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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 144 out of 3,524

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VAERS ID: 1326699 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1820095 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Condition aggravated, Confusional state, Dizziness, Flushing, Hyperhidrosis, Injection site pain, Pain in extremity
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Vestibular disorders (broad), Hypersensitivity (broad), Tendinopathies and ligament 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: Site: Pain at Injection Site-Mild, Systemic: Confusion-Mild, Systemic: Dizziness / Lightheadness-Mild, Systemic: Flushed / Sweating-Mild, Systemic: Weakness-Mild, Additional Details: Pt told us she tends to faint when she gets shots. gave her the janssen shot and in 5 mins she told us she was about to faint. she became confused and started walking. technican went after her and she layed on the ground. called 911. took her bp. told them she did not eat today and most likely why she fainted. pt rested for additional 30mins. had some water and food. Felt better and left for home. called her back at 5pm to follow up. states she is feeling better just a sore arm.


VAERS ID: 1326707 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Body temperature increased, Headache
SMQs:, Neuroleptic malignant 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: 250mg vitamin C, 50mcg vitamin D, 18mg iron
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: elevated temperature, headaches


VAERS ID: 1326713 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: New York  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045B21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Chills-Mild, Systemic: Dizziness / Lightheadness-Mild, Systemic: Fainting / Unresponsive-Mild, Systemic: Flushed / Sweating-Mild


VAERS ID: 1326723 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-05-15
Onset:2021-05-17
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 2 RA / SYR

Administered by: School       Purchased by: ?
Symptoms: Balance disorder, Dizziness, Dizziness postural, Vertigo
SMQs:, Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Vestibular disorders (narrow)

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

Write-up: As of the second day after the shot, I am experiencing vertigo symptoms. Lightheaded when standing quickly, head feels like its "swimming" when I am walking around, balance is off, feels as though the room may start spinning at any moment. Never felt like this before in my life.


VAERS ID: 1326740 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037C21A / 1 LA / IM

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

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

Write-up: Patient fainted after receiving his first dose of the Moderna vaccine. He was very nervous and breathing hard before the vaccine because he is afraid of needles. After receiving his vaccine he was standing in the vaccine area with the woman he was with. The woman was also receiving a vaccine. He was still very nervous about needles and I suggested that he wait in the post-vaccination area so he didn''t have to witness the woman receiving her vaccine. While walking to the post-vaccination area the patient fainted. After fainting he woke up right away. Another pharmacist and a technician immediately went to check on him and assist him. Patient thinks that he fainted because of his fear of needles.


VAERS ID: 1326759 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033C21A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033C21A / 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: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: UPON SUBMITTING THE VACCINE (AFTER ADMINISTRATION) IT WAS DISCOVERED THE PATIENT WAS UNDERAGE TO RECEIVE IT.


VAERS ID: 1326763 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033C21A / 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: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: UPON SUBMITTING PAPERWORK FOR VACCINE (AFTER ADMINISTRATION) IT WAS DISCOVERED THE PATIENT WAS UNDERAGE


VAERS ID: 1326765 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 1 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Erythema, 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:
Current Illness:
Preexisting Conditions:
Allergies: Hives with codeine & APAP
Diagnostic Lab Data:
CDC Split Type:

Write-up: Redness to chest & itchy all over. Pt has history of hives with codeine, tylenol. BP 120/79; HR94; RR 20. Pruritis resolved 20 minutes after Benadryl given


VAERS ID: 1326772 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 14 year old received Janssen Covid 19 vaccine when current approval is only for 18 years and older.


VAERS ID: 1326784 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 1 LA / IM

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

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

Write-up: Pt DOB 1/1/1988. Pt in post observation post 1st dose of Pfizer vaccine. Pt states feeling dizzy while climbing the stairs. Pt states she was able to eat her breakfast. Pt states that the room is rotating. Client was given water and juice, O2 sat and pulse were obtained by RN and EMS was called by RN. EMS evaluated Pt. EMS released Pt from care and d/c home. Client stood up and states that she "feels better" and is no longer dizzy. Husband states he will drive Pt home.


VAERS ID: 1326790 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 LA / IM

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

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

Write-up: 12 year old received Janssen Covid 19 vaccine when current indication is only for 18 years and older. patient has no side effects so far


VAERS ID: 1326807 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Female  
Location: West Virginia  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 1 LA / IM

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

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

Write-up: NONE REPORTED


VAERS ID: 1326811 (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: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 2 LA / 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Around 10-15 minutes after receiving 2nd dose of Covid vaccine, pt complained of feeling dizzy/nauseous and having lightheadedness. She had a brief moment of blackouts. 911 was called and she was transferred to the hospital.


VAERS ID: 1326850 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8735 / 2 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Anxiety, Hyperhidrosis
SMQs:, Neuroleptic malignant syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Sweating, anxiety. BP 136/83, HR 95, RR 18. Provided with water, juice & crackers, tolerating well. Patient stable 30 minutes after vaccination & released from vaccination site


VAERS ID: 1326852 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH PAA165969 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Cold sweat, Dizziness, Feeling hot
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: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: monitored blood pressure and pulse ox. BP was 152-93 and 167-92 pulse ox was 98%
CDC Split Type:

Write-up: patient became very dizzy and light headed about 5 minutes after receiving vaccine. She also felt hot and clammy.


VAERS ID: 1326856 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: seizures - other vaccines not given here but stated a history of seizures when gets vaccines
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: none
CDC Split Type:

Write-up: When patient filled out the form she stated that she tended to have seizures with immunizations. About 3 minutes after the Covid immunization she did have a light seizure.


VAERS ID: 1326877 (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: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: ACNE FAMILY DISRUPTION, OTHER EXTENDED ABSENCE OF FAMILY MEMBER
Preexisting Conditions: NA
Allergies: NKA
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: This writer witnessed patient having a syncopal event on the chair she was sitting in. With the assist of other health care team, patient was immediately put on the gurney and bed was placed in reverse Trendelenburg so that blood could flow to her brain. Pt immediately became alert and was able to tell us her name. VS were taken and BP was 108/75 and heart rate 76. patient was immediately taken to the emergency room for further care.


VAERS ID: 1326937 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-04-01
Onset:2021-05-17
   Days after vaccination:46
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / IM

Administered by: Private       Purchased by: ?
Symptoms: Angiogram pulmonary abnormal, Coagulation test, Echocardiogram, Immunology test, Pulmonary embolism
SMQs:, Embolic and thrombotic events, venous (narrow), Pulmonary hypertension (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? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Crestor, Flomax, losartan-HCTZ, Zyrtec
Current Illness: None
Preexisting Conditions: Hypertension, hyperlipidemia, and BPH
Allergies: hydrocodone
Diagnostic Lab Data: CTA, Echocardiogram, HIT assay, hypercoagulable work-up
CDC Split Type:

Write-up: Pulmonary embolism


VAERS ID: 1326943 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: New York  
Vaccinated:2021-05-16
Onset:2021-05-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lisinopril naproxen sodium
Current Illness:
Preexisting Conditions: High blood pressure
Allergies: Codeine
Diagnostic Lab Data:
CDC Split Type:

Write-up: Slight fever body aches and pains


VAERS ID: 1326949 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Chills, Fatigue, Headache, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Low grade fever, fatigue around 4pm. 630pm fever 103.2 degrees F. Tylenol 1000mg administered. 930pm- temp 104.9?600mg ibuprofen administered. 9:45pm tmax 106.6 & cold therapy to bring down temp. Fever broke between midnight 5/18 (100.2-Tylenol 1000mg again) and 2am (98.7). 330am- 600mg ibuprofen again for muscle aches. During febrile state, fever accompanied with chills and muscle aches. 9am 5/18? afebrile, fatigue, slight muscle aching & headache. No nausea, vomiting or diarrhea noted.


VAERS ID: 1326950 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003C21A / 1 LA / IM

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

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

Write-up: No adverse affect. Mom filled out appointment online for herself because it would not let her book an appointment for anyone under 18. Then had her son fill out consent form and he came in with her. She did not get shot but had her son get it. He is only 17 years old. We did not realize and gave him the vaccine. We will contact md and moderna.


VAERS ID: 1326954 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8735 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Fall, Feeling hot, Hyperhidrosis, Syncope, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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 started feeling dizzy/faint right after administration, she was sweating and felt hot to the touch, then she convulsed and shot up out of her chair for a few seconds before sitting back down. As she sat back down she vomited and then seemed to get better after. 911 was called and she was better by the time they arrived and blood pressure and vitals where all good.


VAERS ID: 1326969 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-02-14
Onset:2021-05-17
   Days after vaccination:92
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026L20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004M20A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: PMH OF ADVANCED ALZHEIMER''S DEMENTIA, 2ND DEGREE AV BLOCK W/PACEMAKER, HTN, HLD
Allergies:
Diagnostic Lab Data: POSITIVE SARS-COV-2 BY PCR FROM SPECIMEN COLLECTED 5/17/2021
CDC Split Type:

Write-up: ADMITTED TO HOSPITAL AFTER PRESUMED FALL, FOUND TO BE POSITIVE FOR COVID-19 ON ADMISSION. NOTED TO BE ASYMPTOMATIC CURRENTLY.


VAERS ID: 1326970 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031B21A / 2 LA / IM

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

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

Write-up: Onset approx. 12 hours post vaccine. dizziness, fever, achiness, nausea- (about 18 hours post vaccine), headache


VAERS ID: 1326980 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Headache, Nausea, Sleep disorder, 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:
CDC Split Type:

Write-up: Severe nausea and vomiting night of second vaccination, headache, cannot sleep


VAERS ID: 1327017 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Nasal congestion, 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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Sore throat and nasal congestion


VAERS ID: 1327019 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-15
Onset:2021-05-17
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001C21A / 2 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Chills, Injection site erythema, Injection site pain, Injection site pruritus, Injection site warmth, Pain
SMQs:, Extravasation events (injections, infusions and implants) (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Nortel 1/35-28 Cetirizine 10mg Cranberry 500mg Renew Life Women''s Care Probiotic 90 billion One A Day Women''s multivitamin
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: Codeine Mushrooms Papaya Walnuts
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: 05/16/2021: (1) occasional mild itching at and around injection site, (2) substantial soreness of injection are to touch and upon movement, (3) chills, (4) full body aches 05/17/2021 (1) occasional mild itching at and around injection site, (2) approximately 3 inch by 4 inch area of redness of skin around injection site and red skin area hot to the touch


VAERS ID: 1327152 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003C21A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dizziness, Vomiting
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: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Client was vaccinated with the Moderna vaccine at 1600, around 1605 while waiting in the observation area, the client vomited once and experienced some dizziness. EMS attended to client, and an ambulance was called. Vital signs were all WNL. After laying down for 15 minutes the client felt well and denied EMS transport to the hospital. Client left with family member in no apparent distress.


VAERS ID: 1327189 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 RA / IM

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

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

Write-up: Patient was vaccinated at 6:00pm and told to stay at the store until 6:15pm. At approximately 6:40, while sitting in her car, she passed out. She had a friend with her that either called 911 or drove her to the emergency room.


VAERS ID: 1327193 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0161 / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Abdominal pain, Back pain
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

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

Write-up: pt. c/o of upper abdominal pain and back pain. symptoms was resolved and patient went home.


VAERS ID: 1327202 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0161 / 1 RA / IM

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

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

Write-up: c/o of fatigue after vaccine. symptoms was resolved and pt. went home.


VAERS ID: 1327223 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-18
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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt received covid shot and was waiting her 15 minutes. about 5 minutes later she fainted and an ambulance was called and took her to the hospital.


VAERS ID: 1327228 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-05-16
Onset:2021-05-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Hives on necks, chest, belly, back, groin, legs


VAERS ID: 1327242 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-05-13
Onset:2021-05-17
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022C21A / 2 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Angiocardiogram, Chest pain, Echocardiogram normal, Myocarditis, Troponin abnormal
SMQs:, Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (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? 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: Abnormal troponin. Normal echocardiogram and coronary angiogram 5/17/2021.
CDC Split Type:

Write-up: Myocarditis with chest pain, resolved after 48 hours.


VAERS ID: 1327295 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 2 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Body temperature increased, Chest discomfort, Chest pain, Hot flush, Palpitations
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: Headaches for 2 days, relieved with Tyleno.
Other Medications: Lamotripine
Current Illness: no
Preexisting Conditions: Asthma, Depression
Allergies: no
Diagnostic Lab Data: EMT took vitals: BP 150/95, HR 98, O2 99%, Temp 99.3.
CDC Split Type:

Write-up: Chest pressure/chest pain, palpitations, hot flashes. EMT called for 2nd unit to transport patient to hospital.


VAERS ID: 1327296 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: EpiPen, Flonase, Singulair, Flovent, Proair
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient observed for 30 mins no adverse reaction noted


VAERS ID: 1327327 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: California  
Vaccinated:2021-04-22
Onset:2021-05-17
   Days after vaccination:25
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047B21A / 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: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: n/a


VAERS ID: 1327332 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: New York  
Vaccinated:2021-04-19
Onset:2021-05-17
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037A21B / 1 UN / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046B21A / 2 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Atrial flutter, Computerised tomogram thorax normal, Electrocardiogram abnormal, Full blood count normal, Metabolic function test normal, Palpitations
SMQs:, Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Duloxetine 20mg daily, hctz 25mg daily, metoprolol 50mg daily, pravastatin 20mg daily
Current Illness: none
Preexisting Conditions: depression, hyperlipidemia, htn
Allergies: nkda
Diagnostic Lab Data: as above cmp/cbc normal ct chest neg for pe ekg rapid aflutter, no st changes
CDC Split Type:

Write-up: 62 yo male with a past medical history of HTN, HLD, and obesity presented to the ED on 5/17/2021 with complaints of palpitations. The patient noticed his watch stated his HR was $g 120bpm and his wife measured his HR at which time it was greater than 100bpm. He presented to the ED for further evaluation and his EKG was seen as new onset atrial flutter with RVR and HR''s ranging from 115-150bpm. He was hemostable throughout his ED stay and given PO cardizem and IV boluses of cardizem which improved his HR into the 115 range with MAP''s $g 75. He converted to sinus rhythm overnight and discharged home 5/18/2021. He denies any hx of sleep apnea. The patient otherwise denies fevers, night sweats or shaking chills recently and denies any other complaints of chest pain, dyspnea or lightheadedness. He denies any alcohol use but, and is a past smoker. He has had no new prescriptions. He has no hx of thyroid disease. He has not been diagnosed with COPD. CT chest imaging which is negative for a PE. He had covid 19 infection in 12/2020 and was not not hospitalized and recovered at home. He received his 2nd covid vaccine 4/19/2021.


VAERS ID: 1327345 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Muscular weakness, Nervousness, Tinnitus
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Hearing impairment (narrow), Hypoglycaemia (broad)

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

Write-up: On 05.17.21 patient received his first dose of the Pfizer Covid-19 vaccine (lot # EW0182 exp. 08/2022). Client''s mother signaled to EMT that they needed assistance. EMT and RN responded. Client was a 16-year-old male found sitting upright and leaning forward while alert and tracking. Client had a chief complaint of ringing ears and uneasiness. Client stated that he began to notice his ears ringing a few minutes after observation began. Client''s mother was unable to console the client prompting her to calmly wave for assistance. This was the client''s first dose of the Pfizer vaccine. He and his mother both deny any medical history, allergies, or regular medication use. Assessment revealed no hives, rashes, discoloration, swelling, shortness of breath or other signs of anaphylaxis. Client complained of unspecified uneasiness while leaning forward but exhibited no accessory muscle use. Client denied any pain throughout his body. Airway, breathing and circulation were intact. Client stated that he was "nervous" before receiving his vaccine today due to stories he had heard from his peers. Client then stated that he felt like he "couldn''t move [his] hands" despite there being no obvious range of motion compromise. Vitals at 1332 were pulse 76, O2 100%, lung sounds clear bilaterally, alert and oriented to person, place, date and event, respirations 20. Client and mother both consented to an additional 30 minutes. Client was assisted from his observation chair to a bed by EMT and mother and stayed there for the remainder of his observation. After approximately five minutes of lying down, the client stated that he felt "much better." Remaining vitals: 1337 - 118/78, O2 99%, Resp. 16, HR 76, 1349 - 110/76, HR 72, O2 99%, Resp. 16. 1402 118/78, O2 100%, HR 72, Resp. 16. Client''s mother was provided with all relevant vaccine information and instructed to seek medical attention if further concerns arise in the evening. Client denied EMS transport. Client completed his observation at 1402 and departed with his mother at 1402 in positive disposition with steady gait asking his mother if he could go out and "skate".


VAERS ID: 1327435 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-14
Onset:2021-05-17
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 1 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Pain, Pain in extremity, Paraesthesia, Pyrexia, SARS-CoV-2 test negative, Sensitive skin
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: NKA
Diagnostic Lab Data: Over the counter/self administered rapid COVID test (-), 7:30am today (5/18/2021)
CDC Split Type:

Write-up: He noted his skin was sensitive/tingly in his trunk/abdomen and that he felt a little achey when he woke up yesterday morning (5/17/2021) but nothing severe, I just assumed is was post injection soreness, he also had some left arm soreness about 18-24 hours post injection. Around 5pm yesterday (5/17/2021) he has sudden onset of fever (103 degrees) and he had just been checked for volleyball practice at 2:30pm and was afebrile. Fever continued through the night between 102 and 104 with Tylenel every 4 hours and one episode of Ibprofen. Fever down to 99 degrees by 7am this moring (5/18/2021). Did rapid COVID test from drug store and was negative. Pediatricians office said to monitor through day, call back if high fever returned and to notify VAERS.


VAERS ID: 1327441 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-05-13
Onset:2021-05-17
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Catheterisation cardiac normal, Echocardiogram normal, Magnetic resonance imaging abnormal, Magnetic resonance imaging heart, Myocarditis, Troponin increased, Ventricular tachycardia
SMQs:, Torsade de pointes/QT prolongation (narrow), Myocardial infarction (narrow), Ventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (narrow), Cardiomyopathy (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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: no
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: troponin, cardiac MRI, Echo, cardiac cath
CDC Split Type:

Write-up: Myocarditis in the setting of recent second Moderna vaccine. Troponin peaked at 9.67 and trended downward. He was taken for cardiac catheterization on 5/17/2021 and was found to have normal coronaries. He had a cardiac MRI on 5/17/2021 which was found to be positive for myocarditis. Echo completed displaying preserved EF without wall motion abnormality or Due to the episode of NSVT will start low dose metoprolol tartrate until follow up with cardiology in the outpatient setting then hopefully able to discontinue. Post procedure restrictions discussed, patient verbalized understanding. No cardiac rehab indicated.


VAERS ID: 1327488 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 LA / IM

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

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

Write-up: Two minutes after administration of J&J vaccine, patient asked this nurse for water and said, "I feel dizzy." Patient was diaphoretic and pale. Patient remained seated in chair. Felt this was for 15 minutes. His feet were elevated, cold compress to neck, fan directed at patient. Patient never lost consciousness. Took cold water and pretzels. BP at 14:57 was 104/76. Symptoms totally resolved by 1500. Patient and mother report a history of vasovagal fainting with previous blood work/exposure to needles.


VAERS ID: 1327499 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Fatigue, Headache, Injection site pain, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Fever and chills 10 hours after injection Pain at injection site immediately after Headache, fatigue, muscle soreness 24 hours after


VAERS ID: 1327516 (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: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 1 LA / IM

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

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

Write-up: @3:52pm pt c/o headache, dizziness and nausea. Pt. placed in gurney to restwith HOB elevated. V/S monitored. Vitals: 102/63 BP, P-62, RR-17, o2 - 98% RA Patient had sips of water with relief of nausea noted. Vitals monitored @4:18pm vitals BP: 100/70 , P-73, RR-17, o2 -99% RA @4:20pm - pt. verbalized recovered from symptoms. Pt. sent home. Advised to notify primary MD of recent COVID-19 S/E. #21: pt. stable and sent home


VAERS ID: 1327536 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-15
Onset:2021-05-17
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808980 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Fatigue, Headache, Injection site pain, Lymphadenopathy, Neck pain, Oral pain, Oropharyngeal pain, Pain in extremity
SMQs:, Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Extravasation events (injections, infusions and implants) (broad), Vestibular disorders (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Rosuvastatin, low dose aspirin
Current Illness: None
Preexisting Conditions: High cholesterol
Allergies: None
Diagnostic Lab Data: I did not seek any medical attention as the symptoms/effects from the vaccination appear to be within the normal range and are resolving.
CDC Split Type:

Write-up: Immediately after injection significant arm pain that resolved quickly. Approximately 36 hours after injection dizziness. 48 hours after injection neck and head pain on left side, arm soreness, and swollen lymph node on left side of throat. Minor pain in mouth and throat with fatigue and dizziness. Neck and head pain decreasing on day 3 with all other effects resolving but injection site is still fairly sore. Overall, I would say this was probably a normal response associated with my immune system reacting to the injection. I had the virus the first week of December 2020. I would classify my infection as moderate. I was sick with fever, chills and severe body aches and it lasted for 10-14 days.


VAERS ID: 1327543 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-05-16
Onset:2021-05-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: Itchy rash on parts of my arm


VAERS ID: 1327594 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 AR / IM

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

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

Write-up: Patient under age 12 was vaccinated with Pfizer, which is a vaccine error. Troubleshooting: Scribe and vaccinator indicated that the father stated she is "almost 13" and that the DOB in our registration system is incorrect. Per the contractor, father "would not allow" the vaccinator to talk with his daughter. Reported at the direction of the medical director.


VAERS ID: 1327628 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-04-13
Onset:2021-05-17
   Days after vaccination:34
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029A21A / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041B21A / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Anticoagulant therapy, Condition aggravated, Pulmonary embolism
SMQs:, Embolic and thrombotic events, venous (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Cialis, hydrochlorothiazide, losartan, aspirin, ibuprofen as needed, melatonin, fish oil, glucosamine
Current Illness:
Preexisting Conditions: hypertension, peripheral vascular disease, degenerative joint disease, history PE s/p spine surgery
Allergies: penicillin, bactrim
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient admitted 5/17/21 with new PE. Placed on blood thinner and discharged 5/18/21.


VAERS ID: 1327649 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Nervousness
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: Systemic: Dizziness / Lightheadness-Mild, Additional Details: patient was very nervous about shot, after shot she got lightheaded, so we had her lay down with feet up, she did fine bp normal and hr 82, after laying down she felt better, had her sit up in chair, when she left felt ok


VAERS ID: 1327660 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-05-14
Onset:2021-05-17
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: pred forte 1% , ketorolac 0.5% opht and ofloxacin opht 0.3%
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: NKDA
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: rash on face, neck and arms


VAERS ID: 1327682 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002C21A / 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: Albuterol, Guanfacine, m-dryl, Metformin, and Vitamin D3.
Current Illness: unknown
Preexisting Conditions: Diabetes and obesity.
Allergies: Unknown
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Due to a paperwork error, patient was given the Covid-19 vaccination, Moderna. She is only 13 years old and the vaccine is not approved for under 18. Patient is not exhibiting an adverse reaction or any symptoms on this date.


VAERS ID: 1327694 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031B21A / 2 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Aphonia, Chest pain, Erythema, Headache, Loss of consciousness, Pain, Respiratory arrest, Swelling face, Throat tightness
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Angioedema (narrow), 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), Acute central respiratory depression (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), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (narrow), Respiratory failure (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? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Metoprolol, Hydrochlorothiazide, Plavix
Current Illness: Broken Pelvis,
Preexisting Conditions: Asthma, 3 Heart Stents
Allergies: Penicillin, Phenergan, Reglan, Endor, Compazine, Sulfa, Keflex, Toradol, Repatha Shellfish, Strawberries, MSG
Diagnostic Lab Data:
CDC Split Type:

Write-up: Passing Out, Loss Of Voice, Throat Closing Up, Can Not Breath, Chess and Body Pains, Headaches, Face Swelling, Face Red


VAERS ID: 1327697 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Cough, Lacrimation increased, Throat irritation
SMQs:, Anaphylactic reaction (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Lacrimal disorders (narrow)

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

Write-up: After waiting the 15 minute period, we left the vaccination site. 5-7 minutes later patient began coughing and had watering eyes while describing an itchy throat. Itching sensation continued, along with the coughing, intermittently for about 15 - 20 minutes. We had liquid Benadryl in the car and gave patient one dose of the appropriate amount. Symptoms were already beginning to subside when Benadryl was given and Benadryl was precautionary.


VAERS ID: 1327699 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808978 / 1 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Inappropriate schedule of product administration, Interchange of vaccine products
SMQs:, Medication errors (narrow)

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

Write-up: PATIENT PREVIOUSLY RECIEVED 1 DOSE OF PFIZER VACCINE (1/7/2021-LOT EJ1685) FACILITY SPOKE TO PRESCRIBER SINCE THE PFIZER DOSE WAS NOT AVALIABLE FOR THE RESIDENT. PRESCRIBER ADVISED THEM TO ADMINISTER JANSSEN TO VACCINATE RESIDENT


VAERS ID: 1327781 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Conjunctival haemorrhage
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Conjunctival 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: Benadryl and Aspirin 81mg orally
Current Illness: None.
Preexisting Conditions: None.
Allergies: Penicillins
Diagnostic Lab Data:
CDC Split Type:

Write-up: Bilateral mild subconjunctival bleed


VAERS ID: 1327805 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-05-16
Onset:2021-05-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Myocarditis, Troponin increased
SMQs:, Myocardial infarction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (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? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: Troponin 3.5
CDC Split Type:

Write-up: Myocarditis with elevated Troponin and chest pain the day after vaccination


VAERS ID: 1327839 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-04-06
Onset:2021-05-17
   Days after vaccination:41
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN N/A / UNK - / -

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

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

Write-up: Patient received his single Janssen COVID-19 vaccine on 4/6/2021 and is admitted to the hospital on 5/17/2021 and tested positive for COVID-19 on 5/17/2021. Currently hospitalized, not discharged


VAERS ID: 1327843 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient fainted after getting the vaccine; she woke up and stated she was fine. Called EMS and they spoke to her but she did not want them to come . Followed up with patient next day and she stated she was fine as well


VAERS ID: 1328022 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Chest discomfort
SMQs:, Anaphylactic reaction (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: no
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Pt received 1st dose of Pfizer vaccine. Per safety officer to this writer: Pt sitting in post observation and c/o chest tightness without difficulty breathing. Pt denies other symptoms. HR and oxygen sat WNL. Pt states symptoms resolved on own after 10 min. Pt instructed to seek medical care if symptom persist. Pt exited facility in company of Pt.


VAERS ID: 1328037 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805020 / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Fear of injection, 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: History of syncope
Preexisting Conditions: History of syncope
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: 5/17/21 Patient given Janssen vaccine at 1859. 1905 : patient had an episode of syncope. BP:90/55, pulse: 50 1906: patient awake , alert and oriented.x4 1910: BP: 114/71, pulse 57. Alert and oriented x4 Patient reports a history of syncope and fear of needles. 1930: patient reports doing well. Vital signs stable, alert and oriented x4


VAERS ID: 1328054 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-05-15
Onset:2021-05-17
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8731 / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Epistaxis
SMQs:, Haemorrhage terms (excl laboratory terms) (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: Spiranolactone 50MG 2x Daily
Current Illness: NA
Preexisting Conditions: NA
Allergies: NA
Diagnostic Lab Data: None, Pediatrician directed us to report to CDC
CDC Split Type:

Write-up: Massive nose bleeds from left nostril on 5.17.21 and 5.18.21


VAERS ID: 1328229 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cold sweat, Dyspnoea, Hyperhidrosis, Pallor
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (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: gabapentin 600mg; omeprazle 40mg; chantix 1mg
Current Illness: None reported
Preexisting Conditions: Diabetes, hypertension, anxiety
Allergies: NKDA
Diagnostic Lab Data: None reported
CDC Split Type:

Write-up: The patient returned to the pharmacy shortly after receiving a Janssen COVID vaccine. He was sweating, pale, clammy, and breathing hard. We had him sit, helped him calm his breathing; I assessed for wheezing and swelling of the tongue, but he did not have those symptoms. The patient was able to speak and did not report dizziness or lose consciousness. Paramedics responded. I spoke with the patient this morning, and he reports no residual symptoms.


VAERS ID: 1328253 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-15
Onset:2021-05-17
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 UN / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Echocardiogram, Electrocardiogram, Electrocardiogram ST segment elevation, Myocarditis, Troponin increased
SMQs:, Myocardial infarction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (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? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None known allergies
Diagnostic Lab Data: EKG 5/18 diffuse ST elevation ECHO 5/18 normal Troponin 5/18 17540
CDC Split Type:

Write-up: Developed chest pain and diagnosed with myopericarditis based on EKG and elevated troponins. admitted for monitoring


VAERS ID: 1328267 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-05-01
Onset:2021-05-17
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / UNK LA / IM

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

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

Write-up: Red , not raised rash over lower extremities


VAERS ID: 1328523 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Alabama  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Hyperhidrosis, Syncope, Throat tightness, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Hypoglycaemia (broad)

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

Write-up: After receiving the vaccine, the patient stated that he felt light-headed, and was sweating profusely. He vomited. His blood pressure was 118/82 mmHg, pulse 81 bpm, and respirations 16 bpm. He said he felt like his throat was closing, so we gave him liquid diphenhydramine. At this point, we called 911. The patient was alert and talking the whole time. The patient went with EMS. The patient came back later after being released from the hospital and said that he didn''t have an allergic reaction, but he had vasovagal syndrome.


VAERS ID: 1328539 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: stent placement Feb 2021
Preexisting Conditions: unknown
Allergies: unknown
Diagnostic Lab Data: Standard fire rescue check for vitals on 05/17/2021
CDC Split Type:

Write-up: Patient experienced syncope/fainted and profuse sweating after receiving dose of J&J vaccine


VAERS ID: 1328726 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: D.C.  
Vaccinated:2021-05-04
Onset:2021-05-17
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / IM

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

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

Write-up: Developed large, reddened, itchy whelps on backs of legs. Has never experienced this before.


VAERS ID: 1328952 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SC

Administered by: Private       Purchased by: ?
Symptoms: Injection site haemorrhage, Injection site nodule, Injection site pain
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Extravasation events (injections, infusions and implants) (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: MultiVitamin and Zoloft 100mg and probiotics
Current Illness: None
Preexisting Conditions: Depression and anxiety; low back pain; peri-menapausal
Allergies: Penicillin, diflucan - hives Sensitivity to some adhesives
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Bleeding at site; pea sized nodule; soreness


VAERS ID: 1328965 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1820095 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Chest pain, Chills, Headache, Peripheral coldness
SMQs:, Anaphylactic reaction (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: blisovi fe, myrbetriq, grape seed
Current Illness:
Preexisting Conditions: ibs, oab, grover''s disease
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: persistent headache, cold feet, chills, chest pain/pressure


VAERS ID: 1328966 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-13
Onset:2021-05-17
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Vaccination complication
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: Had taken a single dose of Dramamine on May 15th
Current Illness: None
Preexisting Conditions: None
Allergies: Seasonal allergies
Diagnostic Lab Data: None
CDC Split Type:

Write-up: ?COVID arm?


VAERS ID: 1328987 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-13
Onset:2021-05-17
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal distension, Burning sensation, Pruritus, Urticaria
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Peripheral neuropathy (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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: Thyroid for hypothyroidism, iron, calcium calcitrate, glucosamine chondroitin, Allegra and Claritin
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: Hives, itching , burning, and slight swelling inside and around the belly button.


VAERS ID: 1329003 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-05-09
Onset:2021-05-17
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

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

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

Write-up: 7 days after injection my arm became red, itchy, sore, and hot. The symptoms are still present.


VAERS ID: 1329005 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-05-16
Onset:2021-05-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: 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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Aspirin Plavix Simvastatin Mirapex
Current Illness: None
Preexisting Conditions: Cardiac disease Anxiety
Allergies: Adhesive tapes Shellfish Iodine
Diagnostic Lab Data:
CDC Split Type:

Write-up: Low grade fever 99.9-101.7 for 24 hours


VAERS ID: 1329007 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Injected limb mobility decreased, Nervousness, Pain, Pain in extremity, Vaccination site pain, Vaccination site warmth
SMQs:, Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

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

Write-up: HORRIBLE unbearable arm pain and chills throughout my body i would not be reporting this if the pain wasn?t this bad i feel scared and someone nervous because i can barely use my left arm where the vaccine has went in. I got the vaccine on Monday 11:20 am and then after was fine and normal then i went home and worked out at around 4:30 and after that the pain increase but it wasn?t until the Tuesday which is the day after i got my vaccine that i could not function with out ibuprophen and the second that it wore off the vaccine site was hot and the pain was radiating throughout my arm making it near impossible to do anything it is now Wednesday and the pain has gotten way worse and i am unsure of what to do other than to force myself to take Advil so i can function


VAERS ID: 1329156 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Oregon  
Vaccinated:0000-00-00
Onset:2021-05-17
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Poor quality product administered
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: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210532249

Write-up: VACCINE WAS LEFT AT ROOM TEMPERATURE FOR APPROXIMATELY 4 HOURS AFTER FIRST PUNCTURE; This spontaneous report received from a pharmacist concerned multiple patients. The patient''s weight, height, and medical history were not reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, intramuscular, batch number: Unknown) dose was not reported, administered on 17-MAY-2021 for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On 17-MAY-2021, the subject experienced vaccine was left at room temperature for approximately 4 hours after first puncture. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of vaccine was left at room temperature for approximately 4 hours after first puncture was not reported. This report was non-serious.


VAERS ID: 1329165 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Arkansas  
Vaccinated:0000-00-00
Onset:2021-05-17
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Poor quality product administered
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: Sulfonamide allergy
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210532970

Write-up: DOSE GIVEN OUTSIDE OF 6 HOUR APPROPRIATE STORAGE CONDITIONS; This spontaneous report received from a pharmacist concerned a 46 year old female. The patient''s height, and weight were not reported. The patient''s concurrent conditions included allergic to sulfa antibiotics.The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 203A21A expiry: UNKNOWN) dose was not reported, administered on 17-MAY-2021 18:00 for prophylactic vaccination. No concomitant medications were reported. On 17-MAY-2021, the subject experienced dose given outside of 6 hour appropriate storage conditions. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of dose given outside of 6 hour appropriate storage conditions was not reported. This report was non-serious. This case, from the same reporter is linked to 20210532044.


VAERS ID: 1329668 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Arkansas  
Vaccinated:0000-00-00
Onset:2021-05-17
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Poor quality product administered
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: Comments: The patient had no known drug allergies.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210532044

Write-up: DOSE ADMINISTERED OUTSIDE OF APPROPRIATE STORAGE CONDITIONS; This spontaneous report received from a pharmacist concerned a 60 year old male. The patient''s height, and weight were not reported. The patient''s pre-existing medical conditions included the patient had no known drug allergies.The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 203A21A, expiry: UNKNOWN) dose was not reported, administered on 17-MAY-2021 for prophylactic vaccination. No concomitant medications were reported. On 17-MAY-2021, the subject experienced dose administered outside of appropriate storage conditions. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of dose administered outside of appropriate storage conditions was not reported. This report was non-serious. This case, from the same reporter is linked to 20210532970.


VAERS ID: 1329871 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Body temperature increased, Chills, Pain
SMQs:, Neuroleptic malignant 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: Propranolol 120mg, norethindrone, and sumatriptan
Current Illness:
Preexisting Conditions: Acid reflux, chronic migraines
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: High body temperature, full body shivers, body aches


VAERS ID: 1329875 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Oklahoma  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anaphylactic reaction, Asthenia, Dizziness, Dysphagia, Dyspnoea, Injection site pain, Loss of consciousness, Muscle tightness, Syncope, Throat tightness, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Angioedema (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Anaphylactic/anaphylactoid shock conditions (narrow), Dystonia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), 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), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Vestibular disorders (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Site: Pain at Injection Site-Medium, Systemic: Allergic: Anaphylaxis-Medium, Systemic: Allergic: Difficulty Breathing-Medium, Systemic: Allergic: Difficulty Swallowing, Throat Tightness-Severe, Systemic: Dizziness / Lightheadness-Severe, Systemic: Fainting / Unresponsive-Severe, Systemic: Weakness-Severe, Additional Details: Patient lost conciousness a few minutes after dose was given. Patient was unresponsive for approximately 2 minutes. Neck felt tight, difficulty breathing, was not alert/oriented when finally awoken. Patient was given 1 shot of epi 0.3 due to a temporary interuption in breathing that lasted seconds. By the time paramedics arrived, he was becoming more alert. Was taken to the ER and discharged.


VAERS ID: 1329880 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Alabama  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 2 AR / IM

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

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

Write-up: Error: Booster Given Too Early


VAERS ID: 1329912 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chills, Headache, 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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever, chills, body aches, headache.


VAERS ID: 1329920 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-04-26
Onset:2021-05-17
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / N/A RA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Muscle spasms, Tinnitus
SMQs:, Dystonia (broad), Hearing impairment (narrow)

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

Write-up: Tinnitus began @ 3 weeks after shot Also have had calf cramping from about 10 days after shot. Not sure if calf is related.


VAERS ID: 1330022 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Public       Purchased by: ?
Symptoms: Influenza like illness, 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: Moderna Covid 19, same symptoms as the first dosage
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever and flu like symptoms


VAERS ID: 1330086 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0162 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Family showed up to receive vaccine for minors, I proceeded through the steps an failed to notice his DOB placed him outside of the CDC''s age limits. I administered the 1st dose of Pfizer (lot EW0162, 03.mL). Was notified by supervisor, and will double check DOB''s in the future.


VAERS ID: 1330090 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Headache, Nausea, Pain, Vomiting
SMQs:, Acute pancreatitis (broad), Guillain-Barre syndrome (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: Prozac, multivitamin
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Headache, body ache, nauseated, vomiting, weak


VAERS ID: 1330091 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: New York  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0158 / 1 LA / IM

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

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

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


VAERS ID: 1330147 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 RA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Age 13, gardisil, vascovagal syncope
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Muscle pain in arm of injection


VAERS ID: 1330196 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-14
Onset:2021-05-17
   Days after vaccination:33
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (UNKNOWN)) / UNKNOWN MANUFACTURER - / 1 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Burning sensation, Chest discomfort, Herpes zoster
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (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: Take metformin 2500 mg daily Jardiance 10 mg daily, levothyroxine 70 mcg daily, crestor 10 mg daily. Vitamin c 500 mg daily, vitamin d 4000 mg daily
Current Illness: Diabetes, hashimoto hypothyroidism, high cholesterol and tryglycerides.
Preexisting Conditions: As above
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Shingles I am a 54 year old male living in another country. I have developed shingles as diagnosed by my doctor on 17th May 2021. During night between 16th May and 17th May, I developed these shingles rashes. I had first dose of Astrazeneca vaccine (called Covishield) on 14th April 2021. Nearly a month later I developed shingles. I am Type-2 diabetic for the last 20 years with excellent control and no organ damage so far. Still on 2500 mg metformin chloride per day and 10 mg Jardiance per day. I also have high cholesterol and high triglycerides since 15 years and I am on 10 mg Crestor a day. I also suffer from Hashimoto hypothyroidism (an auto immune condition) since 15 years and take about 70 mcg of levothyroxine a day. I am otherwise a fit person with regular exercise and a BMI of 20.5. I have been taking Vitamin C 500 mg for last 20 years, and regularly take Zinc and Vitamin D. Vitamin D level 60 ng/ml. Looks like Covid vaccine induces shingles in people with auto immune disorder that was not thoroughly checked and studied due to urgent need of vaccine roll out. If stress reduces immunity and is the reason for eruption of shingles, I have been suffering stress from the last one year due to job loss and threat of job loss. But why Shingles erupted only after Covid vaccination? I should have suffered it earlier! It takes two weeks for covid vaccine to become active which could have caused body to fight it and thus lowering immunity. May be immunity is lowering more than necessary when compared to other vaccines. Advantage is taken by shingles virus due to this lowered immunity and causing shingles. I have never suffered chickenpox during my entire life as I could have been vaccinated as a child for chickenpox. But I still got shingles now after Covid vaccination. Four years ago, due to job requirements, I had to take multiple vaccinations such as rabies, etc. At the time I did not suffer shingles? But now only after Covid vaccination from Astrazeneca! Seems quick rollout of vaccine has created additional problems for certain groups of populations. Luckily, I began treatment within 24 hrs with antiviral medication. My friend suffered from shingles 5 years ago. He complained about terrible shooting pain which is the case with shingles it seems. Surprisingly, so far I have not had any shooting pain, no itching, etc. A mild discomfort and a slight burning sensation on upper left chest, left back where shingles formed. But it shingles as confirmed by doctor. Covid vaccination is inducing new kind of shingles with less pain?


VAERS ID: 1330218 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Epistaxis
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Allegra 10ml daily
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: Severe allergies to tree nuts; mild dairy allergies, seasonal allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient developed a bloody nose within 20-25 minutes of receiving her vaccination. It gradually subsided. We called her pediatrician, who did not advise urgent care or similar. She has never had a bloody nose before to my knowledge.


VAERS ID: 1330272 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 1 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Erythema, Limb discomfort
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Patient''s mom called about 40 mins after receiving dose and said that patient''s right hand (vaccine was in right deltoid) felt tight and was red. She said that he did NOT have any redness or swelling at injection site. She said that he is on the spectrum, so complicates asking him about symptoms. She confirmed that he was NOT experiencing any lip/tongue swelling or trouble breathing. She said he was running hand under water because it "felt tight". After counseling, I followed up with her 40 mins later and she reported that his symptoms were much improved without any treatment.


VAERS ID: 1330368 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007CZ1A / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cough, Headache, Nasal congestion, Pain, Pyrexia
SMQs:, Anaphylactic reaction (broad), 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 11 PM on 17th: Headache, Fever, Morning of 19th: Stuffed Nose, Coughing, Body Aches. Took Ibuprofen and DayQuil, mildly suppressed the symptoms, but headache stayed extreme until the 19th.


VAERS ID: 1330386 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 RA / IM

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

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

Write-up: RN gave patient wrong dose


VAERS ID: 1330432 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 RA / IM

Administered by: Work       Purchased by: ?
Symptoms: Interchange of vaccine products, No adverse event
SMQs:, Medication errors (broad)

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

Write-up: RN gave wrong dose. Patient was notified. Patient has not had any adverse effects thus far. He will be monitored for the next few weeks, & was given a phone # to call if he experiences any problems.


VAERS ID: 1330455 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / N/A RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, Muscle spasms, Vaginal haemorrhage
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Retroperitoneal fibrosis (broad), Dystonia (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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: Adderall 30mg XR Adderall 10mg instant Fluoxetine Wellbutrin XL Iron Vitamin Vitamin C Vitamin D
Current Illness:
Preexisting Conditions: irregular periods
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: A couple hours after getting the J&J vaccine, I experienced extreme cramping and a light/medium flow of blood from my vagina. The cramps were very painful - on a scale of 1 to 10, an 8. I have been bleeding ever since. Sometimes there will be only be a drop or two of blood that comes out for a couple hours but usually it is much more than that. It''s like I''m on my period, but I am not. I have an IUD and also am on the birth control pill (Junel). I am not on the placebo week on my birth control pill pack, so I should not be experiencing a period right now, but ever since the shot, I have been bleeding and experiencing intense cramps and pain since.


VAERS ID: 1330477 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: N/A
CDC Split Type:

Write-up: RN gave wrong dose of vaccine. Patient was notified of error. No adverse side effects thus far. He was given phone # to contact if he experience any problems. He''ll be monitored for next few weeks with phone calls.


VAERS ID: 1330494 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest X-ray, Dyspnoea, Erythema, Laboratory test, Palpitations, Pharyngeal swelling
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations: Influenza 2019
Other Medications: Synthroid, Prilosec, Allegra, Pepcid, hydroxizine, celexa, hormone replacement therapy, Brio
Current Illness: Nothing new
Preexisting Conditions: Allergies, asthma, gastroparesis.
Allergies: Penicillin, Sulfa, ethromycin. Keflex, soy, wheat, dairy, multiple seasonal allergies
Diagnostic Lab Data: Epinephrine, solumedrol, chest X-ray, xopenex, labs, IV Benadryl
CDC Split Type:

Write-up: At 30min after shot my heart started racing, redness on face and going down neck, then difficulty breathing with swelling of my throat.


VAERS ID: 1330534 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-05-12
Onset:2021-05-17
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043AZ1A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Arthralgia, Chromaturia, Dehydration, Headache, Hyperhidrosis, Myalgia, Pruritus, Renal pain, Vision blurred
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Glaucoma (broad), Lens disorders (broad), Eosinophilic pneumonia (broad), Retinal disorders (broad), Hypersensitivity (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (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: sulfa drugs Alleve crustaceans
Diagnostic Lab Data: none
CDC Split Type:

Write-up: day followimg shot: i awoke to extreme pain in all muscles and joints, profuse sweating, blurred vision, headache just behind my eyes muscle/joint pain lasted approx 24 hours; ibuprofen offered some relief. sweating lasted 3 days and resulted in dehydration to the point where my kidneys ached; i drank as much water as i could but my urine remained dark headaches/blurry vision lasted 2 days 5 days after the shot, the soles of my feet began to feel itchy, and the itchiness has been ongoing even up to now (7 days after shot) 7 days after shot, itchiness has also begun affecting the palms of my hands


VAERS ID: 1330560 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-05-11
Onset:2021-05-17
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chills, Dyspnoea, Headache, Pain, Rash, Respiratory tract congestion, Sinus congestion
SMQs:, Anaphylactic reaction (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: bupropion 150 mg daily
Current Illness: Patient denied
Preexisting Conditions: no
Allergies: nkda, no food allergies, past history of seasonal allergies as child
Diagnostic Lab Data: Seen at on 5/18/21
CDC Split Type:

Write-up: Patient received Janssen vaccine on 5/11/21 @ Pharmacy, noted 12 hours after the vaccine had headache, body aches, and chills. The on 5/17/21 woke with a head to tow rash. Went to ED and was treated with Prednisone and antihistamines. 5/19/21 noted chest and head congestion, shortness of breath and return of rash on his back only. Patient referred to see provider 5/19/21 to rule out covid infection and discuss the treatment of symptoms.


VAERS ID: 1330589 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Maine  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK AR / IM

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

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

Write-up: Pfizer vaccine mixed incorrectly (used sterile water).


VAERS ID: 1330615 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Maine  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK AR / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Incorrect product formulation 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: Pfizer vaccine mixed incorrectly (used sterile water)


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