma, Allergies to peanut, shell fish, and seasonal
Allergies: Allergies to food
Diagnostic Lab Data:
CDC Split Type:

Write-up: Cannot keep balance


VAERS ID: 1324014 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0170 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: birth control
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: none
Diagnostic Lab Data: BP WAS 96/62 AND PULSE WAS 64 BEFORE LEAVING
CDC Split Type:

Write-up: PATIENT PASSED OUT IN DAD''S ARMS, CAME TO WHEN WE LAID HER DOWN SWEATINESS AND DIZZINESS RESOLVED ON ITS OWN


VAERS ID: 1324022 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: South Dakota  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821286 / 1 RA / IM

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

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

Write-up: Patient administered after punctured vial sterility Beyond Use date/time


VAERS ID: 1324024 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / N/A LA / IM

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

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

Write-up: PATIENT BRIEFLY FAINTED. CONSUMED 20 OZ SODA AND WATCHED FOR ADDITIONAL 15 MINUTES AND RELEASED.


VAERS ID: 1324042 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Zyrtec at home. Benadryl at injection clinic
Current Illness: n/a
Preexisting Conditions: exercise induced asthma, anaphylaxis following allergy immunotherapy, allergic rhinitis
Allergies: Pollen
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: 5 minutes after receiving covid vaccine shot felt itchiness on injection site, left arm. 5 minutes later felt itchiness on right shoulder and arm. Monitored VS. Pt''s mother & doctor at the bedside. 25 mg PO Benadryl given. pt discharged home per MD''s order.


VAERS ID: 1324045 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 - / IM

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

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

Write-up: patient fainted. smelling salts used, cold pack to neck area and pt put in lying position with feet up


VAERS ID: 1324070 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Eye movement disorder, Pallor, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Patient became very pale eyes rolled behind head and was unable to keep head up. Fainted for a few seconds before waking up again.


VAERS ID: 1324075 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / IM

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

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

Write-up: Vaccine mixed with too little diluent


VAERS ID: 1324078 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022B21A / 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? 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: N/A
CDC Split Type:

Write-up: Patient (15 yo) was given Moderna vaccine which is only approved for 18+ yo.


VAERS ID: 1324081 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient''s guardian stated that patient''s birthdate , but when billing insurance we found that the birthday was actually, meaning the patient was 11 at time of vaccination. We called the guardian and they confirmed that they lied about the birthday.


VAERS ID: 1324090 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Pharmacist gave patient one dose of diphenhydramine 25mg (after verifying patient could swallow) tablet at 1:02 pm
Current Illness: None
Preexisting Conditions: None
Allergies: NKA
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Shortly after exiting the pharmacy, the patient''s dad came back to the pharmacy propping up his son. Stated his son got light-headed and almost fainted. The pharmacist had the patient come into the vaccine area, sat him down, and took his blood pressure (106/80). His breathing was monitored and when it checked out, the pharmacist gave a single dose of diphenhydramine 25mg. The patient drank 2 x 16oz of water. Paramedics were called as a precaution. The patient was able to walk out on his own. The pharmacist made a follow up call at 2PM and the father acknowledged that his son is doing fine.


VAERS ID: 1324095 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Dyspnoea, Hyperhidrosis, Paraesthesia
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: micronor, flexeril, fluoxetine, lorazepam, omeprazole
Current Illness: NA
Preexisting Conditions: mood disorder, smoker, anxiety
Allergies: Banana, Latex, Sulfa, tegaderm, morhphine, silver nitrate
Diagnostic Lab Data: 117/74 BP, 99 O2, Pulse 91
CDC Split Type:

Write-up: Patient stated that she was having problems breathing, sweating and felt tingling all over. She said she felt she had a tight chest. An emergency response was called and the patient blood pressure, pulse and O2 was checked and was normal. She was given an ice pack to the back of the neck and stopped sweating. Upon questioning, she had not eaten anything all day and had only drank some pepsi and milk the day. Within 20 minutes she feeling much better and said she was feeling normal again. She was checked by a provider to make sure everything was ok.


VAERS ID: 1324118 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: hx. of syncope with vaccines, do not recall which vaccine
Other Medications: on medications but unknown at this time
Current Illness: depression and anxiety
Preexisting Conditions:
Allergies: NKDA
Diagnostic Lab Data: Vital signs
CDC Split Type:

Write-up: Immediately after receiving vaccine, pt had a syncopal event with brief LOC. Caught by medical staff and lowered to the ground - placed supine with legs elevated. Pt quickly regained consciousness and was alert and oriented x3. Has a history of syncope with vaccines and medical procedures. Dad present. Vital signs obtained and noted to be WNL HR 84 NSR Spo2 98% on room air B/P 123/61 laying down 118/62 sitting Pt hydrated with juice and was able to sit up and ambulate freely. Stayed for an additional 15 minute of observation without incident and left for home with dad.


VAERS ID: 1324136 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-05-16
Onset:2021-05-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Confusional state, Nausea, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Methadone 100mg
Current Illness:
Preexisting Conditions:
Allergies: All antihistamines
Diagnostic Lab Data:
CDC Split Type:

Write-up: (@ hr 12 Nausea, Fever) (@ hr 24 Mental Confusion) The mental confusion was concerning enough to prompt this report. I could not remember where I got the vaccine. I could not remember where my son lived. Once a friend reminded me I remembered but still struggled with details for about one and one half hour.


VAERS ID: 1324141 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Muscle rigidity, Pallor, Seizure, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Parkinson-like events (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

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 known
Current Illness: None known
Preexisting Conditions: Previous incidence of seizures but has been seizure free for approximately 5 years
Allergies: None known
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: Patient received the vaccination. Approximately 20 seconds after receiving the dose patient said "I''m going to faint''. Patient appeared to faint but also appeared to be having a seizure. The patients legs appeared to go rigid and he make movements with his arms. He appeared very pale. The patient "came to" within approximately a minute? Patients mother and I were able to lay Patient down on the floor. I asked his mother if she would like us to call 911 and she said yes. Prior to the incident, I discussed Patients past history of seizures with his mother. She sail he had seizures when he was younger and had been on medication, but he was no longer on any medication and had been seizure free for approximately 5 years.


VAERS ID: 1324164 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / N/A LA / IM

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

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

Write-up: Patient immediately felt dizzy and fainted a few minutes after getting the vaccine. She had to lay down on the ground to prevent falling.


VAERS ID: 1324171 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821286 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dyspnoea, Fall, Head injury, Loss of consciousness, Nausea, Seizure
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

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

Write-up: Patient felt nausea and could not breath so he stood up and took a breath. When he stood up he lost consciousness and fell. Patient hit his fore head and started having a seizure. The seizure lasted about 1-2 minutes before he regained consciousness. Patient was taken away by the EMS


VAERS ID: 1324187 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cold sweat, Dizziness, Dyspnoea, Hyperhidrosis, Pallor, Tinnitus, Vision blurred
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Glaucoma (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Hearing impairment (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: VENTOLIN HFA 90 mcg/actuation Inhl HFAA SHAKE WELL AND INHALE 2 PUFFS PO EVERY 4 HOURS AS NEEDED FOR SOB OR WHEEZING OR COUGH. 100 DAYS SUPPLY FOR ASTHMA IS 1 CANISTER (18 G). USE WITH SPACER DEVICE IF PRESCRIBED inhaler, assist devices (AE
Current Illness: none
Preexisting Conditions: INTERMITTENT ASTHMA
Allergies: none
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Patient received in RN triage area, post-COVID vaccination administration. Patient being observed for 15 minutes as recommended per CDC guidelines and facility policy on post-vaccination RN monitoring. Patient sitting in chair and reported feeling dizzy/lightheaded, blurred vision, ringing in the ears, patient noted pale, clammy, and diaphoretic, patient reporting feeling short of breath. Rapid response called. 14:05 Vitals: 75/34, HR: 54, 97% Patient placed on gurney, in the supine position. Patient and mother denies adverse reactions to vaccinations in past. Denies any medical history besides asthma. 14:10 Vitals: Bp: 105/53, Hr 83, 100% on 2L. Patient now denies any dizziness/lightheadeness, blurred vision, ringing in ears, and shortness of breath. 14;15 BP109/65, HR: 72, O2: 100%. COVID vaccination fact sheet and discharge information provided to patient on D/c from clinic, patient advised to review. Verbalized understanding. Appointment for 2nd COVID vaccination provided to patient. All questions and concerns addressed. Advised to follow up as needed. Patient departed with mother at 1435 symptom free.


VAERS ID: 1324196 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Minocycline
Current Illness: None known
Preexisting Conditions: None known
Allergies: NKDA
Diagnostic Lab Data: Blood pressure 129/86 mmHg O2 sats 98%
CDC Split Type:

Write-up: Patient received shot from our technician and immediately began to lose conciseness. He never fully lost conciseness, but was very pale and began sweating. Patient was moved for the chair to the floor. He was given orange juice and 911 was called by the staff pharmacist. After about 10 - 15 minutes, patient began to return to normal color and sweating had stopped. First response arrived, checked vitals, and patient left with his mother, who was present throughout the event. Patient declined ambulance transport.


VAERS ID: 1324201 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8736 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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 fainted about 30 seconds after the vaccination. She regained herself after about 5 seconds.


VAERS ID: 1324214 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 1 LA / IM

Administered by: Unknown       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? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient complained of feeling lightheaded and dizzy. EMT called and vital signs stable. BP 92/50 HR 77. Patient refused stated she was feeling better and refused to transport to hospital.


VAERS ID: 1324227 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: New York  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821286 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Confusional state, Dizziness, Hyperhidrosis, Pallor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: 10 minutes following vaccine patient became confused, sweating, pale and dizzy, lasted 10-15 minutes and then resolved without treatment.


VAERS ID: 1324234 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Nausea, Vision blurred
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Lens disorders (broad), Retinal 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: n/a
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: n/a
Diagnostic Lab Data: Contacted 911, patient was feeling better by the time EMTs got here.
CDC Split Type:

Write-up: Patient was experiencing chest tightness, vision was fuzzy, felt nauseous.


VAERS ID: 1324256 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1820095 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Peripheral swelling, Seizure, Skin discolouration
SMQs:, Cardiac failure (broad), Angioedema (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

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

Write-up: LIGHT HEADEDNESS, THEN SEIZURE FOR ABOUT 10 SECONDS. WE CAUGHT PATIENT AND LIED HIM ON THE FLOOR AND TURNED PATIENT ON A SIDE, ARM WAS SWELLING AND TURNED ORANGE. PATIENT WAS CONCIOUS, EMT ARRIVED AND TOOK HIM TO THE HOSPITAL.


VAERS ID: 1324285 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: New Hampshire  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: HPV - FELT DIZZY / FAINTED
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: NONE
Diagnostic Lab Data: NOT APPLICABLE
CDC Split Type:

Write-up: PATIENT FELT DIZZY. I KEPT HER AWAKE. SHE FELT A LITTLE NAUSEATED ALSO. CALLED 911 TWICE. BY THE TIME 911 PEOPLE SHOULD UP 20 MINUTES LATER, PATIENT WAS DOING FINE AND WALKED OUT WITH THE 911 PERSONNEL.


VAERS ID: 1324287 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821286 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anxiety, Condition aggravated, Dizziness, Fatigue
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

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

Write-up: Felt dizzy and light headed after vaccine. Did not want to take BP due to increasing anxiety. Anxiety before the vaccination. Stayed in store for 30 minutes. I called the patient back at 5:00pm; he stated he was felling fine minus some fatigue.


VAERS ID: 1324288 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0175 / 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? 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: NA
CDC Split Type:

Write-up: Syncope 5 minutes after the vaccination


VAERS ID: 1324316 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Feeling hot, Nausea, Retching
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

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

Write-up: Pt became nauseated about 5 minutes after receiving her first dose of the Pfizer vaccine. She dry-heaved about 3 times but did not vomit. She stated that she also felt hot so was given two ice packs. She had only eaten a handful of snacks that morning. Denied dizziness or lightheadedness. BP 110/72, pulse 64 bpm. After 5 minutes she stated that she was feeling better. Pt left after 15-minute observation period with symptoms resolved


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