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From the 7/16/2021 release of VAERS data:

Found 479,813 cases where Vaccine is COVID19 and Patient Did Not Die



Case Details (Reverse Sorted by Onset Date)

This is page 15 out of 4,799

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VAERS ID: 1466837 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-02-13
Onset:2021-07-09
   Days after vaccination:146
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL8982 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, Ageusia, Anosmia, Coronavirus infection, Cough, Ear pain, Fatigue, Headache, Myalgia, Nasal congestion, Nausea, Oropharyngeal pain, Pyrexia, Rhinorrhoea, SARS-CoV-2 RNA increased
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: Unknown
Diagnostic Lab Data: SARS CORONAVIRUS-2 RNA, V; Detected
CDC Split Type:

Write-up: Symptomatic, started on 7/9/21 with cough, runny nose, muscles aches, nausea, loss of smell & taste, sore throat, nasal congestion, fever, headache, fatigue abdominal pain, & ear ache.


VAERS ID: 1466843 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-01-07
Onset:2021-07-09
   Days after vaccination:183
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1284 / 2 LA / IM

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

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

Write-up: Patient received 2 doses of COVID-19 vaccine (#1 on 17 Dec 2020 and #2 on 07 Jan 2021). On 09 Jul 2021 he had COVID-19 testing (as part of blood drive operations), and was positive for COVID-19 (but asymptomatic).


VAERS ID: 1466845 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-28
Onset:2021-07-09
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Feeling abnormal, Impaired work ability, Influenza like illness, Swelling, Varicella
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Dementia (broad), Guillain-Barre syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Opportunistic infections (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: Prostagenix.
Current Illness: None
Preexisting Conditions: None
Allergies: None.
Diagnostic Lab Data: None. Have not yet seen a doctor for this.
CDC Split Type:

Write-up: Slept badly 9-Jul-2021. Woke up with strong flu-like symptoms - fuzzy headed, ears hot (probably fever, but thermometer broken), total lack of energy. Did not make it out of bed beyond bathroom visits and light snacks 9-Jul-2021 or 10-Jul-2021. More energy Monday 11-Jul-2021 and was able to work a few hours. I then noticed a lump on lower left neck jaw that looks like mumps, which I had as a child, and pox all over my body that look like chicken pox, which I also had as a child. I believe mumps/chicken pox symptoms began earlier, probably before the flu-like symptoms, but they were not yet severe and I did not carefully note them. Chicken pox has gotten worse through 11-12-Jul-2021 with over 100 pox, particularly bad on knees and elbows with about 70 in those areas alone. Prior to vaccination, I had taken only 1 sick day in over 20 years. I just don''t get sick beyond minor cold-like symptoms.


VAERS ID: 1466875 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-07-09
Onset:2021-07-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1820096 / 1 LA / IM

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

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

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


VAERS ID: 1466879 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-07-09
Onset:2021-07-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 1820096 / 1 LA / IM

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

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

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


VAERS ID: 1466899 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-07-09
Onset:2021-07-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048B21A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Chest pain, Heart rate abnormal, Hypertension, Palpitations
SMQs:, Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Hypertension (narrow), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: none
Preexisting Conditions: Osteoarthritis
Allergies: shellfish, erythromycin, injectable benadryl, codeine, HCTZ, injectable Depo-Medrol, injectable Cortisone
Diagnostic Lab Data: unavailable
CDC Split Type:

Write-up: Approximately 3 hours after receiving vaccination, heart racing and Blood Pressure high. Pulse 120 to 184. Blood Pressure 264/130. Took 2 Nitroglycerin and baby aspirin. Went by ambulance to Emergency Room. Discharged from ER with diagnosis of chest pain per patient. Was in emergency room for approximately 3 hours once blood pressure and heart rate stable.


VAERS ID: 1466921 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-02-07
Onset:2021-07-09
   Days after vaccination:152
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK5730 / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK9231 / 2 - / -

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

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

Write-up: Got covid-19 six months after receiving Pfizer vaccination.


VAERS ID: 1466943 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-07-09
Onset:2021-07-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 2 LA / IM

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

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

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


VAERS ID: 1467024 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-07-09
Onset:2021-07-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 LA / IM

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

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

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


VAERS ID: 1467055 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-09
Onset:2021-07-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8736 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Incorrect product formulation administered
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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 recived Pfizer vaccine as second dose instead of Moderna which she recieved as first dose. Patent was assessed by PCP and denied any symptoms or abnormalties.


VAERS ID: 1467085 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-07-09
Onset:2021-07-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022B21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Electrocardiogram, Hypoaesthesia, Injection site pain, Pain in extremity, Tachycardia, Troponin
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Tendinopathies and ligament disorders (broad), Dehydration (broad)

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

Write-up: By 9pm on day of vaccination, pt was feeling pain in chest and left arm and tachycardia accompanied by numbness in both hands and injection site pain.


VAERS ID: 1467185 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-07-09
Onset:2021-07-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8736 / 1 - / IM

Administered by: Public       Purchased by: ?
Symptoms: Dehydration, Headache, 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), Dehydration (narrow)

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

Write-up: Patient passed out at store several hours (2.5) after vaccine administration. He was transported via EMS to hospital and given fluids and told he was dehydrated. He still complains of headache 4 days later. He did not hit his head when he passed out.


VAERS ID: 1467213 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-07-07
Onset:2021-07-09
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA86780 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Ear pain, Fatigue, Pain, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

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

Write-up: Pt. states received 2nd Phizer 07/07/2021 07/09/2021 Body ache, fatigue after 3 days different parts of the body started to swell (under arm pit, behind ear) Ear pain intense 07/13/2021 Primary visited (continue Ibuprofen) Follow Up 07/15/2021


VAERS ID: 1467216 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-07-09
Onset:2021-07-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002C21A / 2 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024C21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Blood creatine phosphokinase normal, Blood thyroid stimulating hormone normal, Bone pain, Decreased appetite, Full blood count normal, Hyperhidrosis, Limb discomfort, Metabolic function test normal, Muscular weakness, Myalgia, Pain in extremity, Paraesthesia, Platelet count normal
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Eosinophilic pneumonia (broad), Osteonecrosis (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: clonidine, quetiapine, atorvastatin, symbicort, spiriva, ibuprofin,
Current Illness: none
Preexisting Conditions: kidney stones, high blood pressure, copd
Allergies: none
Diagnostic Lab Data: CK- CBC-CMP14-D PLT-TSH-- all results normal
CDC Split Type:

Write-up: muscle weakness, sweating, weak, loss of appetite, bone pain, muscle pain, fingers tingling. hands hurting, left leg heaviness.


VAERS ID: 1467243 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: New York  
Vaccinated:2021-06-22
Onset:2021-07-09
   Days after vaccination:17
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blister, Herpes zoster, Herpes zoster reactivation, Rash
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Opportunistic infections (broad)

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

Write-up: Herpes-Zoster reactivation resulting in shingles. Typical shingles symptoms occurring on right side of body include rashes and blisters. Standard treatment of Valacyclovir 1000mg 3x per day prescribed.


VAERS ID: 1467554 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-09
Onset:2021-07-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004D21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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 came on Saturday explaining that she developed rash on face, right arm, back, and leg on Friday evening after administration. She also experienced heart palpitations. I advised her to take Benadryl and to see a doctor if symptoms worsen.


VAERS ID: 1467782 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-07-09
Onset:2021-07-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / IM

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

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

Write-up: After vaccination felt very dizzy and had sweating


VAERS ID: 1468201 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-07-09
Onset:2021-07-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 2 AR / IM

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

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

Write-up: 2nd dose pfizer vaccine was given to patient on 07/09/2021. We found out on 07/09/2021 vaccine was stored outside the recommended 31 day expiration window.


VAERS ID: 1468210 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Alaska  
Vaccinated:2021-07-08
Onset:2021-07-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal discomfort, Arthralgia, Asthenia, Chest discomfort, Confusional state, Dizziness, Dysphonia, Fatigue, Heart rate irregular, Malaise, Oropharyngeal pain, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiac arrhythmia terms, nonspecific (narrow), Vestibular disorders (broad), Hypersensitivity (broad), Arthritis (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: Vitamins, Calcium, Vit D3
Current Illness: None
Preexisting Conditions: Hypothyroid
Allergies: None
Diagnostic Lab Data: TBD
CDC Split Type:

Write-up: Joint ache, fatigue, weakness, tightness or chest and throat, sore throat, hoarseness, dizziness, confusion, heartbeat (irregular), upset stomach, feeling tired / unwell.


VAERS ID: 1468364 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-07-09
Onset:2021-07-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 LA / IM

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

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

Write-up: 1st dose pfizer vaccine was given to patient on 07/09/2021. We found out on 07/09/2021 vaccine was stored outside the recommended 31 day expiration window.


VAERS ID: 1468366 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-07-09
Onset:2021-07-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 2 RA / IM

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

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

Write-up: 2nd dose pfizer vaccine was given to patient on 07/09/2021. We found out on 07/09/2021 vaccine was stored outside the recommended 31 day expiration window.


VAERS ID: 1468369 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-07-09
Onset:2021-07-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: 1st dose pfizer vaccine was given to patient on 07/09/2021. We found out on 07/09/2021 vaccine was stored outside the recommended 31 day expiration window.


VAERS ID: 1469635 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Texas  
Vaccinated:0000-00-00
Onset:2021-07-09
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1820095 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Body temperature, Epistaxis, Pyrexia
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Abstains from alcohol; Non-smoker; Sulfonamide allergy
Preexisting Conditions: Medical History/Concurrent Conditions: Iron deficiency; Comments: The patient did not have any history of drug abuse or illicit drug use. The patient received acne medication.
Allergies:
Diagnostic Lab Data: Test Date: 20210709; Test Name: Body temperature; Result Unstructured Data: 101.3 F; Test Date: 20210709; Test Name: Body temperature; Result Unstructured Data: 99.5
CDC Split Type: USJNJFOC20210723259

Write-up: NOSE BLEED; FEVER OF 38.5 CELCIUS 101.3F; This spontaneous report received from a patient concerned a 25 year old female. The patient''s weight was 69 kilograms, and height was 66 centimeters. The patient''s past medical history included iron deficiency, and concurrent conditions included non alcohol user, non smoker, and sulfa allergy, and other pre-existing medical conditions included the patient did not have any history of drug abuse or illicit drug use. The patient received acne medication. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 1820095, expiry: UNKNOWN) dose was not reported, administered on 08-JUL-2021 for prophylactic vaccination. No concomitant medications were reported. On 09-JUL-2021, the subject experienced nose bleed. On 09-JUL-2021, the subject experienced fever of 38.5 Celsius 101.3f. Laboratory data included: Body temperature (NR: not provided) 99.5, 101.3 F. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from nose bleed on 09-JUL-2021, and had not recovered from fever of 38.5 Celsius 101.3f. This report was non-serious.


VAERS ID: 1469646 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-07-09
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Adverse event, 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? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210724550

Write-up: VACCINE GAVE ALMOST ALL THE REACTIONS; EVERYTHING HURT; This spontaneous report received from a patient concerned a 43 year old female. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported.The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unk) dose was not reported, administered on 09-JUL-2021 for prophylactic vaccination. The batch number was not reported. Per procedure, no follow-up will be requested for this case. No concomitant medications were reported. On 09-JUL-2021, the subject experienced vaccine gave almost all the reactions. On 09-JUL-2021, the subject experienced everything hurt. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the vaccine gave almost all the reactions and everything hurt was not reported. This report was non-serious.


VAERS ID: 1469647 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Connecticut  
Vaccinated:0000-00-00
Onset:2021-07-09
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, Headache, Nausea, Pain in extremity, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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: USJNJFOC20210724637

Write-up: VOMITING (WHEN SHE VOMITS, NOTHING COMES OUT); HAND SORENESS; FEVER; NAUSEA; HEADACHE (FEELS SHE CAN SCREAM); WEAKNESS; This spontaneous report received from a patient concerned a 60 year old female. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 207A21A expiry: unknown) dose was not reported, administered on 09-JUL-2021 for prophylactic vaccination. No concomitant medications were reported. On 09-JUL-2021, the subject experienced vomiting ( nothing comes out). On 09-JUL-2021, the subject experienced hand soreness. On 09-JUL-2021, the subject experienced fever. On 09-JUL-2021, the subject experienced nausea. On 09-JUL-2021, the subject experienced headache (feels she can scream). On 09-JUL-2021, the subject experienced weakness. Treatment medications included: oxycodone/paracetamol. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the fever, nausea, vomiting (nothing comes out), headache (feels she can scream), weakness and hand soreness was not reported. This report was non-serious.


VAERS ID: 1469659 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:0000-00-00
Onset:2021-07-09
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Abstains from alcohol; Non-smoker
Preexisting Conditions: Comments: Patient did not took any medications, no known allergies and drug abuse or illicit drug usage.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210725508

Write-up: RINGING IN THE LEFT EAR; This spontaneous report received from a patient concerned a 55 year old male. The patient''s height, and weight were not reported. The patient''s concurrent conditions included non alcoholic, and non smoker, and other pre-existing medical conditions included patient did not took any medications, no known allergies and drug abuse or illicit drug usage. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 204A21A, expiry: UNKNOWN) dose was not reported, administered on 09-JUL-2021 for prophylactic vaccination. No concomitant medications were reported. On 09-JUL-2021, the subject experienced ringing in the left ear. Treatment medications included: ibuprofen. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from ringing in the left ear on 09-JUL-2021. This report was non-serious.


VAERS ID: 1469695 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-07-09
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Foaming at mouth, 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), Convulsions (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: No medical history was reported.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: loss of consciousness; He started foaming at the mouth; This spontaneous case was reported by a physician (subsequently medically confirmed) and describes the occurrence of LOSS OF CONSCIOUSNESS (loss of consciousness) in a male patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No medical history was reported. On an unknown date, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 09-Jul-2021, the patient experienced LOSS OF CONSCIOUSNESS (loss of consciousness) (seriousness criterion medically significant) and FOAMING AT MOUTH (He started foaming at the mouth). At the time of the report, LOSS OF CONSCIOUSNESS (loss of consciousness) and FOAMING AT MOUTH (He started foaming at the mouth) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. No concomitant medication reported. No treatment information was provided. Very limited information regarding these events has been provided at this time. Further information has been requested.; Sender''s Comments: Very limited information regarding these events has been provided at this time. Further information has been requested.


VAERS ID: 1470091 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-07-09
Onset:2021-07-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1816022 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain upper, Chills, Decreased appetite, Fatigue, Headache, Myalgia, Nausea
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: At 6:30PM the day of the shot, I experienced chills, nausea, headaches, stomach aches, and the worst was muscle pain. I was in bed from 6:30 and woke up at 10:00AM the next day. I treated the pain by drinking tons and tons of water and took amphetamine 500MG. Saturday 7/10, I head a pounding heachache in the afternoon. Experienced fatigue all day. Sunday 7/11, continued headache and continued fatigue AM/PM Monday 7/12, nausea came back, heachache, fatigue, had to leave work early at 2:00PM Tuesday 7/13, nausea, stomach pains, heachache, fatigue, lack of appetite started at 4:30PM Now 7/14, continued heachache.


VAERS ID: 1470116 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-07-09
Onset:2021-07-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 LA / IM

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

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

Write-up: No adverse event- however, this was an administration error. Patient had previously received COVID-19 Johnson & Johnson vaccine on 03/19/2021, which was not known by pharmacy at time of administration.


VAERS ID: 1470118 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-07-09
Onset:2021-07-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW01810 / 1 RA / IM

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

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

Write-up: No adverse event- however, this was an administration error. Patient had previously received Covid19 Johnson and Johnson vaccine on 03/19/21 which was not known by pharmacy at time of administration.


VAERS ID: 1470140 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-07-08
Onset:2021-07-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Chest discomfort, Paraesthesia, Rash, Rash macular
SMQs:, Anaphylactic reaction (narrow), Peripheral neuropathy (broad), Guillain-Barre syndrome (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: Pzizer covid19 vaccine (2nd dose) Lot FA6780 Exp 9/21/2021
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: 4-5 days of a tingling sensation, chest tightness (mild, intermittent) post vaccination. Generalized macular rash on chest/back. Denies any shortness of breath or swelling. Vitals stable and within normal limits.


VAERS ID: 1470187 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-07-09
Onset:2021-07-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041B21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Paraesthesia oral, Tachycardia, Vision blurred
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypoglycaemia (broad), Dehydration (broad)

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

Write-up: Dizziness, Blurred Vision, Tachycardia, Tingling lips.


VAERS ID: 1470202 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-03-05
Onset:2021-07-09
   Days after vaccination:126
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016M20A / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029A21A / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Abdominal pain, Aortic arteriosclerosis, Asthenia, Atrioventricular block first degree, Bradycardia, Chest X-ray abnormal, Computerised tomogram abdomen abnormal, Computerised tomogram pelvis abnormal, Decreased appetite, Diarrhoea, Electrocardiogram abnormal, Hyperhidrosis, Iliac artery occlusion, Iliac artery stenosis, Lung opacity, Nausea, QRS axis abnormal, Renal atrophy, Renal cyst, SARS-CoV-2 test negative, SARS-CoV-2 test positive
SMQs:, Acute pancreatitis (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Conduction defects (narrow), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Embolic and thrombotic events, arterial (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Noninfectious diarrhoea (narrow), Tubulointerstitial diseases (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Albuterol Sulfate Inhaler, Chlorthalidone oral tablet, CloNIDine HCI tablet, Coreg oral, Glimeppiride oral, Omeprazole, Rosuvastatin, Amlodapine, Potassium, Multivitamins,
Current Illness:
Preexisting Conditions: Depression, Diabetes Mellitus, Hypertension, Angioedema, Bronchospasm, Stomatitis, Vertigo, Subdural Intacranial Hemorrhage, Lung Disease
Allergies: ACE inhibitors, Allpurinol, NSAIDs, Rampiril, Valtrex, Atorvastatin
Diagnostic Lab Data: EKG- bradycardia (rate 58), first degree AV block, left axis deviation CT abdomen/pelvis- mild patchy groundglass opacities in left lung base that are increased compared to prior, kidneys showed right renal cortical atrophy and bilateral exophytic renal lesions favoring cysts, aorta showed severe calcification without aneursym and occlusion or stenosis of bilateral common iliac arteries suspected Chest XR- probable post therapeutic changes in left chest, possible early infiltrate in left lung base
CDC Split Type:

Write-up: Patient is breakthrough case with Moderna. First dose on 2/8/21 and second on 3/5/21. Vaccine info above.Tested antigen positive on 7/5 at Hospital. Tested PCR Negative on 7/9. Patient presented to ER with abdominal pain, nausea, generalized weakness, loss of appetite, significant sweats, and diarrhea. Patient stated this had started about 5 fays prior. Patient received Normal Saline IV fluids 1000 mL and ivermectin in the ER. Patient was transferred to floor on 7/9 and was still inpatient when this nurse called for follow up on 7/14.


VAERS ID: 1470229 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-04-09
Onset:2021-07-09
   Days after vaccination:91
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0153 / 1 UN / UN

Administered by: Pharmacy       Purchased by: ?
Symptoms: COVID-19, Cough, Nasal congestion, Oropharyngeal pain, Rhinorrhoea, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unnown
Preexisting Conditions: Unknown
Allergies: Unnown
Diagnostic Lab Data: SARS-CoV-2 N gene Resp Ql NAA+probe~SARS-COV-2 (COVID-19) - CLINIC COLLECT KIT OR EXTERNAL KIT; Positive
CDC Split Type:

Write-up: Symptomatic, started on 7/9 with cough, runny nose, sore throat & nasal congestion.


VAERS ID: 1470232 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-02-25
Onset:2021-07-09
   Days after vaccination:134
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 023M20A / 2 - / -

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

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

Write-up: Patient hospitalized after testing positive for COVID-19. Patient is fully vaccinated


VAERS ID: 1470234 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-04-30
Onset:2021-07-09
   Days after vaccination:70
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 2 UN / UN

Administered by: Pharmacy       Purchased by: ?
Symptoms: COVID-19, Cough, Nasal congestion, Oropharyngeal pain, Rhinorrhoea, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: Unknown
Diagnostic Lab Data: SARS-CoV-2 N gene Resp Ql NAA+probe~SARS-COV-2 (COVID-19) - ES CLINIC COLLECT KIT OR EXTERNAL KIT; Positive
CDC Split Type:

Write-up: Symptomatic, started on 7/9 with cough, runny nose, sore throat, & nasal congestion.


VAERS ID: 1470326 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-07-09
Onset:2021-07-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Genital lesion, Sexually transmitted disease test, Skin exfoliation
SMQs:, Severe cutaneous adverse reactions (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Buspirone Fluoxetine Lorazepam Bupropion Lamatrigine
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: STI testing 7/13/21
CDC Split Type:

Write-up: Peeling sores around genital area not recognized by gynecologist


VAERS ID: 1470429 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-09
Onset:2021-07-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood glucose normal, Blood pressure abnormal, Dizziness
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypertension (broad), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: No incidence of previous vaccine
Diagnostic Lab Data: Patient''s blood pressure was checked by the pharmacist, which reported 80/60 mmHg and patient was lowered with feet elevated. Paramedics were called and blood pressure returned to a normal reading of 116/74 mmHg, by the time the paramedics arrived. Paramedics also check the patient''s blood glucose and reported a normal reading.
CDC Split Type:

Write-up: Patient was seated and alert at time of vaccination. After receiving the first dose, patient began to ask questions about side effects of vaccines after discussing prior to vaccine. Pharmacy intern notified patient to wait for 15 minutes to be observed for reactions. After approximately 2 minutes, patient''s husband came to find the pharmacist and alert that the patient was complaining of dizziness and lightheadedness. Patient''s blood pressure was checked by the pharmacist, which reported 80/60 mmHg and patient was lowered with feet elevated. Paramedics were called and blood pressure returned to a normal reading of 116/74 mmHg, by the time the paramedics arrived. Paramedics also check the patient''s blood glucose and reported a normal reading.


VAERS ID: 1470472 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-24
Onset:2021-07-09
   Days after vaccination:107
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8732 / 2 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6199 / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Cough, Headache, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: COUGH,MUSCLE ACHES,HEADACHE


VAERS ID: 1470484 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-07-08
Onset:2021-07-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH CW0198 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest X-ray normal, Dyspnoea, Dyspnoea exertional, Electrocardiogram normal
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Tree Nuts and Sesame
Diagnostic Lab Data: Her pediatrician ordered a chest x-ray and EKG to rule out any serious issues, and both tests (conducted on July 13, 2021) were normal.
CDC Split Type:

Write-up: Beginning the day following the 2nd does of the Pfizer vaccine, my daughter has been experiencing shortness of breath with minimal activity that she had not experienced before the vaccine. Today, July 14, 2021, is day 6 and her symptoms have continued. Her pediatrician ordered a chest x-ray and EKG to rule out any serious issues, and both tests (conducted on July 13, 2021) were normal. He prescribed an Albuterol inhaler to be used twice daily for one week. She started the Albuterol today, on July 14, 2021.


VAERS ID: 1470494 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-07-08
Onset:2021-07-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 2 LA / IM

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

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

Write-up: Injection site is red, hot to the touch, itches, sore when pressed on. Visible ?red? rash like patch below injection site. Has gotten larger and moved down the arm towards the Left elbow. Started 24hrs after second dose. Treating with ibuprofen, diphenhydramine and ice.


VAERS ID: 1470541 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Kansas  
Vaccinated:2020-12-29
Onset:2021-07-09
   Days after vaccination:192
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025J20-2A / 1 LA / IM

Administered by: Military       Purchased by: ?
Symptoms: COVID-19, Dyspnoea, Headache, Pyrexia, Respiratory tract congestion, Rhinorrhoea, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: SARS COV-19 Nasopharyngeal swab and PCR; resulted positive 13 JULY 2021
CDC Split Type:

Write-up: SARS-COV-19 Infection. Congestion, runny nose, fever, headache, shortness of breath. Fully vaccinated as of 26 January with second booster of Moderna, Lot No. not recorded in patient record.


VAERS ID: 1470616 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: New York  
Vaccinated:2021-07-02
Onset:2021-07-09
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test, Chest X-ray, Chest pain, Electrocardiogram, Troponin
SMQs:, Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Zyrtec
Current Illness: no
Preexisting Conditions: no
Allergies: no
Diagnostic Lab Data: yes EKG, chest x-ray and run blood work for treponins
CDC Split Type:

Write-up: Having a stabbing pain in the center of her chest, went on for a few days. Was taken to the dr whom advised them to take her to the ER.


VAERS ID: 1470742 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-07-08
Onset:2021-07-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood glucose decreased, Blood test, Disturbance in attention, Fatigue, Lethargy, Loss of consciousness, Metabolic function test, Pain, Rhinorrhoea, Seizure
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Depression (excl suicide and self injury) (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Novalog, Levothyroxine, vitamin D
Current Illness: None
Preexisting Conditions: Type 1 Diabetes
Allergies: Arithromyisin
Diagnostic Lab Data: Blood tests - metabolic panels to include gas levels and several physical examinations for neurological issues. No neurologist has examined the patient and the first available appointment is scheduled for August 31, 2021.
CDC Split Type:

Write-up: Patient received the vaccination at approximately 7pm 07/08/2021. He had a prolonged blood glucose from 6am-9:18am and consumed 75 grams of Carbohydrates and had a bg reading of 64 and steady on his continuous glucose monitor. Patient lost consciousness and had a seizure at approximately 9:20 am 07/09/2021. The seizure lasted approximately 3 minutes. Glugagon was administered due to the thought that it was Diabetic hypoglycemic. He was taken to medical facility and released. He was taken to another medical facility on Sunday July 11 to be evaluated for neurological issues. He is continuing to have symptoms of fatigue and overall lethargy, body aches and runny nose and his ability to focus is impaired.


VAERS ID: 1470764 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-07-01
Onset:2021-07-09
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021C21A / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Adverse event, Chest discomfort, Dyspnoea
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: None
Diagnostic Lab Data: Patient reported he was not seen for his adverse event.
CDC Split Type:

Write-up: Patient called 7/14/2021 to report that on 7/9/2021 at 11PM he experienced heaviness in chest and trouble breathing that lasted 24-25 hours and went away. Stated he did not go to the hospital or talk to his PCP.


VAERS ID: 1470848 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-07
Onset:2021-07-09
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Deep vein thrombosis, Oedema, Pain, Ultrasound Doppler abnormal
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Gabapentin Losartan Pepcid AC
Current Illness: None.
Preexisting Conditions: Chronic pain peripheral neuropathy acid reflux
Allergies: Intolerance for prednisone
Diagnostic Lab Data: Ultrasound Ultrasound result: ULTRASOUND RIGHT LOWER EXTREMITY VEINS ** HISTORY **: 57 years old, pain and edema. Rule out DVT. ** TECHNIQUE **: Ultrasound images of the right lower extremity deep veins including the common femoral vein, junction of the common femoral vein with the great saphenous vein, proximal deep femoral vein, femoral vein, and popliteal vein acquired. Color and spectral Doppler ultrasound images also acquired. The fullest visualized extent of the aforementioned veins was interrogated. COMPARISON: None available. ** FINDINGS **: RIGHT LOWER EXTREMITY DEEP VEINS: Nonocclusive peripheral clot noted in the right popliteal vein suggestive of subacute to chronic in nature. The remaining right lower extremity deep veins are patent with normal compressibility and flow. SOFT TISSUES: Visualized soft tissues are normal.
CDC Split Type:

Write-up: Confirmed DVT in right calf behind the knee that started on 7/9/21, 2 days after the 2nd vaccine injection.


VAERS ID: 1471010 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-09
Onset:2021-07-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 2 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anxiety, Chest discomfort, Heart rate increased, Palpitations, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None, perfectly healthy
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None. I used readings from my electronic device, which I have used for over a year - way before taking the Pfizer Vaccine. It tracks my heart rate and I felt and saw the noticeable change.
CDC Split Type:

Write-up: I felt heart palpitations, which prompted me to check my heart rate using my electronic device. It was an uncomfortable feeling in my chest. Before getting the vaccine, my resting heart rate was always in the 50s. After my 2nd Pfizer dose, my resting heart rate jumped up by 20+! It''s now in the high 70s to 80s. During the 2 days following vaccination, I came down with a high fever. I took Tylenol. So I thought my higher heart rate was due to my body fighting off the fever. But it has been almost a week since! I don''t have a fever anymore; however, my resting heart rate is still in the 80s. Is this a permanent change? I''m worried about long-term damage to my heart. It''s also not good to know that my resting heart rate increased by 20bpm.


VAERS ID: 1471027 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: Nevada  
Vaccinated:2021-07-07
Onset:2021-07-09
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWOL78 / 1 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Oral pruritus
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow)

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

Write-up: Roof of mouth super itchy few days after shot


VAERS ID: 1471043 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-07-09
Onset:2021-07-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 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: Does not like needles.
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: PATIENT WAS VERY NERVOUS ABOUT NEEDLES AND TOOK SHOT OK BUT FAINTED SHORTLY AFTER..RESCUE SQUAD CAME AND CHECKED HIOM OUT AND RELEASED HIM AS BEING OK.


VAERS ID: 1471289 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-07-06
Onset:2021-07-09
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8735 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: C-reactive protein, Computerised tomogram head, Metabolic function test, Tic, Urine analysis
SMQs:, Dyskinesia (broad), Dystonia (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: Date of Birth: 12/21/2007 Procedure Date: 07/14/21 Admission Date: ***CAT SCAN HEAD W/O*** CT OF THE BRAIN HISTORY: Headaches, seizure. TECHNIQUE: Standard, without contrast. All CT scans performed at this location utilize dose optimization techniques as appropriate to the performed exam. FINDINGS: No intracranial bleed, mass, infarct or other abnormality. IMPRESSION: 1. Normal CT brain. Signature indicates physician''s verification of document. Dictation Date / Time: 07/14/21 1319 Transcribed Date / Time: 07/14/21 1349 CBC done on 07/14/2021 showed no abnormalitites CMP done on 07/14/2021 showed only a Positive C reactive protein U/A showed no Abnormalities
CDC Split Type:

Write-up: Motor and verbal tics similar to Tourettes without coprolalia. Tics last for about 3-4 secs involving the shoulders, neck and arms with 1-2 words repeated during tic. The intervals can range from 1 min to 30 secs.


VAERS ID: 1472394 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Hawaii  
Vaccinated:2021-06-21
Onset:2021-07-09
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021C21A / 2 UN / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 008C21A / 1 UN / IM

Administered by: Public       Purchased by: ?
Symptoms: Cerebrovascular accident, Magnetic resonance imaging head abnormal
SMQs:, Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: NONE
Diagnostic Lab Data: MRI 7/14/2021
CDC Split Type:

Write-up: Patient suffered stroke


VAERS ID: 1474182 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-07-09
Onset:2021-07-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Chest pain, Dizziness, Dry throat, Dysphonia, Electric shock sensation, Feeling abnormal, Feeling drunk, Flushing, Hypoaesthesia, Hypoaesthesia oral, Laboratory test normal, Lip swelling, Oropharyngeal discomfort, Paraesthesia oral, Peripheral coldness, Throat irritation
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: Within 5 minutes of receiving the vaccine (Friday 7/9/21), started feeling dizziness, whoozy, flushed, scratchiness in throat, pulse 49; stable after 30 min; pharmacist brought out the EpiPen, just in case. Within 2-3 hrs., tingling, numbness, fullness of lips, scratchy throat and raspy voice, tipsy sensation, general overall "weird" feeling; during the same timeframe, felt a numb, tingling, cold sensation of my left ring finger. By late evening, I started feeling a "zapping" sensation that occurred randomly throughout my body, like small, low voltage zaps or static charges. By late morning the following day (Saturday), started to feel a "bubble" sensation in my chest and throat, which continued intermittently. By evening time, lips finally normal, but throat was very dry/raspy; zapping sensations continued. By mid-day the next day (Sunday), central chest pressure persisted and became more noticeable; went to the ER, had a full workup for chest pain, which was all normal. By Monday, all symptoms had resolved.


VAERS ID: 1474273 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-07-08
Onset:2021-07-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 00181 / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prenatal Vitamin
Current Illness: None.
Preexisting Conditions: None.
Allergies: None.
Diagnostic Lab Data: No medical test or lab results were ran because I only had two tele appointments on July 9th, 2021 and was advised to take Tylenol and drink lots of fluids/water
CDC Split Type: vsafe

Write-up: On July 9th, 2021 around midnight I had a fever of 102, I called my OBGYN hotline around 3:00AM for a appointment and they advised me to take Tylenol. The fever continued until Saturday , July 10, 2021 and fluctuated to 100 to 101 and by the afternoon it was gone. I also had an appointment on July 9th , 2021 with my Dr. and he told me to continue to take the Tylenol.


VAERS ID: 1474287 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-07-08
Onset:2021-07-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: flu like symptoms from 1st Pfizer vaccination on 6/17/2021 50years old
Other Medications: no
Current Illness: no
Preexisting Conditions: no
Allergies: no
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Forgot to dilute the 2nd Pfizer dose


VAERS ID: 1474751 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-08
Onset:2021-07-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain, Asthenia, Discomfort, Headache, Hypersomnia, Mobility decreased, Pain, Photophobia
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Corneal disorders (broad), Retinal disorders (broad), Depression (excl suicide and self injury) (broad), Tendinopathies and ligament 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: Birth control
Current Illness: Long Covid
Preexisting Conditions: Long Covid
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: I received the J&J vaccine last Thursday afternoon 7.8.21 and had a very strong reaction to the shot. The vaccine was received at 3:30pm and sometime after midnight I started experiencing intense body aches and pain with some abdominal pain. After waking up I was also having severe headaches and was light sensitive. This continued throughout the day Friday and I was unable to get out of bed at all. I slept for hours at a time and was so uncomfortable the other times that it was difficult to even find a position that felt good. On Saturday this got a little better but remained with body aches and bad headaches until late afternoon where I was sweating for several hours and then quickly regained my energy and the headaches resolved early evening. It was about 40 hours worth and pretty difficult. I reported this to my Doctor who suggested I enter the information into the vaers site.


VAERS ID: 1474979 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-07-09
Onset:2021-07-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Hypoaesthesia, Paraesthesia
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad)

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

Write-up: PT HAS BEEN EXPERIENCING TINGLING ARM/NUMBNESS AND CHEST TIGHTNESS SINCE RECEIVING VACCINE.


VAERS ID: 1460332 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-06-29
Onset:2021-07-09
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Lethargy, Nausea, Post-acute COVID-19 syndrome
SMQs:, Acute pancreatitis (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypoglycaemia (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Dilaudid, hydromorphone, clonazapam
Current Illness: N/A
Preexisting Conditions: Sleep apnea, PTSD, GAD, Depression, Tachycardia
Allergies: Codeine
Diagnostic Lab Data:
CDC Split Type:

Write-up: Nausea, lethargic, covid arm


VAERS ID: 1461669 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-07-02
Onset:2021-07-09
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Erythema, Peripheral swelling, Post-acute COVID-19 syndrome, Pruritus
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (narrow)

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

Write-up: Covid arm - redness, bump and itchy (almost like a mosquito bite)


VAERS ID: 1476516 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:2021-07-09
Onset:2021-07-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Other       Purchased by: ?
Symptoms: Inappropriate schedule of product administration, Maternal exposure during pregnancy, SARS-CoV-2 test, Scan, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Medication errors (narrow), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: FOLIC ACID; MOMETASONE
Current Illness: Pregnancy (Estimated due date:20Jan2022)
Preexisting Conditions: Medical History/Concurrent Conditions: Sinusitis
Allergies:
Diagnostic Lab Data: Test Name: COVID-19 virus test; Test Result: Negative ; Test Name: Scan; Result Unstructured Data: Test Result:Normal
CDC Split Type: GBPFIZER INC2021887764

Write-up: Maternal exposure during pregnancy; Vomiting; Inappropriate schedule of vaccine administered; This is a solicited case from a contactable consumer. This is the second of two reports. The first report was received from the Regulatory Agency (RA), regulatory authority report number is GB-MHRA-YCVM-202105130719425120-TCJI5, Safety Report Unique Identifier GB-MHRA-ADR 25289789. The initial safety information received was reporting only non-serious adverse drug reactions. Upon receipt of follow-up information on 11Jul2021, this case now contains serious adverse reaction. Information processed together. A 35-year-old female patient received second dose of BNT162b2 (PFIZER-BIONTECH COVID-19 VACCINE), via an unspecified route of administration on 09Jul2021 (Batch/Lot number was not reported) as single dose for COVID-19 immunisation. The patient was pregnant, last menstrual period was 16Apr2021, not currently breastfeeding. Medical history included ongoing pregnancy estimated due date: 20Jan2022, sinusitis from an unknown date and unknown if ongoing. Concomitant medications included folic acid taken folic acid supplementation, start and stop date were not reported and mometasone taken for sinusitis from an unspecified start date to 16Apr2021. The patient previously received first dose of BNT162b2 (PFIZER-BIONTECH COVID-19 VACCINE) for COVID-19 Immunisation and experienced maternal exposure during pregnancy and painful arm. The patient experienced maternal exposure during pregnancy on an unspecified date with outcome of unknown and vomiting on 10Jul2021 with outcome of not recovered, inappropriate schedule of vaccine administered on 09Jul2021 with outcome of unknown. The events maternal exposure during pregnancy and vomiting were serious, medically significant. The mother reported she became pregnant while taking BNT162b2. The mother was 12 Weeks pregnant at the onset of the event. The mother was due to deliver on 20Jan2022. The patient underwent lab tests and procedures which included COVID-19 virus test: negative on unspecified date and scan: normal on unspecified date. Additional information: the patient has not tested positive for COVID-19 since having the vaccine. The patient was not enrolled in clinical trial. The patient has not had symptoms associated with COVID-19. The patient does not think vaccination had an adverse effect on any aspect of the pregnancy. The patient was exposed to the vaccine first-trimester (1-12 weeks). Details of scans or investigations: Scan at 7 weeks was all fine. The reporter''s assessment of the causal relationship of the event with the suspect product was not provided at the time of this report. Since no determination has been received, the case is managed based on the company causality assessment. No follow-up attempts are possible; information about lot/batch number cannot be obtained.; Sender''s Comments: The causal association between the reported events and the suspect drug BNT162B2 is assessed as possibly related based on a temporal association and known drug safety profile. The impact of this report on the benefit/risk profile of the Pfizer product is evaluated a part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to Regulatory authorities, Ethics committees, and Investigators, as appropriate.,Linked Report(s) : GB-PFIZER INC-2021540722 Same patient/product,different dose & events


VAERS ID: 1455936 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-07
Onset:2021-07-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Dizziness, Fatigue, Headache, Hyperventilation, Mood swings, Myalgia, Pain, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Eosinophilic pneumonia (broad), Depression (excl suicide and self injury) (broad), Vestibular disorders (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: none
Current Illness: none
Preexisting Conditions: athsma
Allergies: pollen, cats, dandruff, dogs
Diagnostic Lab Data:
CDC Split Type:

Write-up: sore muscles all over entire arm in pain when used Extreme chills fever mood swings extreme fatigue muscle pains headache dizziness hyperventilating


VAERS ID: 1456344 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-07-01
Onset:2021-07-08
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -

Administered by: Public       Purchased by: ?
Symptoms: Abdominal pain, Headache, Tearfulness
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Depression (excl suicide and self injury) (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: Not.
Current Illness:
Preexisting Conditions:
Allergies: Milk protein.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Headaches, cramps in the abdomen were observed. Tears of sadness and sorrow were shed.


VAERS ID: 1456972 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-07-06
Onset:2021-07-08
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009D21AP / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Painful respiration, Productive cough, Sleep disorder
SMQs:, Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Infective pneumonia (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: Aurovela 24 FE, Zoloft 50 MG, off brand Claritin 10MG, I also took some Tylenol strength yesterday morning around 7 or 8 for my sore muscles.
Current Illness: None
Preexisting Conditions: None
Allergies: I''m lactose intolerant.
Diagnostic Lab Data: I have not sought out medical help yet. I''m hoping it will go away on it''s own.
CDC Split Type:

Write-up: I started having chest pain some time this morning and it made it somewhat difficult to continue sleeping. It hurts when I breathe but it also hurts while I''m just sitting here. I''ve taken a hot shower and right now I''m breathing in steam. I''ve been hacking up phlegm. It''s a very sharp stabbing pain.


VAERS ID: 1456979 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-07-07
Onset:2021-07-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 29267-1000-2 / 2 RA / IM

Administered by: Senior Living       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: Levothyroxine, omeprazole, atenolol, escitalopram
Current Illness:
Preexisting Conditions: Hypertension
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Day after injection, discovered small patch on upper right back. Examined by a doctor and confirmed shingles.


VAERS ID: 1456985 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-07-08
Onset:2021-07-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030B21A / 2 LA / IM

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

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

Write-up: Inappropriate vaccine dose administered due to early retraction of needle. Pt did not receive the full dose. Gave patient the full dose after event.


VAERS ID: 1457001 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-07-07
Onset:2021-07-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 20SA21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Eye pain, Headache, Injection site bruising, Injection site pain, Insomnia, Myalgia, Neck pain, Pain, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Glaucoma (broad), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Janssen COVID-19 Vaccine EUA Bruising and soreness around injection site, low-grade fever (~100.25 degrees Fahrenheit), muscle aches mostly along posterior chain from shoulders/neck to legs, sleeplessness, mild headache behind eyes. Symptoms first appeared approximately 12 hours after injection. Patient self-treated with 400 mg of Ibuprofen at approximately 9:00 AM on 7/8/21, roughly 19 hours after injection. Symptoms were minimized.


VAERS ID: 1457023 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-07
Onset:2021-07-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Insomnia, Nausea, Pyrexia, Tremor
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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: No
Current Illness: No
Preexisting Conditions: No
Allergies: No
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever Nausea Uncontrolled shaking Sleeplessness


VAERS ID: 1457024 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-07-07
Onset:2021-07-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Alendronate Sodium 70mg weekly, Apixaban 2.5mg BID, Aricept 10mg HS, Ascorbic acid 500mg BID, Calcium Alginate-SIlver Pad for skin care, Diphenoxylate-Atropine 2.5-0.025mg q6hr PRN, Milk of Magnesia Suspension 30mL (400mg/mL) daily PRN for
Current Illness: ESRD, muscle wasting/atrophy, generalized muscle weakness, difficulty walking, lack of coordination, Dialysis dependent, DM, hyperkalemia, HTN, insomnia, fluid overload
Preexisting Conditions: ESRD, muscle wasting/atrophy, generalized muscle weakness, difficulty walking, lack of coordination, Dialysis dependent, DM, hyperkalemia, HTN, insomnia, fluid overload
Allergies: NKA
Diagnostic Lab Data: none at this time
CDC Split Type:

Write-up: Health Commission organized a vaccine clinic for facility. Patient was a new admission to facility the night before, patient''s son had contacted facility administrator regarding the clinic stating his mother never received her second dose of Pfizer. Patient''s son presented patient''s CDC vaccination card with Pfizer vaccination given on 4/7/2021, but second dose was left blank. Patient''s son stated she was supposed to get her second shot in dialysis when she was due but they did not give it to her because was feeling ill. Health Commission registered and administered her second shot and completed the CDC vaccination card. After the administration of vaccine, patient''s son had called facility administrator and told her that his father just now had given him a second separate card that had documented the completion of the Pfizer vaccine. No adverse events noted at this time. RN advised facility administrator to make aware RN taking care of her in facility, to contact PCP and to closely monitor the patient.


VAERS ID: 1457057 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-07-08
Onset:2021-07-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024C21A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Inappropriate schedule of product administration, No adverse event
SMQs:, Medication errors (narrow)

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

Write-up: Patient received 2nd dose 1 week early. No s/s, or adverse reactions


VAERS ID: 1457063 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-07-07
Onset:2021-07-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 UN / UN
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0162 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0162 / 2 RA / IM

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

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

Write-up: patient attended a drive-through vaccination clinic held by a Health Clinic on 06/14/21. on CDC pre-vaccination screening form, patient has indicated that she had not received any covid vaccines prior to that date. patient received Pfizer covid vaccine dose 1 on that day. Data entry staff was unable to find patient in system ( hand-written last name was misread) a new profile was created on system and dose 1 pfizer was recorded. patient came back on july 7 ( clinic was closed for holiday) to receive dose 2 of pfizer to complete series. on 07/07/21, patient received dose 2 of pfizer vaccine. With the correct spelling of last name, staff discovered the duplicate profile and noticed that patient had received a Moderna dose 1 on 03/09/2021. No further information ( lot number, type of injection, injection site, etc) about that dose could be identified. Dr., clinic medical director administered the second dose of pfizer and watched the patient for 15 minutes. No adverse effects have been reported. He left a message this morning (07/08/2021) on patient'' s voicemail to call back and check on her.


VAERS ID: 1457066 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-07-08
Onset:2021-07-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / UNK LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prednisone, Lisinopril
Current Illness: Hemolytic anemia (remision)
Preexisting Conditions: Hemolytic anemia
Allergies: Sulfa
Diagnostic Lab Data: Vital signs were taken.
CDC Split Type:

Write-up: 5 minutes after administration patient refers episode of dizziness and subjective fever.


VAERS ID: 1457070 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-07-08
Onset:2021-07-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024C21A / 2 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Inappropriate schedule of product administration, No adverse event
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: n/a
Current Illness: n/a
Preexisting Conditions: HTN, hyperlipidemia
Allergies: Trimethoprim/sulfa, amoxicillin, Bactrim, trazodone, and relafen
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Patient was given 2nd dose moderna vaccine 5 days early. Currently no s/s or adverse reactions.


VAERS ID: 1457082 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-05-28
Onset:2021-07-08
   Days after vaccination:41
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / SYR

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

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

Write-up: Swelling and soreness in left arm.


VAERS ID: 1457096 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-07-08
Onset:2021-07-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Exposure during pregnancy, Obstructive airways disorder, Throat irritation
SMQs:, Angioedema (broad), Asthma/bronchospasm (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Eosinophilic pneumonia (broad), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Albuterol inhaler and multi-vitamin
Current Illness: No known illness, however; had vomiting, nausea and diarrhea a couple of weeks ago, but patient had positive pregnancy test two weeks ago as well.
Preexisting Conditions: Asthma
Allergies: No known allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received 1st dose of Pfizer vaccine (Lot # EW0196), left deltoid at 0831, at 0840 patient started to complain off itching throat 7/10. Vitals signs taken at 0845 and normal, Diphenhydramine 50mg (Lot # 6124006) given IM at 0900 in right deltoid by RN ., vitals signs taken again at 0909 and normal. Patient stated itching decreased to 3/10 after diphenhydramine given. Had NP evaluate patient and airway is swollen. Sending patient to ED via ambulance.


VAERS ID: 1457098 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-07-07
Onset:2021-07-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 2 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Malaise, Nausea, Pain in extremity, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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, nausea, arm/shoulder pain, generally feeling unwell


VAERS ID: 1457118 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-07-08
Onset:2021-07-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0175 / 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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Ocrevus but not at the current month.
Current Illness: Unknown.
Preexisting Conditions: Unknown.
Allergies: None known.
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: Patient previously received Moderna in March and April and failed to notify us. Insurance company informed us upon billing.


VAERS ID: 1457126 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-07-08
Onset:2021-07-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH PFR; EW01858 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest X-ray, Chest pain, Dyspnoea, Electrocardiogram, Full blood count, Liver function test, Metabolic function test, Palpitations, Troponin
SMQs:, Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: INFLUENZA (UNCLEAR HISTORY)
Other Medications: UNCLEAR
Current Illness: SYNRINGOMYELIA
Preexisting Conditions: SYRINGOMYELIA
Allergies: SERTRALINE, FLUOEXTINE, TRAMADOL, MUSHROOMS, DULOEXTINE
Diagnostic Lab Data: CBC, BMP, TROPONIN, LFTS, EKG, CXR
CDC Split Type:

Write-up: CHEST PAIN, SOB, PALPITATIONS


VAERS ID: 1457130 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-07-01
Onset:2021-07-08
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Atrial fibrillation, Blood test normal, Condition aggravated, Echocardiogram normal, Electrocardiogram abnormal
SMQs:, Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Cardiomyopathy (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: ibuprofen
Current Illness: no
Preexisting Conditions: 4 years ago atrial fibrillation crisis
Allergies: no
Diagnostic Lab Data: 07|03|2021 normal blood analysis, normal echo cardiogram, abnormal electrocardiogram, atrial fibrillation
CDC Split Type:

Write-up: atrial fibrillation crisis, which improved after a day of admission to the hospital


VAERS ID: 1457131 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-07-08
Onset:2021-07-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / UNK UN / IM

Administered by: Other       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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE PER PT
Current Illness: NONE PER PT
Preexisting Conditions: NONE PER PT
Allergies: NKA
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: PT WALKED UP OBS NURSE TO REPORT FEELING DIZZY AND LIGHT HEADED. PT LOOKED PALE. LOWER PT TO THE FLOOR KEPT PT IN OBSERVATION FOR EXTRA TIME/ UNTIL PT VOICE AND DISPLAY THAT SYMPTOMS RESIDES.


VAERS ID: 1457151 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-04-08
Onset:2021-07-08
   Days after vaccination:91
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Concussion, Condition aggravated, Headache, Hypertension, Loss of consciousness, Vaccination complication
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), Hypertension (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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: AMITRIPTYLINE, ATORVASTATIN, XANAX, LOSARTAN, CBD OIL, CENTRUM SILVER
Current Illness: CORONARY ARTERY DISEASE(CAD), DEGENERATIVE JOINT DISEASE (DJD), ANXIETY DISORDER
Preexisting Conditions: CORONARY ARTERY DISEASE(CAD), DEGENERATIVE JOINT DISEASE (DJD), ANXIETY DISORDER
Allergies: SEASONAL ALLERGIES, PEANUT BUTTER, SHELL FISH?
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Today 7/8/2021 patient walked into the Pharmacy and reported that he had adverse reaction as result of his Janssens covid-19 vaccination from 4/8/2021. he reported that he had headache for three weeks which went away, then on June 4th 2021 he was coming down a stairway and passed out. He was take to urgent Care and was treated for Hypertension and re-aggravation of concursion according to patient.


VAERS ID: 1457164 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-08
Onset:2021-07-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: No adverse event, Product preparation issue
SMQs:, Medication errors (broad)

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

Write-up: Gave undiluted vaccine to patient. Did not realize second bottle in bag was diluent until after vaccine was administered. Notified team lead of event, who in turn notified the chief as well as patient. Through recommendation, patient was asked to stay a total of 45 minutes instead of the usual 15 minutes. Patient has no history of vaccine reactions based on vaccine pre-assessment sheet. No symptoms throughout 45 minutes of wait time. Patient was provided water during wait. Initially assessed for any signs of reaction; given instructions to notify staff if he experienced any emergent symptoms. He remained stable throughout the wait. He was notified if he experienced severe muscle aches in the next 48 hours, he can forego second dose in series, and that event is recorded in incident report in facility. Recommended patient to call nurse advice line if he experienced symptoms in the next 48 hours after vaccination.


VAERS ID: 1457166 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: New York  
Vaccinated:2021-07-08
Onset:2021-07-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7533 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Anxiety, Chest discomfort, Dyspnoea, Electrocardiogram normal, Headache
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (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: Flu 2020
Other Medications: n/a
Current Illness: 3 weeks ago had reaction to tuna fish
Preexisting Conditions: Diabetic Asthma
Allergies: Sulfa, penicillin, aspirin & seafood Uses an epi pen for seafood
Diagnostic Lab Data: EKG, NSR
CDC Split Type:

Write-up: While in observation @ 1125 c/o of not able to breath, headache and chest discomfort right side. Placed in WC back to med eval. VS taken 166/101, sat 99%RA, HR 106 and respiration 20. Mask removed and fluids offered. Anxious and holding her chest. Pt speaks Spanish interpreter line used for translation. EKG done by EMS . VS monitored, friend speaks no English for support. Resting in chair VS repeated after no further headache and decrease in chest pressure. BP 146/101. Pt history of DM and asthma. Lung sounds clear, inhaler present and not needed. Pt declines any further work up or transport to hospital. Reviewed with pt need to call PMD regarding events with post vaccine and to discuss 2nd dose with PMD. Pt to bring someone to drive with 2nd dose and her inhaler with her. Verbalized understanding to call 911 for any difficulty breathing, hives or continued chest pressure. Discharged ambulatory @ 1205 with friend with no further chest pressure or headache. RS, NP


VAERS ID: 1457179 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-07-08
Onset:2021-07-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051C21A / 2 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Inappropriate schedule of product administration, No adverse event
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: tylenol prn hctz amlodipine estradiol protonix lasix effexor astelin nasal spray
Current Illness: htn, gerd
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt was given first dose of Moderna on June 29,2021 and came back and was administered 2nd dose of Moderna same lot number 051c2a on today. no reaction observed. pt tolerated first vaccine without any reaction or response. will follow up with pt daily. Pt was assessed by FNP and was given Tylenol in the clinic no reaction observed. no fever.


VAERS ID: 1457188 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-07-02
Onset:2021-07-08
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 RA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Citalopram 20mg Adderall 20mg BID
Current Illness: None
Preexisting Conditions: None
Allergies: NKA
Diagnostic Lab Data: None
CDC Split Type:

Write-up: 1 Days post vaccine: pain, swelling, bruising 2 days post vaccine continuing to present day of 6 days post vaccine: itching, with new redness and mild swelling at injection site


VAERS ID: 1457241 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-07-07
Onset:2021-07-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 053C21A / 2 LA / IM

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

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

Write-up: Patient is having arm pain and swelling at injections site. he is experiencing shooting and burning sensations from injection to the elbow recommended tylenol, cold pack and talk in primary md


VAERS ID: 1457251 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-07-08
Onset:2021-07-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 LA / IM

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

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

Write-up: Patient was given 0.3 ml of vaccine to left arm by nurse in office, undiluted from vial


VAERS ID: 1457258 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-08
Onset:2021-07-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Anxiety, Blood glucose normal, Chills, Feeling cold, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: TDAP as a child, unkown
Other Medications: Insulin
Current Illness: Type 1 Diabetes
Preexisting Conditions: Type 1 Diabetes
Allergies: TDAP, at childhood.
Diagnostic Lab Data: BS- 142
CDC Split Type:

Write-up: 9:45 AM client feels "throat closing, " shivering and cold. NP, safety, and EMT were called and arrived at scene. NP, assessed pt. no throat or tongue swelling present, client states he feels anxious, otherwise feeling "OK". 9:54 BP 134/77, HR 104, O2 92%, BS 142. client was laid on the floor with a sheet with his legs elevated, blanket was placed on his upper body. 10:00 NP, reassessed pt and stated he is not having a reaction to the vaccine. Client states "I feel better." 10:08 Patient is sitting in the chair BP 127/80, HR 94, O2 99% 10:10 NP assessed client and stated that he is well enough to go home. Advised client that if he has chest pain, or shortness of breath to report to the ER or call 911. Client verbalized that he feels much better. 10:15 patient is alert and oriented to person place time and situation, he safely ambulates to the car and his mother provides transportation.


VAERS ID: 1457270 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-08
Onset:2021-07-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Fall, Head injury, 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: After receiving his first dose of Pfizer Covid vaccine was standing while mother was asking a few questions and as they were about to walk over to the observation area, he passed out and fell. He hit his head on the corner of a metal plate. Pt may have been "out" for ~30 sec and came to immediately and was A+Ox3. All his vital signs were stable (BP 118/66, HR 86, O2 100). Mother was present and the ambulance was called at 10:23. Mother denies past history of fainting with IZs, denies remarkable mhx. Paramedics arrived by 10:28 and per mom''s request was taken to ED.


VAERS ID: 1457288 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-07-08
Onset:2021-07-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0202 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: No adverse event, Product preparation issue
SMQs:, Medication errors (broad)

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

Write-up: COVID-19 vaccine was mixed with 0.8 ml instead of 1.8 ml after administration patient didn''t have any reactions.


VAERS ID: 1457290 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-07-08
Onset:2021-07-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Dyspnoea
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Obesity, T2D
Allergies: Bananas, Pineapple, Latex
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was experiencing dizziness and lightheadedness after vaccine. Patient stated she was having trouble breathing and her mother administered an epi pen while she was in the waiting area. She stated her MD told her to administer the epi pen if she had any side effects after the shot. Patient refused EMS and said her mom would drive her to the ER.


VAERS ID: 1457294 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-07-08
Onset:2021-07-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood glucose normal, Dizziness, 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: None. Administered benadryl 25 mg after vaccination.
Current Illness: none.
Preexisting Conditions: anxiety
Allergies: none.
Diagnostic Lab Data: Blood sugar 107.
CDC Split Type:

Write-up: Patient developed dizziness, had a vasovagal reaction where heart rate dropped to 50s and improved to 70-80s after patient had a chance to rest. She was given 25 mg of benadryl, observed for 30 minutes and recovered without incident and was discharged homed.


VAERS ID: 1457298 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-07-08
Onset:2021-07-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Product reconstitution quality 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: Error: Incorrect Reconstitution-


VAERS ID: 1457302 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-07-08
Onset:2021-07-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: 1457307 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-08
Onset:2021-07-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: 14 year-old experienced an adverse reaction after receiving her 2nd Pfizer vaccination. She had complaints of dizziness and was observed to vomit.


VAERS ID: 1457319 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-07-07
Onset:2021-07-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 078C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Asthenia, Cough, Dyspnoea, Injection site pain, Pain, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Cardiomyopathy (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Patient called to report severe arm pain in left arm where shot was given radiating up to the shoulder. She reported having no energy and a fever. She also said she had a cough and some shortness of breath, or struggling to breathe.


VAERS ID: 1457320 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-07-08
Onset:2021-07-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 005C21A / 1 LA / SYR

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

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

Write-up: Was given Moderna, 17yrs of age, vaccine is for 18 yrs and older


VAERS ID: 1457323 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-07-08
Onset:2021-07-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048CD1A / 4 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Feeling hot, Hyperhidrosis, Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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: NOT DISCLOSED TO PHARMACY
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: NO KNOWN ALLERGIES
Diagnostic Lab Data: none
CDC Split Type:

Write-up: shortly after receiving vaccination patient became nauseated and hot and sweaty. eventually vomited as well. after about 5 minutes symptoms resolved and patient felt normal


VAERS ID: 1457346 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Mississippi  
Vaccinated:2021-07-07
Onset:2021-07-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025A21A / 2 RA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Asthenia, Blood glucose, Chest X-ray normal, Computerised tomogram head, Confusional state, Haemoglobin decreased, Haemoglobin increased, Influenza A virus test negative, Influenza B virus test, Platelet count decreased, Pyrexia, Tremor, Urine analysis, White blood cell count decreased
SMQs:, Haematopoietic erythropenia (broad), Haematopoietic leukopenia (narrow), Haematopoietic thrombocytopenia (narrow), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: promethazine prn nausea norco 7.5 prn icar c daily torsemide 100 qd ambien q hs lisinopril 40 mg qd magnesium 400 mg qd omeprazole dr 20 mg qd gabapentin 800 mg tid zanaflex 5mg bid prn clonidine hcl 0.1 mg q hs atorvastatin 80 mg po qid me
Current Illness: no acute illness
Preexisting Conditions: atrial fibrillation sick sinus syndrome presence of cardiac pacemaker localized edema hypokalemia hypomagnesemia cerebral infarction, unspecified type 2 DM with diabetic neuropathy GERD without esophagitis other recurrent repressive disorders primary insomnia emphysema fibromyalgia
Allergies: erythromycin isosorbide mononitrate methyldopa penicillins pregabalin
Diagnostic Lab Data: labs collected in ER: WBC 3.0, Hgb/ Hct 9 and 29, Platelet 103. Glucose 114. Covid swab negative, flu A & B negative.
CDC Split Type:

Write-up: 7/8/21 0430: Resident sitting on floor in room. Staff assisted back up, resident noted to have fever of 103 degrees. Shaking movements of extremities, weakness in legs, and confusion noted. Resident sent to local ER. Ct of head showed no acute process, CXR showed no acute process, and urinalysis did not indicate a UTI. Resident returned to facility after about 2 hours in the emergency room. At time of return was coherent and no longer confused.


VAERS ID: 1457352 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-07-08
Onset:2021-07-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 20521A / 1 - / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016C21A / 1 - / IM

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

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

Write-up: First dose received mRNA Moderna vaccine 2 months ago and received Janssen today. No ASE noted, client tolerated well.


VAERS ID: 1457358 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-08
Onset:2021-07-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Zoloft, Buspar
Current Illness: ALLERGIC RHINITIS, BIPOLAR 2
Preexisting Conditions:
Allergies: Baclofen, Cortisone, Latex, Kenalog, Nicotine, PCN, Toradol, Vicodin
Diagnostic Lab Data: Took to ED
CDC Split Type:

Write-up: Itching to throat, states swelling of tongue, Change in voice


VAERS ID: 1457361 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-07-08
Onset:2021-07-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Paraesthesia, Trigeminal nerve disorder
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad)

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

Write-up: Patient refers symptoms of paresthesia in left trigeminal distribution.


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