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

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



Case Details (Reverse Sorted by Onset Date)

This is page 149 out of 3,524

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VAERS ID: 1389760 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-05-03
Onset:2021-05-17
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 023C21A / 1 LA / -

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Dyspepsia, Electrocardiogram normal, Fatigue, Headache, Palpitations
SMQs:, Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific dysfunction (narrow), Cardiomyopathy (broad), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: prevalite powder, multi vitamin, celebrex
Current Illness: none
Preexisting Conditions: chronic joint pain, hips ,lower back
Allergies: penicillin
Diagnostic Lab Data: EKG WAS NORMAL 5.24.2021 THYROID BLOOD TEST 5.24.2021 NORMAL EKG NORMAL 6.10.2021 BLOOD PRESSURE GOOD, WAITING FOR AN EVENT MONITOR
CDC Split Type:

Write-up: HEART PALPATIONS, INDIGESTION,HEADACHE, FATIGUE, DIZZINESS/LIGHTHEADED, PRIMARY DR HAS PERFROMED EKG, BLOOD TEST FOR THYROID, SYSTEMS STILL CONTIUED, DIZZINESS , WENT TO CARDIOLOGIST , I HAVE BEEN A VERY HEALTHY LADY, NEVER NO PROBLEMS WITH MY HEART, SUGAR, BLOOD PRESSURE ETC.... WAITING FOR AN EVENT MONITOR


VAERS ID: 1390036 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-05-16
Onset:2021-05-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test normal, Chest pain, Echocardiogram normal, Electrocardiogram normal, Hypoaesthesia, Magnetic resonance imaging head normal, Magnetic resonance imaging neck, Magnetic resonance imaging normal, Scan with contrast normal
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: No prescriptions
Current Illness: No other illnesses
Preexisting Conditions: No chronic conditions
Allergies:
Diagnostic Lab Data: received an EKG, echocardiogram, and an MRI with dye of the neck and head, along with blood work. All tests returned normal.
CDC Split Type:

Write-up: Developed chest pain and numbness on the left side of the body. She explained it felt like lidocaine was injected all over the left side of her body. The symptoms resolved on Wednesday, May 19th when she was receiving testing for her condition.


VAERS ID: 1390039 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Female  
Location: California  
Vaccinated:2021-04-24
Onset:2021-05-17
   Days after vaccination:23
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Herpes zoster
SMQs:, Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Many Rxs but not the cause
Current Illness: Chf, copd
Preexisting Conditions: Chf, copd
Allergies: No
Diagnostic Lab Data: Given anti viral and gabapentin
CDC Split Type:

Write-up: Developed Shingles. There have been numerous patients in our area that have developed shingles awhile after their 2nd vaccine. they are mainly people with compromised innume systems.


VAERS ID: 1391117 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7533 / 1 LA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Vaccination site erythema, Vaccination site pain
SMQs:

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: Comments: List of non-encoded Patient Relevant History: Patient Other Relevant History 1: None
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021664733

Write-up: Redness in the left arm; Soreness in the left arm; This is a spontaneous report received from a contactable consumer. A female patient received first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, Formulation: Solution for injection, Lot/Batch number: EP7533, Pfizer NTEC), via an unspecified route of administration in Arm Left on 17May2021 at 10:00 (age at vaccination was 54) as 1st dose, single dose for covid-19 immunisation. Medical history included and concomitant medications were not reported. The patient previously took metoprolol 50mg twice a day has been taking this medication for about 5 years for hypertension. After 1st dose of the vaccine she has been experienced redness and soreness in her arm has been persisting since the day she got her first vaccine, on 17May2021. She was not allowed to get the 2nd dose today 07June2021 due to she still have redness and soreness in the left arm and asked to secure medical clearance in order for her to get the 2nd dose she was just waiting for her primary care doctor''s response she wants to know what will happen if she was not able to get the 2nd dose on time she will be in Hawaii in 2 weeks time. Caller states that she was calling about the Covid 19 Vaccine. Stated they told her to call and report this. Caller states that she called her primary care provider. Said that she needs to get her vaccines because she was traveling soon and needs them for that. And patient said she tried to fill out the report online but had issues with the website not letting her press the enter button. Caller states she went to the emergency room this past Friday due to the pain in her left arm being worse that day. She was not admitted to the hospital. The outcome of the events was reported as not recovered.


VAERS ID: 1391202 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 1 RA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test, Pharyngeal swelling, Sinusitis, 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: SYNTHROID; MULTIVITAMIN N [AMINOBENZOIC ACID;ASCORBIC ACID;BETAINE HYDROCHLORIDE;BIOFLAVONOIDS NOS;BIOTIN;CALCI; CRANBERRY
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Allergic reaction to drug; Back injury; Hypothyroidism (It is medically induced hypothyroidism.); Lymphedema; Pre-diabetic (Verbatim: Pre-diabetic)
Allergies:
Diagnostic Lab Data: Test Name: Blood test; Result Unstructured Data: Test Result:Synthroid increased; Comments: Had bloodwork done, before the vaccine and they had just increased her dose of Synthroid over a month ago.
CDC Split Type: USPFIZER INC2021670963

Write-up: Her sinuses start draining as well; tongue and throat swelling; tongue and throat swelling; This is a spontaneous report from a contactable pharmacist from a Pfizer sponsored program. A 64-years-old female patient received bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE, Solution for injection, Batch/Lot Number: EW0176; Expiration Date: 31Aug2021), dose 1 via an unspecified route of administration, administered in Deltoid Right on 17May2021 16:00(Age at vaccination 64 years) as 1st dose, 0.3 ml single dose for covid-19 immunisation. Medical history included Pre-diabetic, Hypothyroidism (It is medically induced hypothyroidism), lymphoedema, disabled with back injury , She is allergic to other medications. Concomitant medications included syntroid (LEVOTHYROXINE SODIUM) aminobenzoic acid, ascorbic acid, betaine hydrochloride, bioflavonoids nos, biotin, calcium, calcium pantothenate, choline bitartrate, colecalciferol, copper, cyanocobalamin, folic acid, glutamic acid, hesperidin, inositol, iodine, iron, magnesium, manganese, nicotinamide, potassium, pyridoxine hydrochloride, retinol palmitate, riboflavin, rutoside, thiamine mononitrate, tocopheryl acetate, zinc (MULTIVITAMIN N) cranberry (CRANBERRY) taken for urinary tract infection. The patient did not receive any other vaccines within four weeks prior to the vaccination. On 17May2021 15 to 20 min after vaccine application the patient experienced tongue and throat swelling, her sinuses start draining as well on an unspecified date. That morning, she had taken an over the counter antihistamine and was thinking that is probably what stopped the reaction. that is her typical response when faced with something she is allergic to. She is allergic to other medications, medication she took was generic Claritin She does not remember the dose or anything else. When she looked at the CDC information on medications to find out, she did not recognize any of the meds and thought she would be safe. The patient underwent lab tests and procedures which included blood test found synthroid increased (Had bloodwork done, before the vaccine and they had just increased her dose of Synthroid over a month ago). Patient had no medications or treatments after the event occurred. The outcome of events tongue and throat swelling was recovered 10 to 15 minutes on 17May2021 . sinuses start draining outcome was unknown. Patient states that it is okay to contact her later and that her physician does not know about this. She has not contacted them yet but will see in a week or so.


VAERS ID: 1391654 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-04-26
Onset:2021-05-17
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-06-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH E6021 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW6204 / 2 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Abdominal pain upper, Anaemia, Autoimmune hepatitis, Biopsy bone marrow abnormal, Chest X-ray, Chills, Computerised tomogram abdomen abnormal, Echocardiogram abnormal, Electrocardiogram abnormal, Fatigue, Hepatomegaly, Laboratory test abnormal, Malaise, Pain, Pyrexia, Sinus bradycardia, Splenic infarction, Splenomegaly, Supraventricular tachycardia, Ultrasound abdomen abnormal
SMQs:, Liver related investigations, signs and symptoms (narrow), Hepatitis, non-infectious (narrow), Acute pancreatitis (broad), Haematopoietic cytopenias affecting more than one type of blood cell (broad), Haematopoietic erythropenia (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Disorders of sinus node function (narrow), Supraventricular tachyarrhythmias (narrow), Retroperitoneal fibrosis (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Malignant lymphomas (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 13 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Aspirin 81 mg daily, atorvastatin 10 mg daily, vitamin D 50,000 unit capsule weekly, metformin 500 mg BID, meloxicam 15 mg daily, atenolol 25 mg daily
Current Illness: None
Preexisting Conditions: HTN, DM type II, metabolic syndrome, hyperlipidemia, osteoarthritis,
Allergies: Augmentin
Diagnostic Lab Data: CT abd 5/22/21, US abd 5/22/21, chest xray 5/22/21, EKG 5/22/21, Echocardiogram 5/23/21 bone marrow bx 6/2/21.
CDC Split Type:

Write-up: Patient developed low grade fever, chills, body aching, RUQ pain, malaise, fatigue on 5/17/21. Saw PCP on 5/21/21 found to be anemic, went to ER and was admitted on 5/22/21. Splenic infarcts, Splenomegaly, and Hepatomegaly. Diagnosed with autoimmune Hepatitis after multiple tests such as bone marrow biopsies, CT scans, and labs. She also developed sinus bradycardia pauses and bouts of SVT.


VAERS ID: 1391772 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-05-16
Onset:2021-05-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal pain lower
SMQs:, Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

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

Write-up: Lower abdominal pain


VAERS ID: 1321501 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-05-14
Onset:2021-05-16
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Menstruation irregular
SMQs:, Fertility 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: Prilosec OTC Magnesium
Current Illness: None
Preexisting Conditions: GERD
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Started period 48 hours after second moderna dose - never experience irregularity in period before


VAERS ID: 1321604 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-05-15
Onset:2021-05-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / UNK LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Feeling cold, Skin warm
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: Diclofenac sodium
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: I am very warm to the touch and I feel cold


VAERS ID: 1321632 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-05-15
Onset:2021-05-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Headache, Injection site pain, Nasal congestion, Nausea, Pyrexia, Tremor, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Fever of 102.4, chills, soreness at injection site, throwing up, nausea, head ache, uncontrollable shaking, stuffy nose.


VAERS ID: 1321638 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-16
Onset:2021-05-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dyspnoea, Respiratory rate increased, Tachycardia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Dehydration (broad)

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

Write-up: SOB, rapid breathing. tachycardia on examination. Rest, normal to go home.


VAERS ID: 1321669 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-05-15
Onset:2021-05-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8734 / 1 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Dyspnoea, Hyperventilation, Hypoaesthesia, Migraine, Paraesthesia, Tenderness
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Peripheral neuropathy (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: Trival prolaspe mitro vavle and 1st degree AV block diagnosis in December 2016 - she goes for regular check ups no restrictions on life or activities
Allergies: Witch hazel
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Migraine, facial numbness and tingling central to nose and mouth area. Feeling like she was unable to breathe when ascending steps that resulted in hyperventilating which lasted 18 minutes. Normal breathing rhythm returned after 43 minutes. Right arm extremely tender. Oxygen and heart rate at 23 min were 98 for O2 and heart rate 73 BPM.


VAERS ID: 1321713 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-04-30
Onset:2021-05-16
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Cough, Nasal congestion
SMQs:, Anaphylactic reaction (broad)

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

Write-up: nasal congestion and cough


VAERS ID: 1321788 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: New York  
Vaccinated:2021-05-16
Onset:2021-05-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821286 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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 passed out for a minute after receiving vaccine . Got dizzy and fell off chair. EMS called and came. Pt left on own will after 1/2hr.


VAERS ID: 1321803 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-05-16
Onset:2021-05-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1820095 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Device connection issue, Immunisation, 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: Over half of vaccine was lost through loose needle. Dose of vaccine was repeated since over half of original dose was lost.


VAERS ID: 1321811 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-05-16
Onset:2021-05-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009C21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hyperhidrosis, Injection site pain, Injection site pruritus, Pain
SMQs:, Neuroleptic malignant syndrome (broad), Extravasation events (injections, infusions and implants) (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: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: onions
Diagnostic Lab Data: none
CDC Split Type:

Write-up: patient stated arm throbbing and itchiness at injection site and down his arm. he was also had sweaty palms. described it as the itchiness after being stung by a bee. Gave the patient something to eat, a bottle of water. and gave the patient one 25mg Benadryl .


VAERS ID: 1321812 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-16
Onset:2021-05-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EE8736 / 1 - / -

Administered by: Public       Purchased by: ?
Symptoms: Immediate post-injection reaction, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (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? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None
Allergies: Nka
Diagnostic Lab Data:
CDC Split Type:

Write-up: Syncopal episode immediately after dose. Patient recovered to baseline within 10 minutes.


VAERS ID: 1321846 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-05-16
Onset:2021-05-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Loss of consciousness, Pallor, Pulse abnormal, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), 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: unknown
Preexisting Conditions: unknown
Allergies: unknown-penicillin
Diagnostic Lab Data: EMS took pt to hospital
CDC Split Type:

Write-up: vomiting, passing out; 5-10 min post vaccination, pt became diaphoretic, pale, thready -palpable pulse, began to lose consciousness, ems called to eval. pt. RN/EMS lowered to the floor-pt put on side and he vomited. regained consciousness after vomiting- EMS transported hospital


VAERS ID: 1321849 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-05-16
Onset:2021-05-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022C21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Dizziness. Seen by an onsite EMS. Discharged home at 12:40 p.m. Recorded by employee.


VAERS ID: 1321860 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-05-16
Onset:2021-05-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Injection site pain, Pain in extremity
SMQs:, Extravasation events (injections, infusions and implants) (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: pain above injection site, mild below distal extremity. no swelling or discoloration. Pt. tensed up during the time of the vaccination. Ice pack applied


VAERS ID: 1321863 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-05-16
Onset:2021-05-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 LA / IM

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

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

Write-up: Patient did not remain seated for 15 minutes post-vaccination as instructed. He fainted and hit his head. He regained consciousness quickly, but remained diaphoretic with bradycardia. He was provided water and an icepack, and he was instructed to lay flat with legs elevated until he recovered.


VAERS ID: 1321870 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-05-16
Onset:2021-05-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 1 RA / 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? 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: unknown
Allergies: n.a
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt had nothing to eat or drink today. pt. reported he was light headed. BP:122/75 HR:81 O2:98


VAERS ID: 1321878 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-05-16
Onset:2021-05-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fall, Hypotension, Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), 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), Dehydration (broad), Hypokalaemia (broad)

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

Write-up: Patient lost consciousness for under one minute. When he lost consciousness his blood pressure dropped and he fell forward (didn''t hit the floor). He was given water to bring up his blood pressure and cool rags to cool him off.


VAERS ID: 1321879 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-05-16
Onset:2021-05-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21 / 1 LA / IM

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

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

Write-up: about 1 minute after receiving vaccine patient fainted for about 30 seconds. I touched her hand and she came to. Her husband came in to be with her and we gave bottled water. She sat in chair about 15 minutes and went home with her husband


VAERS ID: 1321880 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-05-15
Onset:2021-05-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0169 / 1 - / -

Administered by: Public       Purchased by: ?
Symptoms: Fatigue, Injection site pain, Oropharyngeal pain
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Extravasation events (injections, infusions and implants) (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Women''s One-a-Day multivitamin
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Tired, minor sore throat, soreness at injection site (upper left arm)


VAERS ID: 1321886 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-05-16
Onset:2021-05-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Feeling jittery, Headache
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: BP:128/76 HR:80 02:98 headache and jittery. strong pulse, alert, does not like crowds and the vaccine. EMS REFUSAL


VAERS ID: 1321894 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-05-16
Onset:2021-05-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dizziness, Hypoacusis, Visual impairment
SMQs:, Anticholinergic syndrome (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Hearing impairment (narrow), Vestibular disorders (broad), Hypoglycaemia (broad)

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

Write-up: PT REPORTED BEING DIZZY, SAW SPOTS, HEARING WAS MUFFLED BP: 90/70 HR:88 02:98 PT. OFFERED WATER AND WAITED IN OBSERVATION LONGER-SIGNED WAIVER AND LEFT ON THIER OWN


VAERS ID: 1321896 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-05-16
Onset:2021-05-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 1 RA / IM

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

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

Write-up: PT REPORTED BEING DIZZY AND A HEADACHE. PATIENT REPORTED BEING NERVOUS BP: 140/80 HR:75 02:98


VAERS ID: 1321904 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-05-16
Onset:2021-05-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood glucose, Feeling hot, Loss of consciousness, Seizure, Syncope
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), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

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

Write-up: Patient received her first dose of the Pfizer Covid-19 vaccine. While waiting for observation, patient started to faint and seized. She also reported being hot and asked to take off her sweater. Paramedic was called and patient was taking to the nearby hospital. Patient reported black out while sitting on her chair, though by the time paramedic finish with the transportation patient reported vision recovery.


VAERS ID: 1321909 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-05-16
Onset:2021-05-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 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: none
Current Illness: none but she smokes
Preexisting Conditions: Bipolar 2 Ehlers-Danlos Syndrom
Allergies: none
Diagnostic Lab Data: I called 911 but patient asked me to cancelled it as she felt fine and didn''t need ambulance , I called patient couple of hours later she was fine and didn''t seek any medical facilities so as far as I know no medical test are done.
CDC Split Type:

Write-up: Syncope ,temporary loss consciousness for less than 1 minute I think was so short.


VAERS ID: 1321911 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Oklahoma  
Vaccinated:2021-05-16
Onset:2021-05-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 035C21A / 1 LA / IM

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

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

Write-up: 19 year old patient came to pharmacy with dad to get first dose of Moderna Vaccine. Questionnaire was completed online with no''s to all questions. Patient was sitting in booth and seemed comfortable while getting vaccine, but immediately after started to lean towards wall and faint. Patient''s father and I supported patient so he didn''t fall and injure himself. Patient was nonresponsive for about 5 to 10 seconds before he became responsive. He was able to sit by himself after about 1 minute of support from his dad. Patient was given water and waited 15 minutes in the booth while being monitored. He seemed to be himself after about 5 minutes. During those 15 minutes I talked to patient''s dad about patient''s medical history. He may had 1 seizure when he was younger due to ADHD medication but test results did not confirm it as a seizure. He also passed out one time in high school while watching biology movies with blood. Discussing this incident with the father and patient, we agreed this patient seems to have suffered from syncope due to fear of needles. I gave his father my business card and told him to call me if the patient reported any symptoms after leaving or if he had any questions whatsoever. I let them know I would be reporting this to VAERS and encouraged him to follow up with his PCP about this incident.


VAERS ID: 1321916 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Rhode Island  
Vaccinated:2021-05-16
Onset:2021-05-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A211A / 1 LA / IM

Administered by: Other       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? 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: Dizzy sweaty


VAERS ID: 1321919 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-05-16
Onset:2021-05-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal discomfort, Malaise, Syncope, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Fainting / Unresponsive-Mild, Additional Details: Patient seemed to have a faiting spell about 10 minutes after vaccine was given, patient came too and felt "sick to his stomach", patient stated he felt okay, but once paramedics came, mom wanted him to go to with them to the hospital.


VAERS ID: 1321924 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-05-16
Onset:2021-05-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 1 LA / IM

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

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

Write-up: Error: Incorrect Reconstitution


VAERS ID: 1321926 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Michigan  
Vaccinated:0000-00-00
Onset:2021-05-16
Submitted: 0000-00-00
Entered: 2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 1 RA / SYR

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

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

Write-up: Pt was feeling faint and lost color for a minute. We gave him juice, water and he ate a snickers bar. After 15 minutes he was feeling better and left with his mom.


VAERS ID: 1321938 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-16
Onset:2021-05-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Per vaccinator, vaccination needle separated from syringe. No vaccine received by patient. Dose readministered.


VAERS ID: 1321944 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-05-16
Onset:2021-05-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Seizure, Syncope, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

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

Write-up: Syncope, seizure lasting less than 5 min, vomiting


VAERS ID: 1321948 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-16
Onset:2021-05-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: As per vaccinator, vaccination needle got separated from syringe and vaccination came all over patients arm. Patient didn?t receive vaccination. Dose was readministered to patient.


VAERS ID: 1321951 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-05-16
Onset:2021-05-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood glucose normal, Nervousness, Seizure, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

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

Write-up: Patient has a seizure history. Mother stated they have had numerous vaccines in the past without a problem though. Patient was waiting the period of time afterwards. Mother then stated she was having a reaction. Mother stated she is a nurse and said she believed the patient was having a seizure. Mother later was not sure if patient had fainted also since she was nervous about receiving the shot in the first place. After paramedics arrived, they took her glucose and was 77. Paramedics let mom then take patient home to get food.


VAERS ID: 1321961 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-05-16
Onset:2021-05-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022B21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fall
SMQs:, Accidents and injuries (narrow)

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

Write-up: Post vaccination, patient tried to stand up and had a fall. Patient was conscious not requiring any treatment. Ambulance was called but the service was not needed. Patient was accompanied by his father


VAERS ID: 1321971 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: New York  
Vaccinated:2021-05-16
Onset:2021-05-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

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

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

Write-up: Urticaria


VAERS ID: 1321972 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-16
Onset:2021-05-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0161 / 2 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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: PATIENT REPORTED IRON DEFICIENCY THAT MIGHT HAVE BEEN GOING ON FOR SERVERAL MONTHS AND NOT CURRENTLY TAKING ANY IRON SUPPLEMENT
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: PATIENT FAINTED WITHIN 5 MINUTES OF VACCINE, BUT REGAINED CONSCIOUSNESS QUICKLY. PATIENT APPEARED PALE. PATIENT REMAINED SEATED FOR 30 MINUTES AND PARAMEDICS ARRIVED TO CONDUCT EVALUATION OF PATIENT.


VAERS ID: 1321988 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-05-16
Onset:2021-05-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3302 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Exposure during pregnancy
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow)

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

Write-up: PATIENT REPORTS DISCUSSING VACCINE WITH HER OBGYN. OBGYN ADVISED HER TO WAIT UNTIL SECOND TRIMESTER AND PT OPTED TO WAIT UNTIL LATE SECOND TRIMESTER--SHE IS 17 1/2 WEEKS PREGNANT. PATIENT RECEIVED VACCINE WITH NO APPARENT DISTRESS. PATIENT WAS ADVISED TO WAIT IN THE STORE FOR 15 MINUTES FOR MONITORING. SHE WALKED OVER TO COSMETICS TO SHOP BRIEFLY THEN REPORTS FEELING A LITTLE "LIGHT HEADED" SO SHE WAS RETURNING TO PHARMACY TO SIT DOWN WHEN SHE BECAME DIZZY AND LOWERED HERSELF TO THE GROUND IN A SOMEWHAT CONTROLLED FASHION. RPH RENDERED AID AND CONTACTED EMS FOR FURTHER EVALUATION. PATIENT SAID SHE FELT FINE OTHERWISE AND WAS NO LONGER FEELING DIZZY. RPH ADVISED PT TO REMAIN UNTIL EMS COULD EVALUATE. EMS ARRIVED TO SCENE AND ASSESSED PT''S VITALS. PATIENT WAS RELEASED TO HER HUSBAND AND LEFT WITHOUT ASSISTANCE. PATIENT WAS ADVISED TO FOLLOW UP WITH OBGYN FOR FURTHER EVALUATION.


VAERS ID: 1321992 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-05-16
Onset:2021-05-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: 04/24/2021 Pfizer Covid vaccine
Other Medications: unknown
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: unknown
CDC Split Type:

Write-up: Patient was given Pfizer Vaccine on 5/16/21 at 11:00-11:10am. I read through the patient medical history through the handheld and noticed there was "yes" on seizure history. I ask the mother what happened and she told me it was from the first incident with the Pfizer vaccine. At the time of the first incident the mother stated that patient fainted and convulsed upon regaining consciousness. Patient has had no history of seizures prior to then or had any big injuries that could trigger it. Patient''s mother states physicians think it''s triggered by anxiety and not a true seizure, so MRI or tests was not needed. Doctor recommended patient to come back if it happens again. With the information provided I used professional judgement and was on high alert with the patient. After administrating the vaccine to the patient, I monitored patient''s vitals carefully. Patient was stable and I walked with him to his seat near the wall and left him with his family. About a few minutes later the mother told me to come to her aid. Patient had a 1 time continuous seizure for about 30 seconds-1minute. After regaining consciousness the patient said he did not remember getting the vaccine. Patient''s mother was very concerned and under control and did not overreact to the situation. Also, I promptly relayed to (pharmacist) to call 911 and he called a member of management. While pharmacist was on the phone with 911 the patient regained consciousness. I monitored patient''s vitals while I waited for a member of store management. Store management took a little bit longer to respond (5-10 minutes) but arrived to document the whole incident. About 30 minutes after the incident patient''s vitals were stable and the ambulance was not needed and the family took him to the hospital to get monitored. Patient rode the electric wheelchair was escorted out by store management to the car.


VAERS ID: 1322000 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-05-16
Onset:2021-05-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027C21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Immediate post-injection reaction, Injection site pain, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)

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

Write-up: IMMEDIATE "BURNING" PAIN AT SIGHT OF INJECTION, WHICH SPREAD DOWN LEFT ARM, NOT REACHING ELBOW, THEN ACROSS TOP OF LEFT SHOULDER, BUT NOT PAST NECK. AFTER 5 MIN. THEN FELT TINGLING IN LEFT FINGERS. AT 1:26 PM, PT SAYS THAT THE BURNING, SHOOTING PAIN WAS GONE, LEAVING ONLY A SLIGHT BURN AT THE SITE OF INJECTION AND NO TINGLING. PT LEFT AROUND 1:40 PM TO GO TO THE BATHROOM.


VAERS ID: 1322004 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-05-16
Onset:2021-05-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain upper, Eye movement disorder, Headache, Muscular weakness, Posture abnormal
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ocular motility 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: None reported
Current Illness: None reported
Preexisting Conditions: None reported
Allergies: None reported
Diagnostic Lab Data: EMTs ran basic tests on vitals upon arrival. All in normal range.
CDC Split Type:

Write-up: Approx 6-7 min after receiving vaccine in left arm. Patient''s mother expressed concern about her daughters reaction. She complained of headache, stomachache, weakness in her legs and her eyes rolled back in her head and her head dropped.


VAERS ID: 1322016 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-16
Onset:2021-05-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / UNK LA / -

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:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient fainted post vaccine and was out for about 10 seconds, and then came to. After waiting 15 minutes, drinking some water, and eating a light snack, patient was fine.


VAERS ID: 1322022 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-05-16
Onset:2021-05-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003C231A / 2 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Blood pressure increased, Immediate post-injection reaction, Palpitations
SMQs:, Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Hypertension (narrow), Cardiomyopathy (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: 1207 heart racing BP 164/88, HR 104, Resp 18, Sats 97%. Laid on cot in tx area 1217 BP 151/84, HR 84, Resp 18 Symptoms improved 1227 symptoms resolved, sat in chair BP 150/80, HR 80, sats 98, Resp 17. 1232Left ambulating with daughter for home.


VAERS ID: 1322032 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-05-16
Onset:2021-05-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821286 / 1 LA / IM

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

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

Write-up: PATIENT BECAME LIGHT HEADED, FELT LIKE SHE WAS GOING TO PASS OUT.


VAERS ID: 1322042 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: New York  
Vaccinated:2021-05-15
Onset:2021-05-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Haemorrhoids, Rectal haemorrhage
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Gastrointestinal haemorrhage (narrow), Ischaemic colitis (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: rectal bleeding from interanl hemorrhoid


VAERS ID: 1322047 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-05-16
Onset:2021-05-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW1067 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Injection site rash, Pruritus, Rash macular
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Pt developed white spots on left arm below the immunization site. Pt felt a little itchy. 25 mg of Benadryl given with no change in spots. Pt reported being a little less itchy. No trouble breathing or swallowing. No obvious swelling.


VAERS ID: 1322063 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-05-15
Onset:2021-05-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Abdominal pain upper, Chills, Fatigue, Headache, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Headache the day of after several hours, Fever Chills Stomachache Fatigue after going to sleep.


VAERS ID: 1322077 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: New York  
Vaccinated:2021-05-16
Onset:2021-05-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0171 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Gait disturbance, Vision blurred
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Glaucoma (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: unknown
Current Illness: none stated
Preexisting Conditions: none stated
Allergies: none stated
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Approximately 5 minutes after receiving vaccination, patient reportedly became dizzy and stumbled into a floor display in the waiting area. Mother, who was with patient, states there was no loss of consciousness. Patient then sat in chair and after a few minutes stated symptoms began to resolve. Patient stated having a brief period of fuzzy vision. No signs of an allergic reaction were noted. Patient stayed in waiting area for approximately 1/2 and during that time stated symptoms had completed resolved. Patient then left the store.


VAERS ID: 1322080 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: New York  
Vaccinated:2021-05-16
Onset:2021-05-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 RA / IM

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

Write-up: pt experienced headache 3 minutes post vaccine. patient was given ice pack and had sit for 30 minutes, left feeling better


VAERS ID: 1322087 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-05-16
Onset:2021-05-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009C21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: mild flu like symptoms for 24 hours
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: This dose is a second dose of Moderna vaccine administered to this patient He is under the age of 18 and should have gotten Pfizer vaccine. He got Moderna vaccine the first dose so we had to administer Moderna vaccine as a second dose. He only had mild flu symptoms with the first dose that lasted for 24 hours


VAERS ID: 1322089 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-05-16
Onset:2021-05-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fall, Haemorrhage, Head injury, Hypoaesthesia, Paraesthesia, Syncope, Tremor
SMQs:, Torsade de pointes/QT prolongation (broad), Peripheral neuropathy (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (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? 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 received her first dose of the Pfizer COVID19 vaccine at approximately 12pm. Patient felt fine immediately after the vaccination and was instructed to sit and wait for 15 minutes. The immunizer, watched the patient sit down in a chair. A few minutes later the mother of that patient began screaming help, help. Patient had fainted, falling on the floor and hitting her head. I ran our to assist patient, I instructed my technicians to call 911. Patient was on the floor, shaking. I assisted her in rolling over. When she came to I helped her control her breathing and take deep breaths. I used I gauze pad to stop the bleeding on her head. I made sure she was lying flat on the floor. We gave her an ice pack to help with the numbness and tingling in her hands. The paramedics arrived and took patient to the hospital.


VAERS ID: 1322114 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-16
Onset:2021-05-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / IM

Administered by: Private       Purchased by: ?
Symptoms: Headache, 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Clindamycin Phosphate 1% External Lotion (Cleocin-T) once daily for acne Dapsone 7.5% external Gel (Aczone) once daily for acne
Current Illness: None
Preexisting Conditions: Acne, Allergic Rhinitis, Atopic Dermatitis, Food Allergy
Allergies: Nuts, Avocado
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Frontal Headache and Throat Tightness for 20 minutes. Symptoms resolved after mom gave Benadryl 37.5mg orally.


VAERS ID: 1322118 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Mississippi  
Vaccinated:2021-05-15
Onset:2021-05-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Activated partial thromboplastin time normal, Anion gap decreased, Arachnoid cyst, Benign enlargement of the subarachnoid spaces, Blood calcium decreased, Blood folate normal, Blood magnesium normal, Computerised tomogram abnormal, Computerised tomogram head, Eosinophil percentage decreased, Headache, Hemiparesis, Hypoaesthesia, Lymphocyte percentage decreased, Metabolic function test, Neutrophil percentage increased, Pregnancy test negative, Prothrombin time normal, Toxicologic test normal, Vitamin B12 normal
SMQs:, Rhabdomyolysis/myopathy (broad), Haematopoietic leukopenia (broad), Peripheral neuropathy (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow), Chronic kidney disease (broad), Tumour lysis 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? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: folic acid, vitamin b 12, protime, PTT, magnesium, urine toxicology screen, pregnancy test - all negative or normal CT brain - CSF containing space in the posterior fossa reflecting benign retrocerebellar arachnoid cyst formation or small developing cisterna magna CBC - normal except 76% neutrophils (high), 14.1 % Lymphocytes (low); 0.3% eosinophil (low) CMP - normal except calcium 8.8 (low), anion gap 7 (low)
CDC Split Type:

Write-up: Patient presented to the ER and was subsequently admitted for evaluation of stroke like symptoms of left sided weakness and numbness that started the day after her second vaccination with Moderna Covid 19 . She has associated headache and was admitted to evaluate for possible stroke or other neurologic event. Her first injection was April 17.


VAERS ID: 1322119 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-05-16
Onset:2021-05-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808986 / 1 LA / IM

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

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

Write-up: Patient dizzy stating he may pass out


VAERS ID: 1322120 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-05-16
Onset:2021-05-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 1 RA / IM

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

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

Write-up: The patient fainted after vaccine administration. The patient was fine after about 30 minutes of sitting.


VAERS ID: 1322123 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-05-01
Onset:2021-05-16
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 2 LA / -

Administered by: Other       Purchased by: ?
Symptoms: Headache, Pain in extremity, Product administered to patient of inappropriate age, Somnolence
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Tendinopathies and ligament disorders (broad), Medication errors (narrow), Hypoglycaemia (broad)

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

Write-up: Headache, stabbing pain in left leg, sleepy Took Tylenol


VAERS ID: 1322131 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-05-14
Onset:2021-05-16
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Fatigue, Headache, Nausea, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Exhaustion Headache Lightheaded/dizzy Nausea Fainting


VAERS ID: 1322136 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-05-16
Onset:2021-05-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Patient passed out within a minute of vaccination. Mother and I moved patient to a laying down position where she immediately woke up and knew where she was and what just happened. Declined any other symptoms. Mom said she passes out often after vaccinations. Patient was conscious carrying on a conversation like normal immediately after coming to. Over the next 30 minutes I tried to get patient to a sitting position to take her blood pressure but every time we tried she needed to lay back down because she felt like she was going to pass out. After trying this twice and being unsuccessful I had EMS called to check on patient to make sure nothing more serious going on. EMS came and took a couple blood pressures and pulses which were normal. Patient was starting to feel better. Walked out with EMS and planned on going home.


VAERS ID: 1322137 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-05-16
Onset:2021-05-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Loss of consciousness, Posture abnormal
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), Dystonia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

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

Write-up: Patient slumped over the chair and passed out for a few seconds after the vaccine


VAERS ID: 1322138 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-05-16
Onset:2021-05-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Depressed level of consciousness, Muscle twitching, Petit mal epilepsy
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Dyskinesia (broad), Dystonia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none that are known of patient does not fill at this pharmacy
Current Illness: unknown
Preexisting Conditions: none reported
Allergies: none reported
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Patient had what appeared to be absence seizures (facial twitching, unresponsive but moving eyes, fist clenching) for 30 seconds. This occured 10 minutes post injection. Patient did not fall out of chair as her grandmother was right next to her. 911 was called, patient recovered immediately after and had no other incidence. patient taken to hospital.


VAERS ID: 1322150 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-05-16
Onset:2021-05-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Seizure, Syncope, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: non on file
Current Illness: Covid 19 long hauler
Preexisting Conditions: none
Allergies: non noted
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received injection and sat down in the waiting area with her Mom. Less than 5 minutes after the injection she fainted and appeared to have a small seizure , her mother shouted at her and shook her and she became conscious and vomited. 911 was called , they evaluated the patient and she went to the hospital.


VAERS ID: 1322151 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-05-16
Onset:2021-05-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 1 LA / IM

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

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

Write-up: Pt was brought in by her father for her first dose of Pfizer vaccine. Prior to receiving the vaccine, her father asked her to let the writer know of her fear of needle and what occurs when she she has blood draws or vaccination. Patient states that she usually lays down because she feels faint and passes out at times. After she sat down, another chair was provided to rest her legs. Pfizer dose was administered and within a minute, she acknowledged that she about to passed out. She had a near syncopal episode with both arms contracting. She was carried from the chair to the floor. Her father, who was prepared for this, had ammonia with him and had the patient sniff it and she responded to it. She was observed for little over 30 minutes and walked out of the pharmacy stating that she felt well. Throughout the ordeal, she was responding appropriately.


VAERS ID: 1322161 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-05-16
Onset:2021-05-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 LA / IM

Administered by: Military       Purchased by: ?
Symptoms: Chills, Fatigue, Feeling jittery, Hypoaesthesia, Pain in extremity, Tremor
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Estrogen, tramadol, gabapentine, ambien, biotin, vitamin d
Current Illness: None
Preexisting Conditions: Back pain, depression
Allergies: PCN
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Left arm pain that feels like numbness, chills, shakes, jittery, tired


VAERS ID: 1322172 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-05-16
Onset:2021-05-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 LA / IM

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

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

Write-up: Patient fainted after receiving Janssen Covid-19 vaccination, immediate upon removal of syringe needle at 3:24 pm on 5/16/21. Patient recovered consciousness about 10-15 seconds later and complained of feeling dizzy and light-headed. Wet paper towels were applied to patient''s neck wrist and forehead for 5 minutes but he still felt light headed. Patient then was instructed to lie on the floor and elevate his feet on a chair. After doing this for 5 minutes he felt well enough to sit in the waiting/observation area for another 10 minutes after which he felt well enough to leave.


VAERS ID: 1322189 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-05-11
Onset:2021-05-16
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 - / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Adderall, seroquel, guanfacine, bupropion, metoprolol, omeprazole, glycopyrolate, Ativan
Current Illness:
Preexisting Conditions:
Allergies: Penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Itchy rash on same arm as injection (in area of injection) presenting 4 days after vaccination.


VAERS ID: 1322193 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-16
Onset:2021-05-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 1 OT / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Nausea and slight vomiting. Evaluated by EMS-Cleared


VAERS ID: 1322195 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-05-16
Onset:2021-05-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041C21A / 1 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:
Other Medications: no
Current Illness: no
Preexisting Conditions: no
Allergies: no
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Pt fainted for a second and hit his head. He immediately got up and was given water and an ice pack. He was asked to sit for a bit until he felt much better. He felt better right away but we had him sit for about 1/2 hour. He had not had anything to eat all day


VAERS ID: 1322196 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-05-16
Onset:2021-05-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Balance disorder, Dizziness, Eye movement disorder, Loss of consciousness, Pallor, Rhinorrhoea
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt got J&J vaccine around 1:25pm. After shot administered, while talking to me, patient suddenly slumped over into my arms and eyes rolled back and lost consciousness for about 10 seconds and he was making some gurgling noise. Some excretions came out of his nose and he came to and was able to lie on floor to elevate his feet, but still was very dizzy. First responders showed up and his vitals were WNLs, but pt continued to look pale and struggle to come to upright position for another 15-20 min. Pt''s friend showed up to pick him up and he was able to walk out to the car without issue.


VAERS ID: 1322199 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-05-16
Onset:2021-05-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, Headache, Pallor, Vision blurred
SMQs:, Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: Per father - no other illnesses at time of vaccination.
Preexisting Conditions: Per father- no chronic or long-standing health conditions
Allergies: Penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: 14 year old male reported not being able to see after receiving vaccine. writer noted the boy''s skin pale in color. The boy is able to follow command but has unclear speech. Paramedic on site. Per paramedic the boy has body weakness, mild headache, and blurred vision. Per paramedic vital signs are BP 107/63, R 16, PR 66. The boy recovered under the care of the paramedic.


VAERS ID: 1322207 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-05-16
Onset:2021-05-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002C21A / 2 LA / -

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: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: None
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Given 2nd dose at 2 weeks not 4


VAERS ID: 1322209 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Utah  
Vaccinated:2021-05-16
Onset:2021-05-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808986 / 1 LA / IM

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

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

Write-up: Patient fainted about 5 minutes post vaccine. We had them lay down for a moment and gave them water. Patient waited for 40 minutes after vaccine and recovered.


VAERS ID: 1322213 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-05-16
Onset:2021-05-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW 0183 / 1 AR / IM

Administered by: Other       Purchased by: ?
Symptoms: Loss of consciousness, Presyncope, 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: MVI
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data:
CDC Split Type:

Write-up: Client received Pfizer # 1 @ 09:26 Hx of fainting w/ blood draws and injections in past but did not inform staff Mother present at all times Client had vasovagal episode with syncope within seconds of receiving vaccine Was unresponsive for < 15 seconds. Did not fall or slide off chair at vaccinator''s table Taken to EMS area for observation via W/C BP/P 100/60, 60 lying, sitting and standing Client felt back to normal within minutes of episode EMS advised transport to hospital. Mother declined. Observed for 30 minutes in EMS area Client and mother left EMS area independently @ 10:00


VAERS ID: 1322223 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-16
Onset:2021-05-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003B21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Gastrooesophageal reflux disease, Headache, Hypoaesthesia oral, Nausea
SMQs:, Acute pancreatitis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific dysfunction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

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

Write-up: During the 15 minutes observation following vaccine administration , patient experienced severe nausea, acid reflux, tongue numbness and headache.


VAERS ID: 1322251 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-05-16
Onset:2021-05-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal discomfort, Feeling hot, Nausea, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: WAVE OF NAUSEOUSNESS AND WARMTH, "FEVERISH", UPSET STOMACH.


VAERS ID: 1322259 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-05-16
Onset:2021-05-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 1 LA / IM

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

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

Write-up: Patient felt light headed and fainted. Patient was alert and aware immediately and did not sustain injury. Ambulance was called but patient did not end up needing.


VAERS ID: 1322263 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-05-16
Onset:2021-05-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cold sweat, Nausea, Pallor, Panic attack, Paraesthesia, Syncope, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: faint, pale color, cold sweat, vomiting, nausea, tingling in fingers. EMS was called to the pharmacy lobby. After patient drank some water and juice, he felt better. EMS treated on the scene for suspected panic attack. (Patient saw blood running down arm post injection). Patient and parent left the pharmacy after about 45 minutes from time of injection feeling and looking much better.


VAERS ID: 1322265 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-16
Onset:2021-05-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Not known
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: NKA
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Patient vomited a few minutes after receiving the Janssen Covid 19 vaccine. He rested for 30 minutes and felt fine then. No SOB, or difficult breathing.


VAERS ID: 1322272 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-16
Onset:2021-05-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 03A21A / 1 LA / IM

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

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

Write-up: patient passed out after receiving vaccine due to extreme fear of needles. 911 was called but when patient regained consciousness after 10-20 seconds, she had us cancel the ambulance. She then passed out a second time and we called the ambulance again. She regained consciousness but agreed to have them assess her. She declined to be transported to the hospital and was released after they assessed she was ok.


VAERS ID: 1322279 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-05-16
Onset:2021-05-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO182 / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cold sweat, Electrocardiogram normal, Hyperhidrosis, Hypotension, Laboratory test normal, Loss of consciousness, Retching, Urine analysis, Vision blurred, Vitreous floaters
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Na
Current Illness: Na
Preexisting Conditions: Na
Allergies: Na
Diagnostic Lab Data: Blood Test - normal EKG - normal Urinalysis - normal Pulse and blood pressure low when arrived at hospital
CDC Split Type:

Write-up: About two minutes after she received her shot she told us she was seeing black spots. Then she told me she couldn?t see and she passed out. She started to regain consciousness and a little bit of blurred vision and then she began dry heaving. She was clammy and sweaty at that point but continued to improve after she drank some water.


VAERS ID: 1322299 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-05-16
Onset:2021-05-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003B21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Burning sensation, Dyspnoea, Hyperhidrosis, Tremor
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Hypoglycaemia (broad)

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

Write-up: Patient came to the pharmacist for help about 5 minutes after his immunization, he was shaky. When the pharmacist came out to check on him, he collapsed. He was shaky, sweating, complaining of being on fire. He was given a bottle of water after asking for water. The patient then alternately complained of having trouble breathing and feeling better for several cycles. The EMS arrived about 20 minutes after being called and the pharmacist left the patient in the care of the EMT''s. EMS left about 1/2 an hour later, then the patient''s wife showed up to take him home. After 6pm, the patient was checked on by the pharmacist and he was doing well at that time.


VAERS ID: 1322321 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-16
Onset:2021-05-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 LA / IM

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

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

Write-up: Patient was to receive Pfizer Covid19 vaccination on the appointment but a single shot of Jassen Covid19 was given to her by mistake. Patient had no adverse reactions by the time she left the pharmacy with her family. Her father was taking her to see her PCP and no further adverse reactions had been reported to the pharmacy when father called us at around 2:00pm. Further adverse reactions would be reported once the patient''s family contact pharmacy again


VAERS ID: 1322324 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-16
Onset:2021-05-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 1 - / IM

Administered by: Public       Purchased by: ?
Symptoms: Dizziness, Fall, Head injury, Headache, Pain, Pallor, Syncope, Vision blurred
SMQs:, Torsade de pointes/QT prolongation (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Accidents and injuries (narrow), Glaucoma (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: client had syncope episode after receiving 1st dose Pfizer Covid Vaccine. Client received vaccine at 1336 and was standing next to vaccine station and Father as sibling was receiving vaccine. Within 3 minutes of standing client had syncope episode and hit back of head on floor. RNs responded. PHN called 911 at 1340. Per RN client collapsed and hit back of head, Father tried to hold on but was unsuccessful. As PHN was speaking with paramedics, client regained consciousness. Client stated she remembered feeling dizzy and then woke up on the floor. Client alert and oriented, pale and stated blurry vision. RN elevated legs. Vitals: blood pressure 130/90, pulse 102, oxygen 99%. Father denied any relevant medical history, medications, allergies or history of syncope. Client stated feeling dizzy, denied pain on head or rest of body. Paramedics arrived approximately 1346 and assumed care. After assessment Father signed AMA with paramedics. Client sat in anti gravity chair after paramedics left. EMT stayed with client. Vitals at 1412: blood pressure 120/80, pulse 85, oxygen 96%. Client stated feeling dizzy and head hurts when she moves. Blurry vision resolved. PHN spoke with parents to review ER precautions and advised to make follow up appointment with primary doctor. After sibling was done with observation, client left facility at 1425 with steady gait.


VAERS ID: 1322334 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-05-15
Onset:2021-05-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypoaesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pts hands are numb


VAERS ID: 1322339 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-16
Onset:2021-05-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fall, Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), 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? 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 lost consciousness and fell on the floor 5 mins after receiving the shot. He had no response to any physical contact. His pulse was weak and pupils were dilated. One dose of 0.3mg Epipen was then given to the left thigh of patient. He regained consciousness in about 5 mins after the Epipen shot. His pulse and pupils turned back to normal as well. He was able to stand and answer questions to the EMS team when they arrived to the scene in another 5 mins. Patient was then taken to the ambulance.


VAERS ID: 1322349 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-05-16
Onset:2021-05-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 LA / IM

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

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

Write-up: Pt got J&J COVID vaccine around 5:15pm, a few minutes into observation time, he told RX tech that he wasn''t feeling so well so she suggested he move into the counseling room to lie down. As he got up to move he became lightheaded and had to squad down. We then instructed him to lie down and elevated his feet. We gave him some apple juice and water and he said he felt better after drinking the beverages. He was responsive and alert the entire time, and pharmacist continue to converse with pt until he no longer lightheaded. Pharmacist then asked pt to transition to sitting, continued that observation for 5 more minutes. At around 5:35pm the pt. was able to stand without issue and the pharmacist walked him to his car without further issue.


VAERS ID: 1322371 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-04-27
Onset:2021-05-16
   Days after vaccination:19
Submitted: 0000-00-00
Entered: 2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Injection site pain, Muscle twitching, Musculoskeletal stiffness
SMQs:, Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Arthritis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Tirosint, magnesium, b12, vit c, vit d
Current Illness: none
Preexisting Conditions: hypothyroid condition
Allergies: naproxen, penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Twitching in left arm over several days, followed by arm pain at injection site along with arm stiffness


VAERS ID: 1322376 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-05-16
Onset:2021-05-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 1 RA / IM

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

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

Write-up: Pt. developed a skin rash on chest. Denied any difficulty breathing. Benedryl 25 mg was administered. Vitals were wnl. Rash diminished and pt was cleared to leave.


VAERS ID: 1322382 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-05-16
Onset:2021-05-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 1 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Omega 3 gummy vitamins
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Fainted in chair about 3 minutes after shor was given


VAERS ID: 1322413 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-05-16
Onset:2021-05-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Feverish, slight muscle soreness, mild-moderate headache


VAERS ID: 1322427 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-16
Onset:2021-05-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Headache
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: Medical cannabis Liquid Donegal Baby aspirin COPD inhaler High cholesterol medicine
Current Illness: N/A
Preexisting Conditions: HIV COPD High cholesterol Congestive heart failure
Allergies: N/A
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Headache


VAERS ID: 1322436 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-05-15
Onset:2021-05-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Around 18 hours after getting vaccinated. Rashes start to grow. I first discover it at my injected arm and then it spread to my back, another arm. Then, it starts turning red and itching. The rashes slow its growing at around 25 hours after getting the vaccine


VAERS ID: 1322457 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Oklahoma  
Vaccinated:2021-05-16
Onset:2021-05-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0171 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Eye movement disorder, Fatigue, Loss of consciousness, Musculoskeletal stiffness, Nausea, Pallor, Seizure, Tremor, Visual impairment
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Arthritis (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: No tests were performed this happened in the pharmacy waiting room.
CDC Split Type:

Write-up: About 5 min after receiving shot, his head went to the side, lost consciousness. His legs, arms, hands went stiff and he started shaking. His eyes rolled back in his head, textbook seizure. Lasted a little less than a minute. When came to he said he couldn?t see anything. After about 30 seconds he could start to see. He turned pale, felt like he was going to throw up. But never did. A few minutes later he started to get a little color back in his face. He is tired but was better.


VAERS ID: 1322460 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-05-15
Onset:2021-05-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: HCTZ. Losartan, Clonidine, Vit. D3 , Potassium
Current Illness: no
Preexisting Conditions: High blood pressure
Allergies: Bacatrin sulphur drug
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Appears to be a cyst has appeared just above right groin.


VAERS ID: 1322493 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-05-16
Onset:2021-05-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / N/A LA / IM

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

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

Write-up: This vaccine is not indicated for a 14 year old. It was given in error.


VAERS ID: 1322516 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-05-16
Onset:2021-05-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK LA / IM

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

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

Write-up: Injection site pain Muscle pain in arm on injected arm Treated with OTC acetaminophen (1000mg po x1 dose)


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