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

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



Case Details (Reverse Sorted by Onset Date)

This is page 149 out of 6,867

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VAERS ID: 1549508 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-08-12
Onset:2021-08-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7487 / 2 LA / IM

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

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

Write-up: My son was complaining of dizziness and also had a fever of 102.3 , x5 days after 2nd vaccine, the dizziness lasted about 7 days,


VAERS ID: 1549512 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-08-12
Onset:2021-08-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Muscular weakness, Musculoskeletal stiffness, Seizure, Staring
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Generalised convulsive seizures following immunisation (narrow), Arthritis (broad), Hypoglycaemia (broad)

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

Write-up: Patient was given second Pfizer Covid 19 vaccination at 11:08 am. Within 45-60 seconds had a blank stare, then became limp, then stiffened arms and legs indicative of a brief seizure. After a few seconds with a cool cloth on her forehead, she responded appropriately to questions of name, birth date. Stated "I feel a little dizzy" Then, stated "I''m ok" Left ambulatory with mother at 11:17. Brother had stated that she only ate a gogurt this morning.


VAERS ID: 1549513 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-08-12
Onset:2021-08-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 LA / IM

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

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

Write-up: PATIENT HAD A GRAND MAL SEIZURE, WHERE HE URINATED ON HIMSELF AND LOSS CONSCIOUSNESS WITHIN MINUTES OF VACCINE.


VAERS ID: 1549528 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-08-12
Onset:2021-08-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 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? 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 dizziness, diaphoresis, pale and lightheaded. Numbness to fingers. O2 Sat 96% HR 55, BP 100/60. Pt offered a water and ice pack. He said he felt better after 10 minutes


VAERS ID: 1549551 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-12
Onset:2021-08-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016C21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: Patient mentions he has no health issues that he is aware of.
Preexisting Conditions: None
Allergies: NKA
Diagnostic Lab Data: Patient regained consciousness and was checked in to be seen by PA-C. patient was assessed and his right arm that hit the wall as he fell was examined. Patient reports he has had an issue like this occur before when he was nervous.
CDC Split Type:

Write-up: Patient had a vasovagal reaction 5-10mins after administration and had LOC for a good 5-7secs.


VAERS ID: 1549562 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-08-12
Onset:2021-08-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 LA / IM

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

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

Write-up: C/O dizziness Right hand tingling O2 Sat 95%, HR 80. Offered cold water states feels better after 5 minutes


VAERS ID: 1549584 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-08-12
Onset:2021-08-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002F21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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 presented asking for Moderna vaccination and stated it would be his first dose. Vaccine was billed to medicare which paid with no issues. Pharmacy gave patient first Moderna dose. Afterwards, patient disclosed that he had received 2 doses of Pfizer vaccine previously. Patient had no issue with vaccine.


VAERS ID: 1549589 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2020-12-30
Onset:2021-08-12
   Days after vaccination:225
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / IM

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

Write-up: EMPLOYEE TESTED POSITIVE TO COVID TODAY 8/12/21


VAERS ID: 1549595 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-11
Onset:2021-08-12
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Fatigue, Headache, Injection site pain, Myalgia, Nausea
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Head ache, joint and muscle pain, soreness at injection site, fatigue, nausea.


VAERS ID: 1549596 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-08-12
Onset:2021-08-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: sertraline 50mg, vistaril 25mg, lamotrigine 100mg, aripiprazole 2mg, loratidine 10mg
Current Illness: not known
Preexisting Conditions: anxiety
Allergies: not known
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient fainted after administration.


VAERS ID: 1549609 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-08-12
Onset:2021-08-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC180 / 1 LA / IM

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

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

Write-up: Pt came in requesting the pfizer vaccine. Pt stated he did not received any other covid vaccines previously. Dose was administered. When processing claim through insurance, we discovered pt already received 2 doses of Moderna on 4/10/21 and 5/8/21. Couldn''t reach pt regarding extra dose of pfizer given.


VAERS ID: 1549611 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-12
Onset:2021-08-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Balance disorder, Electrocardiogram, Full blood count, Head discomfort, Headache, Metabolic function test, Pregnancy test urine negative, Presyncope, Vertigo
SMQs:, Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Vestibular disorders (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Plan B take on 8/8/21
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: EKG . CBC. BMP unremarkable. Negativ urine Hcg
CDC Split Type:

Write-up: disequilibrium/vertigo, head fullness/headache, near-syncope


VAERS ID: 1549614 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-08-12
Onset:2021-08-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052E21A / 1 LA / IM

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

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

Write-up: Student is 17 years of age and that was overlooked when administering the vaccine. After administration it was seen.


VAERS ID: 1549615 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-12
Onset:2021-08-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006D21A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Inmate/Patient received dose 2 on the 16th day after dose 1. No adverse event observed at time of reporting


VAERS ID: 1549623 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-08-12
Onset:2021-08-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026D21A / 1 LA / IM

Administered by: Other       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: Information not available at this moment
Current Illness: Information not available at this moment
Preexisting Conditions: Information not available at this moment
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: No Adverse reactions as of now but Patient is not 18 years old yet. Patient is only 17 years and 11 months old when received the shot.


VAERS ID: 1549627 (history)  
Form: Version 2.0  
Age: 10.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-08-12
Onset:2021-08-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 2 LA / IM

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

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

Write-up: NO ADVERSE EVENT OR REACTION. SHOT GIVEN OUTSIDE OF APPROVED PROTOCOL DUE TO FATHER LYING ON ADMINISTRATION FORM AND TO ADMINISTERING PHARMACIST REGARDING HIS DAUGHTERS BIRTHDAY. HE CLAIMED SHE WAS 12 WHEN IN REALITY SHE IS 10.


VAERS ID: 1549631 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-08-12
Onset:2021-08-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Hyperhidrosis
SMQs:, Neuroleptic malignant syndrome (broad), 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: lightheadedness
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient appeared to get light headed and had sweating. Had to move from chair to floor and elevated feet. Patient was given water and some sugar/protein. Ice pack on back of neck as well. Regained to normal in 10-15 mins.


VAERS ID: 1549645 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-08-12
Onset:2021-08-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052E21A / 1 LA / IM

Administered by: Other       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: N/A
Current Illness: N/A
Preexisting Conditions: HLD
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Patient didn''t have an adverse event. Patient was given Janssen COVID-19 Vaccine March, 2021. On 08/12/21 patient was vaccinated with Moderna COVID Vaccine. Patient is AA&OX3, no noted distress, denies any discomfort. Patient vital signs WNL will continue to monitor.


VAERS ID: 1549650 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-08-12
Onset:2021-08-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002F21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Confusional state, Head injury, Hypotension, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

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

Write-up: Shortly after the patient received the vaccination, the patient stated that he felt something. He ended up fainting and hitting his head on the floor. We were able to get him up and he regained consciousness within the minute. He seemed confused initially. We had him sit for observation and monitored his blood pressure. The results of his blood pressure was significantly low. His status (consciousness) seemed to have improved, but due to precautions and his blood pressure, we recommended that he gets seen by a professional. His significant other that was present with him said that they will be heading to an urgent care.


VAERS ID: 1549657 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-12
Onset:2021-08-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0169 / 2 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt arrived to observation area after pfizer dose # 2 and 5 minutes later stated feeling dizzy and assisted to cot and laid down and vitals taken 1:15 pm 110/60, 67 bpm and 97% O2sat Pt given po fluids water and juice and states feeling better and assumed sitting position 1:30pm 100/60, 73 bpm, 98% O2 sat Pt reported feeling well and wanted to depart and iz side effects and ER precautions reviewed and pt and husband verbalized understanding and pt left iz area


VAERS ID: 1549662 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: New York  
Vaccinated:2021-08-12
Onset:2021-08-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Angina pectoris, Cardiac flutter, Dyspnoea, Heart rate increased
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Tachyarrhythmia terms, nonspecific (narrow), Other ischaemic heart disease (narrow), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: Possibly allergy to excessive banana consumption. Results in hives.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Within 20-30 minutes of vaccination (around 1:10PM), started to feel short of breath while walking and a very very slight pain in the heart region of my chest. Generally symptoms were lessened when walking more slowly. Noticed having a fast-beating and/or fluttering heart while laying in bed after waking up from a nap 3 hours later.


VAERS ID: 1549665 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-10
Onset:2021-08-12
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0175 / 2 RA / IM

Administered by: Work       Purchased by: ?
Symptoms: Fatigue, Headache, Lymph node pain, Pain in extremity
SMQs:, 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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Synthroid, Prozac
Current Illness:
Preexisting Conditions:
Allergies: NSAIDS
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Arm pain down to fingers, Lymphnoids in armpit painful. Headache, & fatigue


VAERS ID: 1549666 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Mississippi  
Vaccinated:2021-08-12
Onset:2021-08-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH PD8448 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site erythema, Injection site mass, Injection site warmth, Pyrexia, Rash, Rash erythematous, Rash pruritic
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: only thing taken is tylenol the first day, tylenol pm and advil the second day after vaccination
Current Illness:
Preexisting Conditions:
Allergies: none known per discussion with patient
Diagnostic Lab Data:
CDC Split Type:

Write-up: Per conversation with the patient, she started running a high fever the night after vaccination and then for two days after, she took tylenol to control the fever and starting this morning fever is gone, also starting the night after vaccination a few bumps started to appear which as steadily gotten worse and turned into a red, bumpy itchy rash running down both arms which led to report today, injection side is a red knot and warm to touch, patient advised to take oral antihistamines and apply hydrocortisone and follow up with md


VAERS ID: 1549670 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-01-11
Onset:2021-08-12
   Days after vaccination:213
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK5730 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Cough, Headache, Malaise, Myalgia, Oxygen saturation decreased, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute central respiratory depression (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Tendinopathies and ligament disorders (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: COVID-19 nasal swab
CDC Split Type:

Write-up: Fully vaccinated patient tested positive for COVID-19 on 7/21/21. Symptoms included cough, headache, myalgias, malaise. Patient was hospitalized briefly on 7/24/21 for oxygen saturations reading in high 80s range and was discharged after diagnostic testing revealed stable condition.


VAERS ID: 1549672 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-08-12
Onset:2021-08-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 LA / IM

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

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

Write-up: patient received dose 1 and shortly after receiving fainted. Patient was very pale and pulse was very slow...Lasted a few minutes and patient started to recover. Recovered color within about 10 min


VAERS ID: 1549679 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-08-11
Onset:2021-08-12
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033C21A / 2 RA / SYR

Administered by: Work       Purchased by: ?
Symptoms: Body temperature, Fatigue, Headache, Muscular weakness, Pain in extremity
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Extreme fatigue Sharp headache Total weakness in every muscle Temperature Pain in right arm


VAERS ID: 1549683 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-08-12
Onset:2021-08-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Bell's palsy, Computerised tomogram, Facial paralysis, Magnetic resonance imaging, Neck pain
SMQs:, Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Hearing impairment (broad), Arthritis (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: D3, B12, Fish Oil
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: CT scan MRI Neurologist did facial tests
CDC Split Type:

Write-up: Pain in neck started 2 days after getting vaccine, Face started drooping 6 days later. Thought it was a stroke. Went to the emergency room. Stroke was ruled out and diagnosed with Bells Palsy. Still have 90 days later.


VAERS ID: 1549687 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-07-23
Onset:2021-08-12
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache, Vertigo
SMQs:, Vestibular 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient stated that they experienced headache and vertigo. Resolved after a few days


VAERS ID: 1549693 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-08-06
Onset:2021-08-12
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Circumstance or information capable of leading to medication error, No adverse event, Product administered to patient of inappropriate age
SMQs:, Medication errors (narrow)

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

Write-up: No adverse events noted 8/12/21 via mychart. phone number in chart not correct, unable to reach patient/parent.


VAERS ID: 1549697 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-08-12
Onset:2021-08-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NOT SURE
Current Illness: NOT SURE- NOTHING ON FORM. PARAMEDICS SAID THEY ARE NOT ALLOWED TO SHARE DUE TO HIPPA.
Preexisting Conditions: NOT SURE
Allergies: NO
Diagnostic Lab Data: NOT AVAILABLE
CDC Split Type:

Write-up: PATIENT WAS SCARED TO GET VACCINE AND SAID LAST TIME HE HAD WAS IN HIGH SCHOOL. HE CAME WITH WIFE AND WAS FINE AFTER GETTING IT BUT WAS HOLDING HIS HAND OVER INJECTION SITE AND WAS NERVOUS AND WALKING AROUND. GAVE HIM COLD WATER AND HE SAT DOWN AND WAS TALKING AND ALL OF A SUDDEN IN FEW MINUTES WIFE CALLE D US AND HIS EYE ROLLED UP AND WAS GETTING UNCONSCIUS. HIS WIFE AND I TRIED TO WAKE HIM AND HE GOT ALERT IN ABOUT A MINUTE SO TOLD HIM TO LIE DOWN. HE WANTED TO WALK INSIDE CLINICAL ROOM AND SO HE LIED DOWN WITH FEET ELEVATED IN CLINICAL ROOM. MEANWHILE THE TECH CALLED 911. HE WAS FULLY ALLERT AND TALKING WHILE LYING DOWN AND PARAMEDICS ARRIVED IN 10 MINUTES. HE DID NOT WANT ATTENTION AND DID NOT WANT ANYONE TO KNOW HE HAD FAINTED AND DENIED TO GO TO ER PER PARAMEDICS. HE WALKED OUT AFTER PARAMADICS CHECKED HIM AND HIS WIFE WAS GOING TO DRIVE HIM HOME.


VAERS ID: 1549699 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-04-05
Onset:2021-08-12
   Days after vaccination:129
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / IM

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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NALTREXONE, ZOLOFT, SEROQUEL
Current Illness: ALCOHOL WITHDRAWAL
Preexisting Conditions: DEPRESSION, SCHIZOAFFECTIVE DISORDER, BIPOLAR DISEASE, HCV +
Allergies: HALDOL, PROZAC, PENICILLIN, RASPBERRY, LITHIUM
Diagnostic Lab Data:
CDC Split Type:

Write-up: PATIENT BREAKTHROUGH COVID INFECTION - TESTED POSITIVE AUGUST 12, 2021


VAERS ID: 1549713 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-08-12
Onset:2021-08-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002C21A / 1 LA / IM

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

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

Write-up: Patient fainted about a minute after receiving Moderna Covid-19 vaccination.


VAERS ID: 1549719 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-08-12
Onset:2021-08-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 RA / IM

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

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

Write-up: Patient reported his throat was ''itchy'' and possibly swelling approximately 10 minutes post injection. He sat there 25 more minutes with us checking on him regularly and said it appeared to get better. He had throat swelling in the past to kiwi and bananas.


VAERS ID: 1549722 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-08-12
Onset:2021-08-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045C21A / 2 LA / IM

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

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

Write-up: immunization was administered 5 days early (day 23)


VAERS ID: 1549734 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Virgin Islands  
Vaccinated:2021-08-12
Onset:2021-08-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Eye swelling, Periorbital swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Periorbital and eyelid disorders (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: No known medications
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: Dust, mold
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Patient presented approximately 5:40pm on 8/12/21 with her right eye swollen and puffy. Patient received Moderna COVID-19 vaccine at approximately 3:30pm 8/12/21. She indicated that this is the response when she is exposed to dust or mold and she has had this same reaction when that happens.


VAERS ID: 1549740 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-08-12
Onset:2021-08-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006D21A / 1 LA / -

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

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

Write-up: throat chocking


VAERS ID: 1549742 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-08-12
Onset:2021-08-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Dysphagia, Headache, Hypersensitivity, Swelling face, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Propranolol 40 mg
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Two benadryl shots, steroids shot
CDC Split Type:

Write-up: Allergic reaction swelling in face hard to swallow hives headache


VAERS ID: 1549765 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-11
Onset:2021-08-12
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Feeling of body temperature change, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre 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: Multivitamin
Current Illness: None
Preexisting Conditions: None
Allergies: Pork
Diagnostic Lab Data:
CDC Split Type:

Write-up: Tingling of legs, right leg more than left. Hot/Cold sensation that started today 8/12/21 @11am. Called PCP today at 1636. Awaiting call back.


VAERS ID: 1549768 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-08-12
Onset:2021-08-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040C21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: n/a
Current Illness: none known
Preexisting Conditions: none known
Allergies: no known allergies
Diagnostic Lab Data: The patient checked his blood pressure as requested, but left the store before reporting his results.
CDC Split Type:

Write-up: A few minutes after receiving the shot, the patient claimed to be experiencing lightheadedness and wanted to lie down. He was noticeably sweating. When asked if he felt like fainting, he explained he gets this way when he is near needles, like when he gets a vaccine or receives a new tattoo. The patient asked for a trash can to vomit in and did so when one was provided. After monitoring the patient for a few minutes and giving him a bottle of water to drink from, the patient said he started to feel better. After the 15 minutes post-vaccination monitoring window was reached, the patient said he was OK to go home. He walked to the bathroom with no assistance needed. The patient was advised to check his blood pressure before leaving and to contact a doctor if his symptoms return.


VAERS ID: 1549769 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-08-12
Onset:2021-08-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 LA / IM

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

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

Write-up: needle came apart


VAERS ID: 1549770 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-08-12
Onset:2021-08-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / IM

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

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

Write-up: patient felt light-headed after vaccine, allowed him to lay down in pharmacy and provided water. patient felt better after about 15 minutes


VAERS ID: 1549777 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-12
Onset:2021-08-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052E21A / 2 LA / IM

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

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

Write-up: RPH ADMINISTERED 1.0ML INSTEAD OF 0.5ML


VAERS ID: 1549782 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-08-12
Onset:2021-08-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 3 LA / IM

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

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

Write-up: Patient came to the pharmacy wanting to get the Pfizer COVID vaccine on 8/12/21 at 1:20pm. Patient had made an appointment with another location, but appeared at this location. We told the patient it was no problem, we could administer the vaccine at our location. FT Pharmacy Techinican confirmed with patient this was their FIRST dose (as written on vaccine consent form). Patient said "Yes." Technician asked patient if they had insurance. Patient responded "No." Technician proceeded to ask if left arm was okay, processed the vaccine, and made a vaccine record card. Pharmacist reviewed consent form prior to administering vaccine. Patient had selected "Pfizer Dose 1" and answered "No" to Question 14 ("Have you had the vaccine(s) you are receiving today before?") Following vaccine administration, Pharmacy Intern went to enter vaccine into the management system and discovered patient had already received 2 doses at a Health Center. No adverse events were reported by patient, but pharmacy wanted to report the error.


VAERS ID: 1549791 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-08-12
Onset:2021-08-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052E21A / 2 LA / IM

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

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

Write-up: rph administered 1.0ml instead of 0.5ml


VAERS ID: 1549797 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-12
Onset:2021-08-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052E21A / 1 LA / IM

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

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

Write-up: rph administered 1.0 ml instead of 0.5ml


VAERS ID: 1549799 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-08-12
Onset:2021-08-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002F21A / 1 LA / IM

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

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

Write-up: Was administering vaccine and the screw tip of syringe and needle made a popped sound. After the "pop" the rest of the medication ran down the patients arm. I don''t know how much the patient received. Patient stated he felt the liquid go in his arm and knows he got it.


VAERS ID: 1549804 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-08-12
Onset:2021-08-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypoaesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Sexual dysfunction (broad)

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

Write-up: PATIENT''S WIFE CALLED ABOUT 45MINIUTES AFTER ADMINISTRATION. HUSBAND IS EXPERIENCING NUMBESS IN FACE AND NECK BUT NO OTHER SYMPTOMS. I ADVISED THAT IF IT GETS WORSE OR START HAVING OTHER SYMPTOMS, TO GO TO URGENT CARE/ER OTHERWISE TALK TO FAMILY DOCTOR WHEN THEY REOPEN TOMORROW MORNING. I CALLED THE PATIENT AFTER 30 MINUTES. SAYS IT IS LIGHTENING UP.


VAERS ID: 1549813 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Idaho  
Vaccinated:2021-08-11
Onset:2021-08-12
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Myalgia, Pyrexia, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Fever, chills, vomiting, achy muscles


VAERS ID: 1549821 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-08-12
Onset:2021-08-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0165 / 1 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Muscle twitching, Skin exfoliation, Throat tightness
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Angioedema (broad), Dyskinesia (broad), Dystonia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: yes
Current Illness:
Preexisting Conditions: yes
Allergies: yes
Diagnostic Lab Data:
CDC Split Type:

Write-up: tightness in throat 30 mins after vax-went to er, skin peeling at vax site, twitching in rt arm


VAERS ID: 1549822 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-07-15
Onset:2021-08-12
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Cardiomyopathy, Echocardiogram abnormal, Ejection fraction decreased, Malaise, Myocarditis, Presyncope, Right ventricular dilatation, Syncope, Ventricular hypokinesia
SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Pulmonary hypertension (narrow), Cardiomyopathy (narrow), Hypotonic-hyporesponsive episode (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (broad)

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

Write-up: 19 yo male received Moderna vaccine 1 month ago, Has felt progressively unwell with multiple near syncopal episodes since vaccination. today patient had syncopal episode and was found to have cardiomyopathy/myocarditis and a decreased ejection fraction by cardiac echo, dilated RV and global hypokinesis


VAERS ID: 1549824 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: New York  
Vaccinated:2021-08-12
Onset:2021-08-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypersensitivity, Lip swelling, Nausea, Pallor
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: patient developed allergic reaction after vaccination. Lips were swollen white and very nauseous. Epinephrine was injected in upper thigh and paramedics were called. After few minutes of epinephrine injection, patient gradually was feeling better. Paramedics came and left with patient .


VAERS ID: 1549825 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-12
Onset:2021-08-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Anxiety, Hypoaesthesia, Nausea, Vomiting, Wheezing
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Asthma/bronchospasm (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Hypoglycaemia (broad), Sexual dysfunction (broad)

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

Write-up: 8/12/21 @1407, Clients exhibited anxiety, face numb, and nausea, vomiting, wheezing, right cheek numbness. Pt. is diabetic. Vital signed taken x4. @1407, HR130, SpO2 97%, BP 161/108; @1409, HR 130, SpO2 97%; @1411, HR 126, SpO2 97%, BP 145/014; @1425, HR 114, SpO2 97%, BP 146/91; @1439, HR 110, SpO2 97%, BP 152/105. On site EMS called EMT at 1431, assessed client, and put client to a seated position and fluid is offered. Pt. stated that she hadn''t eaten today. Pt. was given a sandwich, 911 called, fire department arrived to assess patient, advised to transfer to hospital, Pt. refused and signed AMA at 1452. NP educated patient about proper preparation for second dose, i.e. eat the meal, and hydration. Pt. verbalized understanding, and left at 1511.


VAERS ID: 1549837 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-08-12
Onset:2021-08-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 2 - / IM

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

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

Write-up: Patient came to the site requesting 2nd dose of Pfizer. Pt confirmed with the nurse that he was given one dose on July 17th. After 2nd dose was administered today, patients spouse reported that this was actually his 3rd dose, because he was told that his first dose (5/14) which was given at a pharmacy was expired. He was also told that he needed to restart the series so he got his shot again at the same Pharmacy. Before this given information, there were no flagged vaccinations in the system and the nurse was allowed to proceed, since it stated second dose due date was today August 12th, 2021. Vital signs were initiated when he was escorted to the observation area. Vitals were stable and was observed for 40 minutes. Did not experience any adverse reactions. Patient left the facility at 12:05 pm with his wife.


VAERS ID: 1549839 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-08-12
Onset:2021-08-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 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: nkda
Diagnostic Lab Data:
CDC Split Type:

Write-up: vaccine is approved for age $g=18 years only. Patient is 16 years old.


VAERS ID: 1549840 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-07-22
Onset:2021-08-12
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Anticoagulant therapy, Arthralgia, Back pain, Chest pain, Cold sweat, Computerised tomogram normal, Dizziness, Echocardiogram, Electrocardiogram, Fatigue, Pain, Pain in extremity, Peripheral swelling, Spinal pain, Surgery, Thrombosis, Ultrasound Doppler
SMQs:, Cardiac failure (broad), Angioedema (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Immune Gummy Vitamin, Zinc Gummy, protonix, D3, iron
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: When I went to the ER they did EKG, 4 CT''s, echocardiogram, ultrasound on leg.
CDC Split Type:

Write-up: Received the vaccine 7/22/21 at 1:00pm had a sore left arm, felt a bit dizzy & clammy but symptoms went away by Saturday 7/24/21. Monday night 7/26/21 felt really tired & a bit achy. 7/27/21 I woke up with a stabbing knife feeling under my right shoulder blade up my spine & it ran thru front of chest & left leg started swelling a bit. Self medicated with tylenol, advil, ice & heat. 7/28/21 I went to store & bought ladocaine patches, creams to try to relieve the symptoms along with the other things I was doing. 7/29/21 I went to get a massage but I couldn''t take my shirt off & it just hurt too much so it was short & sweet. Friday 7/30/21 my leg was huge! I couldn''t take it any longer & went to the ER at 3:30, I was admitted at 5:00 with blood clots in my stomach & down my left leg. Still not answers on back but it didn''t show any clots with they did the CT''s. I was put on heporon blood thinner & had surgery on 8/2/21. I got to go home on 8/3/21 but started having chest pains & the back pain really bad so went back to ER on 8/6. They did another CT to see if any clots were in back but there wasn''t. Sent home with oxy & fentanyl patches.


VAERS ID: 1549845 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-08-12
Onset:2021-08-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dysphagia, Feeling hot, Hyperhidrosis, Hypoaesthesia
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Hypoglycaemia (broad), Sexual dysfunction (broad)

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

Write-up: After receiving covid vaccine, patient started sweating and feeling warm. Patient also had difficulty swallowing and ears felt numb. After a few minutes she was able to recover and feel fine.


VAERS ID: 1549846 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-12
Onset:2021-08-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Pallor, 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: NOT KNOWN
Current Illness: NONE KNOWN
Preexisting Conditions: NONE KNOWN
Allergies: NONE KNOWN
Diagnostic Lab Data:
CDC Split Type:

Write-up: PATIENT FAINTED IN THE STORE. BROUGHT PATIENT TO IMMUNIZATION ROOM AND HAD HER LIE DOWN ON BACK AND HAVE FEET UP. PATIENT WAS RESPONSIVE AFTER FAINTING, WAS PALE AND STAYED IN THE STORE FOR AN ADDITIONAL 30 MINUTES AFTER FAINTING. MD WAS NOTIFIED OF EVENT. NURSE STATED THAT ONCE SHE FELT BETTER AFTER FAINTING SHE COULD GO HOME


VAERS ID: 1549958 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: New York  
Vaccinated:2021-08-12
Onset:2021-08-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Facial pain, Fall, Glossodynia
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Accidents and injuries (narrow), Glaucoma (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: Patient received vaccine at 1513, walked to observation area, upon sitting, fell to the ground. Within 1min of being approached was able to verbally answer questions. Patient complained of pain on right side of face and tongue. Vital signs were initiated, WNL, patient was provided ice packs, water and crackers; moved to a cooling center after she stated she was feeling better. EMS arrived on site at 1525, took over. Patient was encouraged to go to hospital, patient declined, was educated to follow up with primary healthcare provider. Patient left at 1535 with father, who was driving.


VAERS ID: 1549962 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-12
Onset:2021-08-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002F21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Hyperhidrosis
SMQs:, Neuroleptic malignant syndrome (broad), 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 reported
Current Illness: None
Preexisting Conditions: ADHD
Allergies: None
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: After receiving Moderna Covid-19 vaccine patient felt dizzy while waiting in the post vaccination area and was about to fall from the chair. Pharmacy team rushed to help. Patient was sweating and felt dizzy. She was asked to lie a on the floor facing comfortably. Patient did not had any difficulty breathing or any other symptoms. 911/Paramedics were called right away, who came and took her vitals which came out normal. They suggested that patient do not have to be taken to the hospital. Patiet''s sister came and picked up the patient. Pharmacist followed up on patient''s condition latwer in the afternoon, patient mentioned that she was doing fine.


VAERS ID: 1549964 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: New York  
Vaccinated:2021-08-12
Onset:2021-08-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dizziness, Flushing, Headache, Paraesthesia
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad), Hypersensitivity (broad)

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

Write-up: Patient Complained of dizziness, denies shortness of breath and/or chest pain provided fluid and ice pack. Vital signs started, legs elevated. Kept patient for extra time. At 5:30 pm, patient complained of severe headaches, tingling of extremities, and flushed. Patient was placed on the floor from chair as a precaution, patient placed on right side position. At 5:45 pm Ems was activated. EMS arrived at 6:01 pm. Patient left on stretcher with sister and siblings on an ambulance.


VAERS ID: 1549970 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-12
Onset:2021-08-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939902 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: VOMITING


VAERS ID: 1549977 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-08-12
Onset:2021-08-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest discomfort, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (broad)

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

Write-up: Pt with hx of severe allergic reactions was administered pfizer Covid-19 immunisation, Lot #FD8448, mfr exp 10/31/2021, member reported getting clearance from outside of KP allergist prior to scheduling appointment. Patient kept in holding room under RN super vision. 30 minutes post injection, member reported tighetening of throat and middle of chest. Vital signs stable, 02 sat 100%, patient able to speak in complete sentences, lung sounds clear bilaterally and patient did not appear to be in distress. Pt reported these symptoms have been start of severe allergic reaction in the past. DOD Dr. notified, benadryl 25mg IV ordered and administered. Patient reported symptoms stopped worsening after benedryl, DOD assessed pt after benadryl injection, and ordered solumedrol 125mg IV. Pt observed another 20 minutes after injection, reported symptoms greatly improved. Pt discharged home, advised by Dr. to take otc antihistamine and prescribed prednisone short pack. Patient advised to call Advice Line if symptoms returned or 911 if severe.


VAERS ID: 1549984 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-08-12
Onset:2021-08-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injury associated with device
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: n/a
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: n/a
Diagnostic Lab Data: none
CDC Split Type:

Write-up: patient received full dose of vaccine (syringe was drawn up to proper dose and injected) without any spillage or missed dose. after plunger was fully emptied into patient''s arm, the needle of the syringe detached from the barrel (during the process of pulling the needle out of the arm). patient had no reaction, just reporting this to be on file


VAERS ID: 1549990 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-08-12
Onset:2021-08-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Needle issue, 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: n/a
Current Illness: no
Preexisting Conditions: unknown
Allergies: no
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: patient received full dose of vaccine (syringe was drawn up to proper dose and injected) without any spillage or missed dose. after plunger was fully emptied into patient''s arm, the needle of the syringe detached from the barrel (during the process of pulling the needle out of the arm). patient had no reaction, just reporting this to be on file


VAERS ID: 1549995 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: New York  
Vaccinated:2021-08-12
Onset:2021-08-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: No adverse event
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: n/a
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: n/a
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient did not report any side effects yet.


VAERS ID: 1549997 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Nevada  
Vaccinated:2021-08-12
Onset:2021-08-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: according to patient, but did not occur on his 1st covid vaccine
Other Medications: unknown
Current Illness: no
Preexisting Conditions: no
Allergies: no
Diagnostic Lab Data:
CDC Split Type:

Write-up: after 5 minutes of the patient''s 2nd dose covid vaccine, i heard that this patient fainted and when i look at him he was sitting on the floor. i asked him what happened and if he had a vaccine and he said yes. he said he fainted and said he bumped his head. and he mentioned that everytime he has a vaccine he sometimes feel dizzy. but he said on his 1st vaccine he did not faint. he seems fine so i ask him if he wants to seat down and he said he''s fine. we told him one of the employee called paramedics.


VAERS ID: 1550000 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-08-12
Onset:2021-08-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hyperhidrosis, Pallor, 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: paleness, sweating ,fainting


VAERS ID: 1550001 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-08-09
Onset:2021-08-12
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 2 LA / IM

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

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

Write-up: Patient described a red circular area near the site of injection on the left arm. Patient stated that it was itchy and irritated. She stated that this rash developed after the second dose of her COVID-19 Vaccine (Pfizer).


VAERS ID: 1550007 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-08-12
Onset:2021-08-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Dizziness, Feeling hot, Hyperhidrosis, Nausea, Visual impairment, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

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

Write-up: Patient felt light headed, her vision went dark, felt n/v, hot sweaty . we have her sat on the floor, got her some water and some pretzels. She felt better after awhile and begin to feel better after .


VAERS ID: 1550166 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-06-04
Onset:2021-08-12
   Days after vaccination:69
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 UN / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 5 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Chest X-ray abnormal, Lung opacity, Malaise, SARS-CoV-2 test positive
SMQs:, Interstitial lung disease (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: See EMR
Current Illness:
Preexisting Conditions: on immunosuppressants for heart tx (from iatrogenic heart disease secondary to radiation for breast ca)
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt presented to hospital with positive COVID status s/p full vaccine completed in June. pt is symptomatic, with apparent GGO on CXR


VAERS ID: 1550169 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-08-12
Onset:2021-08-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blindness, Hypotonia, Loss of consciousness, Seizure, Tinnitus
SMQs:, Torsade de pointes/QT prolongation (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Glaucoma (broad), Optic nerve disorders (broad), Retinal disorders (broad), Hearing impairment (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

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

Write-up: Pharmacist described it as a seizure. Went unconscious, lost muscle control, lost vision and had ringing in ears.


VAERS ID: 1550170 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-12
Onset:2021-08-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 0337C21A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Cold sweat, Dizziness, Dry skin, Hyperhidrosis, Pallor, Skin warm
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No use of medications reported by client.
Current Illness: none reported by client
Preexisting Conditions: History of heart murmur during high school reported by client. Per client, his doctor was not able to hear murmur during last physicial and was told that heart murmurs may come and go.
Allergies: tree pollen, no other allergies reported by client
Diagnostic Lab Data: None preformed at this site.
CDC Split Type:

Write-up: Client received his 1st dose Moderna COVID vaccine (LOT# 037C21A, exp: 09/01/2021) at approximately 1519. Lead RN, noted client sitting in observation area with EMT . Lead RN approached EMT and client. Per EMT, client approached EMT and stated that he was feeling sweaty. EMT had the client sit nearest available seat. Client''s skins were pale, clammy, and warm. At 1319, vital signs were taken in sitting position: BP: 122/78, HR: 64, and RR14. Client reports he began to feel sweaty about 5 minutes after receiving vaccination and noted he felt dizzy for about about 1 minute. At 1321, client transferred to zero gravity chair. At 1322, client reported " I am feeling much better" and that his symptoms resolved completely. Client reports he last ate at approximately 1200 and notes he had cereal and coffee. Client denies any other symptoms of shortness of breath, chest pain, palpitations, numbness or tingling, itchiness, or nausea. Client reports allergies to tree pollen, but denies any other allergies to medications or foods. Client reports history of heart murmur and denies use of medications at this time. Vital signs were taken at 1330 in seated position: BP 122/90, HR: 56, RR:14 and skins were pink, warm and dry. At 1345, another set of vital signs were taken: BP 122/84, HR: 56, and RR 12. Co-Lead RN checked in with client at 1545, and client reported he is feeling well and does not have any complaints. Client left observation area at 1545 following 30 minute observation from onset of symptoms. Client walking with a steady gait.


VAERS ID: 1550172 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Hawaii  
Vaccinated:2021-01-11
Onset:2021-08-12
   Days after vaccination:213
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1686 / 2 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1284 / 1 LA / 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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: tested Covid Positive on 8/11/2021 , Patient Asymptomatic


VAERS ID: 1550173 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-08-12
Onset:2021-08-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypoaesthesia oral
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre 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: na
Current Illness: na
Preexisting Conditions: hypertension
Allergies: SMZ
Diagnostic Lab Data: na
CDC Split Type:

Write-up: patient complained of tongue and mouth feeling numb


VAERS ID: 1550181 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-12
Onset:2021-08-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Feeling hot, Heart rate increased
SMQs:, Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dehydration (broad)

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

Write-up: At approximately 1624, patient reported feeling warm and heart racing. RN assessed patient. Patient denied signs and symptoms of anaphylaxis. Patient reported no known allergies and no current medications. At 1624, LVN assessed patient vital signs: blood pressure 136/96 mmHg, pulse 80 beats/minute, and SpO2 100%. Patient given cool pack. Patient placed cool pack on chest. At 1628, patient denied feeling warm and heart racing. At 1630, patient given water. Patient able to drink water. At 1640, LVN reassessed patient vital signs: blood pressure 115/77 mmHg, pulse 66 beats/minute, and SpO2 99%. Patient denied feeling warm and heart racing. LVN educated patient on signs/symptoms of when to seek emergency care, to follow up with primary care provider, and to sign up on v-safe. At approximately 1648, patient left facility with unlabored respirations and steady gait.


VAERS ID: 1550182 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Hawaii  
Vaccinated:2021-01-13
Onset:2021-08-12
   Days after vaccination:211
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1283 / 2 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1284 / 1 LA / 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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: covid Positive


VAERS ID: 1550184 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-08-12
Onset:2021-08-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 LA / IM

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

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

Write-up: Patient felt dizzy and light headed. she also said she felt tingling in her fingers and cramping in her legs. We called 911. while waiting for paramedics, I sat with her. She was able to hold a conversation with me coherently the entire time we spoke. Paramedics arrived and checked her vitals. everything was normal. pt did not want to be transported to ER at that point. Paramedics felt comfortable with her decision. I spoke to her afterwards, she seemed fine and ready to go home


VAERS ID: 1550188 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Hawaii  
Vaccinated:2021-08-12
Onset:2021-08-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052E21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cold sweat, Fatigue, Gaze palsy, Hyperhidrosis, Nausea, Pallor
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: 3 minutes after receiving the vaccination patient started feeling nauseous and clammy. 6 minutes after that, patient eyes started rolling back, he felt very tired, and got sweaty/pale. Patient got taken to the ER by EMS.


VAERS ID: 1550197 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-08-12
Onset:2021-08-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fall, Head injury, Tongue biting
SMQs:, Convulsions (broad), Accidents and injuries (narrow), Generalised convulsive seizures following immunisation (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: Patient received vaccine and was seated in a chair waiting for 15 minute observation period, after about 5 to 10 minutes patient fell out of chair and hit head on ground and bit his tongue, 911 was called and he was taken via ambulance to hospital for further evaluation


VAERS ID: 1550199 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-07-27
Onset:2021-08-12
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 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: Patient''s mom mistakenly provided incorrect date of birth (12yo instead of 11yo) when patient received the first dose. When spoke with patient''s doctor, she said patient is not experiencing any side effects and not to give 2nd dose until patient turns 12 yo


VAERS ID: 1550400 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-08-12
Onset:2021-08-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052E21A / 1 LA / IM

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

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

Write-up: Customer did not notify pharmacist that he had already received two doses of Pfizer Covid vaccine previously. It was also not documented in vaccine database. Moderna single dose # 1 was administered, then customer notified pharmacist that he was wanting a "booster" shot since he had already gotten two doses. He was aware that the booster shots were not authorized at this time. He had not reported any adverse effects from receiving the Moderna vaccine.


VAERS ID: 1550404 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-08-12
Onset:2021-08-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: amoxil 500mg tid10d
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Pt was given immunization about 30 minutes after 6 hour puncture window. Contacted manufacturer. Representative stated that their internal data shows that the immunization maintains potency for 24 hours at 2-30 degrees Celsius and and instructed to use our own judgement. Have not been able to contact the patient yet but will recommend not to repeat first dose and according to manufacturer data she should not experience any untoward effects and immunization should be effective.


VAERS ID: 1550413 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-08-12
Onset:2021-08-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002F21A / 1 LA / IM

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

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

Write-up: Patient experienced syncopy (faintness) after 5 minutes of getting the vaccine and was unconscious for roughly 1 minute. No other symptoms.


VAERS ID: 1550415 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-12
Onset:2021-08-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: patient presented vaccine card for second dose Pfizer vaccine ( 1ST DOSE GIVEN AT DIFFERENT CLINIC), when asked aged patient and mom confirmed 12 years old. upon processing vaccine patient was flagged for age 11 through insurance
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: GIVEN VACCINE UNDERAGE


VAERS ID: 1550424 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-08-11
Onset:2021-08-12
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Body temperature increased, Chest discomfort, Crying, Cyanosis, Dyspnoea, Eructation, Fatigue, Feeling cold, Headache, Heart rate increased, Hyperhidrosis, Nausea, Pain, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Depression (excl suicide and self injury) (broad), Hypotonic-hyporesponsive episode (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad)

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

Write-up: Typical symptoms: whole body aches, headache, nausea, chills, sweats, high temp, burping, vomiting, fatigue Adverse: chest pressure, shortness of breath, bluish nails Pediatrician was called, advised to call 911. Paramedics came?could not catch breath and was having chest pressure, she was crying in pain. They found oxygen level good, elevated heart beat. Within 30 mins, back to normal. Told to go to ER if it continued. Spiked high temp 101.8 for a while and sweating profusely. Then felt better.


VAERS ID: 1550427 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-11
Onset:2021-08-12
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin C, Zinc, Vitamin D
Current Illness: Osteoporosis, cardiomegaly after COVID-19 at the beginning of April 2021
Preexisting Conditions: Osteoporosis, cardiomegaly, COVID-19 after effects
Allergies: Not that we know of
Diagnostic Lab Data: Not done any yet
CDC Split Type:

Write-up: Fever over 99.9 F, chills, body aches


VAERS ID: 1550436 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-12
Onset:2021-08-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Chest discomfort, Chills, Dizziness, Feeling of body temperature change, Heart rate decreased, Somnolence, Tremor
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (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: Unknown
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Client reported chest tightness and a decreasing heart rate. The client reported a declining HR based off an app on his phone. The client also reported feeling hot and cold. The client ambulated unassisted and sat down in an anti-gravity chair. Reclined the anti-gravity chair with the client seated. The client denied any shortness of breath. Vitals obtained at 5:12 PM were as follows: automatic BP 149/88, HR 53, O2 98%. The client denied any chronic conditions. The client does not take any medications regularly. The client has an allergy to Tramadol where he reports a rash on his face. The client also reported dizziness. The client stated he has been drinking water throughout the day and ate at about 1 PM. At 5:14 PM the client denied any other s/s of anaphylaxis. The client reported mild persistent dizziness and was still feeling hot and cold. The client was provided a cool pack on the back of his neck. The client stated "I feel my body shaking" like "shivers." The client denied any numbness in his hands bilaterally. Vitals obtained at 5:14 PM were as follows: HR 58, BP 144/98, O2 98%. The client denied any persistent chest tightness at that time. At 5:12 PM the client stated "I feel much better." The client then reported feeling "sleepy." The client was alert and oriented to person, place, time, and situation. The client stated he drove himself today, but lives about 3 minutes away. Vitals obtained at 5:23 PM were as follows: HR 57, O2 97%, and BP 150/93. The client stated he does not know his regular BP. Manual HR obtained by RN was 50 BPM. Radial pulse 2+ bilaterally. Vitals obtained at 5:28 PM were as follows: HR 51, automatic BP 151/95, O2 98%. Asked if the client felt sleepy and he replied "not too much." The client denied any other s/s of anaphylaxis. The anti-gravity chair was adjusted so the client was sitting upright. Repeat vitals obtained at 5:30 PM were as follows: manual BP 130/80, and manual HR 60 bpm. Educated the client regarding s/s of anaphylaxis and when to seek EMS. Recommended the client follow up with PCP regarding BP. The client voiced understanding of this education. The client stated he felt safe to drive home. The client denied any persistent symptoms. The client stood up unassisted. The client left the vaccination site unassisted with a steady gait.


VAERS ID: 1550653 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-08-12
Onset:2021-08-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 RA / SYR

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

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

Write-up: Tinnitus


VAERS ID: 1550663 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-08-12
Onset:2021-08-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 2 LA / IM

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

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

Write-up: Patient approached the counter about 15 minutes after her second Pfizer Covid Vaccine and stated that her tongue was swollen and her throat may have been a little swollen. I gave her a dose of 25mg of Benadryl and requested remain with me for longer observation. We discussed the protocol for epinephrine use. Patient was still breathing normally and was not having any worsening of symptoms. Approximately 30 minutes after the antihistamine dose, she stated her throat felt a little better, but still did not feel completely normal. She remained at the pharmacy for a little over 2 hours. Since she had not had any worsening of symptoms during that time, I told her that she could leave, but to notify her husband that she was on her way home and recommended famotidine and Benadryl tonight. Additionally, if she did start having any worsening of symptoms, then call 911 and activate the emergency response. We will follow up with her in the morning.


VAERS ID: 1550669 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-08-12
Onset:2021-08-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Dysstasia, Nausea
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (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: n/a
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: nkda
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received the COVID-19 vaccine at 5:17 pm. At 5:22 pm she said she was feeling dizzy, nauseated, fainting feeling. She couldn''t stand up. Her BP was 70/41 with pulse 70 at 5:26 pm, then 87/58 with pulse 77 at 05:33 pm. EMT arrived at 05:35 and her vials improved to 110/80 with pulse 78. She recovered and didn''t need assistance from EMT.


VAERS ID: 1550851 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-08-12
Onset:2021-08-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: About 10-15 minutes after receiving vaccine, patient was still shopping at store and collapsed/lost consciousness at self checkout registers. Paramedics arrived shortly after to help patient. Was told patient regained consiousness but was told not to get up and paramedics assisted him with getting out of store.


VAERS ID: 1550858 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-08-12
Onset:2021-08-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203AZ1A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Computerised tomogram, Dizziness, Drug screen, Immediate post-injection reaction, Laboratory test, Syncope, Urine analysis
SMQs:, Torsade de pointes/QT prolongation (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Drug abuse and dependence (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (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: Patient reports none.
Current Illness: No past medical history reported by patient
Preexisting Conditions: None
Allergies: NKA
Diagnostic Lab Data: Labs (8/12/2021), CT scan (8/12/2021), Urine (8/12/21), UDS (8/12/21)
CDC Split Type:

Write-up: dizziness immediately following vaccination, followed by syncopal episode


VAERS ID: 1550870 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: New York  
Vaccinated:2021-08-05
Onset:2021-08-12
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Condition aggravated, Dizziness, Fatigue, Headache, Injection site erythema, Injection site induration, Injection site pruritus, Injection site rash, Injection site swelling, Meniere's disease, SARS-CoV-2 test, Tinnitus, Vestibular disorder
SMQs:, Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hearing impairment (narrow), Vestibular disorders (narrow), Hypersensitivity (narrow), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None other than Daily vitamin.
Current Illness:
Preexisting Conditions: Meniere''s Disease. Chronic hearing loss.
Allergies: Latex, Ceclor
Diagnostic Lab Data: Rapid Covid Test performed on 08/11/2021 to rule out exposure to infection as a result of severe side effects from first dosage.
CDC Split Type:

Write-up: Received rash, hard bump, redness, and itching at injection site on Day 7 following injection. Also experienced headache and dizziness minutes after receiving injection on site. Extreme fatigue lasting days, but seemed to improve by Day 6. Vestibular Condition - Meniere''s Disease - Tinnitus started to occur and is still ongoing on Day 8.


VAERS ID: 1550872 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-08-12
Onset:2021-08-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypoaesthesia, Muscle tightness, Pain in jaw, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Osteonecrosis (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Women?s one a day, 75 synthroid, nerco birth control
Current Illness: N/A
Preexisting Conditions:
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: By 8 hours post vax facial tingling. By 9 hours, some numbness to the nose and chin. Some pain or tightness to the lower jaw.


VAERS ID: 1550875 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Alaska  
Vaccinated:2021-08-12
Onset:2021-08-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Not available
Current Illness: Not available
Preexisting Conditions: Transplant patient
Allergies: No allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received 3rd dose of Pfizer after denying ever receiving the vaccines series prior.


VAERS ID: 1550877 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-08-11
Onset:2021-08-12
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH #FC3180 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Chest pain, Headache, Sensory disturbance
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

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

Write-up: I have a horrible headache like I?ve never had before and my chest on my left side feels really tight and I have a watery pain sensation right under.


VAERS ID: 1553388 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-12
Onset:2021-08-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Client states, "This happens every time."
Other Medications: none "I have been getting"
Current Illness: none per client
Preexisting Conditions: none per client
Allergies: nka
Diagnostic Lab Data: Vital signs by EMT on site.
CDC Split Type:

Write-up: Rec''d call to observation area. Rec''d client slumped down in chair complaining of lightheadedness and dizziness. With the assistance of another nurse, client was lowered to the floor and 911 activated. Lowered to floor and feet elevated using a chair. Client was alert and responsive, no loss of consciousness, stated, "This happens all the time whenever I get a shot or medical procedure my nerves first give out." EMT arrived and took over. Vitals: BP 122/74, pulse 94, resp. 26 and pulse Ox 97% on room air. Pale complexion. Client stated she has been for almost 24 hours. Per EMT blood sugar was 106 and transferred to ambulance by EMTs for observation at 4:20 pm. At 4:32 pm Rec''d follow report from EMT stated client was stable and cleared to go home. No hospital transfer.


VAERS ID: 1553390 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Female  
Location: New Hampshire  
Vaccinated:2021-08-12
Onset:2021-08-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Paraesthesia oral, Pruritus
SMQs:, Anaphylactic reaction (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (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:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Systemic: Allergic: Itch (specify: facial area, extremeties)-Mild, Additional Details: Says tongue felt tingly? Took benadryl they had from home. RPh monitored regularly and patient otherwise acting completely fine. Advised she could wait in store until she felt better. After about 45 minutes patient went home.


VAERS ID: 1553423 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-08-12
Onset:2021-08-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Peripheral swelling
SMQs:, Cardiac failure (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: swollen forearm-Medium


VAERS ID: 1553425 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Alabama  
Vaccinated:2021-08-12
Onset:2021-08-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939902 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Underdose
SMQs:, Medication errors (broad)

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

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


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