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

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



Case Details (Reverse Sorted by Onset Date)

This is page 154 out of 3,524

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VAERS ID: 1379296 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-16
Onset:2021-05-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Dizziness, Eye movement disorder, Feeling cold, Immediate post-injection reaction, Pallor, Presyncope, Vision blurred
SMQs:, Anticholinergic syndrome (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (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:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Client received her first Pfizer shot (Lot# EW0182 EXP 08/31/21) from RN at 18:40. RN stated within 20-30 seconds after administering shot, client''s eyes rolled back, and she began to pass out. The client''s friend was also in the room. RN stated that she and the friend grabbed the client, held her, and she started responding to their voices within 15 seconds. RN stated she simultaneously called for help. 2nd RN ran down the hallway to grab EMT and 3rd RN called 911. From the Lead''s room, Lead RN and Co-Lead RN observed 2nd RN running down the hallway. Leads proceeded to the hallway and observed a cluster of individuals at vaccination station 5. Lead RN & Co-Lead RN arrived at station 5 at 18:42. Leads observed client conscious and sitting in a chair. Thirty seconds later EMT arrived. Leads observed client was pale in color. Client stated she got dizzy, and her eyes got blurry within seconds after the shot was administered. Client stated she was hot and sweaty, but was not experiencing SOB or trouble breathing. Client was alert and oriented times 4. Co-Lead RN opened the window. RN put a wet towel on client''s forehead and client was transferred to a zero-gravity chair. Client stated she had eaten and drank plenty food and fluids earlier in the day. At 18:48 client stated she was feeling better. EMT took vitals at 18:50. (BP: 82/54 HR: 42). RN took client''s pulse again and stated HR: 76. Client stated she has no known allergies and takes no medications other than birth control. Client also stated she used to take medication for anxiety, but stopped taking the medication 6 months ago. Firefighter EMTs arrived at 18:54 took vitals (BP: 106/74 O2: 99 HR 68) and performed a 12-lead ECG. At this time client stated that she has never given blood because she starts to pass out when she sees blood. She also stated that she passed out 9 months prior when she saw her sister''s blood drawn at the hospital. At 18:58 client''s color was coming back. She stated she was no longer dizzy and felt better, but was now cold because the window was open, and her jacket had been taken off to perform the ECG. RN closed the window. Firefighters took vitals again at 19:00 with client sitting (BP: 104/70 O2: 99 HR: 70) and standing at 19:01 (BP: 106/70 O2: 99 HR: 72). Client stated she felt much better. Client declined transport to hospital. Lead RN provided client with a Pfizer fact sheet and educated client on the common side effects vs the adverse effects of the Pfizer vaccine. Lead RN instructed her to contact her HCP if the common side effects persisted beyond 2-3 days and to go to urgent care or the ER if she experienced any adverse effects. Lead RN also instructed client to call 911 if she experienced any respiratory issues once she was home. RN walked client to observation room for additional 15-minute surveillance. Client walked with a steady gait.


VAERS ID: 1381110 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: California  
Vaccinated:2021-03-05
Onset:2021-05-16
   Days after vaccination:72
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6203 / 2 LA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Balance disorder, Diarrhoea, Disorientation, Guillain-Barre syndrome, Headache, Hypoaesthesia, Muscle spasms, Paraesthesia
SMQs:, Peripheral neuropathy (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Pseudomembranous colitis (broad), Dystonia (broad), Guillain-Barre syndrome (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Demyelination (narrow), Vestibular disorders (broad), Noninfectious diarrhoea (narrow), Hypoglycaemia (broad), Dehydration (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: VASOTEC [ENALAPRIL MALEATE]; MEPIVACAINE HCL
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Shingles
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021584795

Write-up: This is a spontaneous report from a contactable consumer (patient). A 55-year-old non-pregnant female patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, Lot Number: EN6203, expiration date not provided), 2nd dose via an unspecified route of administration, administered in Arm Left on 05Mar2021 at age of 55 years old as a single dose for COVID-19 immunisation; mepivacaine hcl (manufacture unknown), via an unspecified route, date, dose for an unspecified indication. Medical history included Shingles. Concomitant medication included enalapril maleate (VASOTEC) taken for blood pressure. The patient previously took morphine and experienced allergies, BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, Lot Number: EL9265, expiration date not provided), 1st dose via an unspecified route of administration, administered in Arm Left on 11Feb2021 as a single dose for COVID-19 immunisation. The patient experienced guillane-barre syndrome, tingling and numbness in the legs, arms and lower face, severe headache, imbalance, disorientation, muscle spasms, diarrhea, all on 16May2021. The action taken in response to the events for mepivacaine hcl was unknown. The outcome of the events was not recovered. No treatment received for the events. The patient was not pregnancy at time of vaccination. The patient had not received any other vaccines within 4 weeks prior to the COVID vaccine. Prior to vaccination, the patient was not diagnosed with COVID-19. Since the vaccination, the patient had not been tested for COVID-19. Pfizer is a marketing authorization holder of [mepivacaine hcl] in the country of incidence or the country where the product was purchased (if different). This may be a duplicate report if another marketing authorization holder of [mepivacaine hcl] has submitted the same report to the regulatory authorities.


VAERS ID: 1381118 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: West Virginia  
Vaccinated:2021-05-01
Onset:2021-05-16
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8735 / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blindness, Body height, Eye irritation, Inflammation, Iridocyclitis, Ocular hypertension, Open angle glaucoma, Uveitis, Weight
SMQs:, Glaucoma (narrow), Optic nerve disorders (broad), Corneal disorders (broad), Retinal disorders (broad), Ocular infections (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Celiac disease; Gastroparesis
Allergies:
Diagnostic Lab Data: Test Name: Height; Result Unstructured Data: Test Result:145; Comments: cm; Test Name: WEIGHT; Test Result: 73.48 kg; Comments: kg
CDC Split Type: USPFIZER INC2021584892

Write-up: now inflammation that is causing blindness; eye irritation; inflammation; Open-Angle Glaucoma; Uveitis; Granulomatous Anterior Uveitis; Uveitic Ocular Hypertension; This is a spontaneous report from a contactable consumer (patient). A 36-year-old female patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, Lot Number: er8735; Expiration Date: 31Jul2021), 1st dose via an unspecified route of administration, administered in Arm Left on 01May2021 at age of 36 years old as a single dose for COVID-19 immunisation. Medical history included celiac disease and gastroparesis. The patient''s concomitant medications were not reported. The patient experienced open-angle glaucoma, uveitis, granulomatous anterior uveitis, uveitic ocular hypertension, all on 16May2021, now inflammation that is causing blindness, eye irritation, inflammation, all on an unspecified date. The patient underwent lab tests and procedures which included weight: 73.48 kg, height: 145cm, both on an unknown date. Therapeutic measures were taken as a result of all events. The outcome of the events was not recovered. Clinical course: consumer stated, "I was calling to report a possible side effect I do not see to do it online so I decided to call in." Consumer stated, "I had started to having a eye irritation that has turned into glaucoma that they are thinking had a now inflammation that is causing blindness." Consumer informed about Pfizer medical information department. Consumer stated, "Expiration July 31, 2021." Consumer stated, "Its started on Sunday ( Later confirmed May 16 2021)." Site of vaccination: consumer stated," Left arm." Other medication for medical conditions: consumer stated, "No , nothing Its all diet , its diet regulation." Lab Test: consumer stated, "No, everything comes negative." Still experiencing the events: consumer stated, "Yes, its same." Outcome of events: consumer stated," Same." Treatment in response to events: Consumer stated, Valacyclovir, Cyclopentolate, Brimonidine, Acetazolamide, Prednisolone." There had no known allergies. The patient was not pregnancy at time of vaccination. The patient had not received any other vaccines within 4 weeks prior to the COVID vaccine. The patient had not received any other medications within 2 weeks of vaccination. The adverse events (open-angle glaucoma, uveitis, granulomatous anterior uveitis, uveitic ocular hypertension) resulted in following: doctor or other healthcare professional office/clinic visit and emergency room/department or urgent care. The treatment for the adverse events was included medications and eye drops. Prior to vaccination, the patient was not diagnosed with COVID-19. Since the vaccination, the patient had not been tested for COVID-19.


VAERS ID: 1381924 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: New York  
Vaccinated:2021-05-13
Onset:2021-05-16
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 023C21A / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Sciatica, Vertigo
SMQs:, Vestibular disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Equate Multivitamin Gummies
Current Illness: none
Preexisting Conditions: have Osteoarthritis in both knees, nothing debilitating and are not on any treatment for it.
Allergies: Lactose Intolerant, mildly allergic to seafood and has seasonal allergies
Diagnostic Lab Data: none so far, but will be scheduling doctor visit soon.
CDC Split Type:

Write-up: experienced sciatica and vertigo a few days post 1st Moderna vaccine dose on 5/13/2021, symptoms are still on going as of 6/8/2021. Sciatica has subsided mostly but vertigo is still very much there.


VAERS ID: 1382135 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-05-14
Onset:2021-05-16
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Atrial fibrillation, Blood test, Diarrhoea
SMQs:, Supraventricular tachyarrhythmias (narrow), Pseudomembranous colitis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: INSULIN, LASIX, BABY ASPRIN ADAVAN, NORPHAN, VITAMIN D, GENUVEA
Current Illness: None
Preexisting Conditions: Diabetes, Kidney disease, Liver disease, arthritis
Allergies: Allergic to bees
Diagnostic Lab Data: blood work
CDC Split Type:

Write-up: ATRO FIB, weakness, diarea,


VAERS ID: 1382888 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-15
Onset:2021-05-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Arthralgia, Chest pain, Electrocardiogram, Pain in extremity
SMQs:, Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Oxybutynin XR Depakote Norethindrone Gabapentin Baclofen Verapamil Sertraline
Current Illness:
Preexisting Conditions: Caudal Regression Syndrome Klippel-Feil Syndrome
Allergies:
Diagnostic Lab Data: EKG-first dose
CDC Split Type: vsafe

Write-up: The day after the second dose of the vaccine she started to have pains in all of her joints. Her chest felt painful and even her finger joints. It was a constant pain that got worse with movement. The pain scale without the medication was an 8 but with the medication a 5 on the scale of 1-10. Ibuprofen and Hydrocodone helped control the pain but it did not make it totally go away. The joint pain lasted for three weeks to date but the chest pain has improved. Heat pads also help. She has never experienced these symptoms before. There were similar symptoms after the first vaccine but it is much more intense after the second dose. It has been consistent since the second dose of the vaccine but the medication and heat application does seem to help. Hospital after the first dose for chest pain.


VAERS ID: 1382931 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-05-16
Onset:2021-05-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0170 / 1 LA / IM

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

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

Write-up: Parent reported incorrect birthdate in order for child to receive dose, underage at 11 years old at time of vaccination.


VAERS ID: 1382953 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-05-15
Onset:2021-05-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 1 RA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Blood test normal, Flank pain, Lymphadenopathy
SMQs:, Retroperitoneal fibrosis (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Magnesium Daily women?s vitamin
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Blood tests clear and released fro ER. Painful to sit and work. New lymph swelling at neck after second shot.
CDC Split Type:

Write-up: Swollen inguinal lymph node on left side.


VAERS ID: 1383107 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-04-18
Onset:2021-05-16
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Cough, Pyrexia, SARS-CoV-2 test negative
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: On 6/1, I did the COVID testing, and the result was negative.
CDC Split Type:

Write-up: Had three days of fever after the first shot, but most of the time it was a low fever; only took Tylenol once Had two days of fever after the second shot, and this time the fever was higher than last time, reaching 102 F, took Tylenol multiple times 12 days after the second shot, had 4 days of fever. This time the fever was high in general, going to 102 and even 103. Had to take Tylenol multiple time everyday. Also began to cough ....Not sure if this is a delayed effect of the vaccine.


VAERS ID: 1384747 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Nevada  
Vaccinated:2021-05-16
Onset:2021-05-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EU0185 / 1 LA / OT

Administered by: Pharmacy       Purchased by: ?
Symptoms: Off label use, Product use issue, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Medication errors (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Allergy to nuts (Onset Date: at 18months of age); Egg allergy (Onset Date: at 18months of age); Food allergy (Onset Date: at 18months of age)
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021650483

Write-up: Hives all over his body; Her son who is 13 years old received his first dose of the COVID-19 vaccine on Sunday; Her son who is 13 years old received his first dose of the COVID-19 vaccine on Sunday; This is a spontaneous report from a contactable consumer (patient mother) via medical information team. A 13-years-old male patient received first dose BNT162B2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE, Solution for injection, Batch/Lot Number: EU0185), via intramuscular route, administered in Arm Left on 16May2021 15:00 as a SINGLE DOSE for COVID-19 immunisation. Medical history included food allergy, allergy to tree nuts, allergy to sesame seeds and egg allergy (onset date: at 18months of age). The patient''s concomitant medications were not reported. Patient had not received any other vaccines within 4 weeks prior to the first administration date of the suspect vaccine. The patient experienced hives all over his body on 19May2021 22:00 (3 days after vaccination), her son who is 13 years old received his first dose of the COVID-19 vaccine on Sunday on 16May2021. Patient mother called to inquire about side effects for children ages 12-18 (or whatever the ages are that was just released). She had called specifically in regards to children who have food allergies and wanted to know have any side effects been reported. Reporter stated that her son who was 13 years old received his first dose of the COVID-19 vaccine on Sunday, 16May2021. On Wednesday (19May2021) 22:00, after receiving the vaccine he developed hives all over his body including his chest, back, torso, thighs, neck and had been in contact with her son''s allergist and pediatrician inquiring about getting his second dose, but the caller wanted to know what has been reported. She tried to determine the safety of her son which continued with his second vaccination dose and gather much information as she could. She confirmed within 24-48 hours, he recovered completely from the hives. No vaccine administered at military facility. The outcome of hives all over his body was recovered on an unknown date in May2021 and for other events was unknown. Information about lot/batch number is available. Follow-up attempts are needed.


VAERS ID: 1384793 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-05-16
Onset:2021-05-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Hypersensitivity, Incorrect route of product administration, Rash
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Drug abuse and dependence (broad), Hypersensitivity (narrow), Medication errors (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:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Drug hypersensitivity
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021659027

Write-up: Severe allergic reaction; I broke out with rash; BNT162B2 intravenously; This is a spontaneous report from a contactable consumer. A 34-year-old female patient received first dose of bnt162b2 (BNT162B2, Solution for injection, lot: EW0182) intravenously on 16May2021 14:00 (34-year-old at the time of the vaccination) as single dose in left arm COVID-19 immunization. Medical history and concomitant medications were not reported. Patient reported to be allergic to Amoxicillin and Penicillin, other than that no related allergy. No prior vaccination was reported within 4 weeks. Consumer stated to report some basically a severe allergic reaction that she had to the COVID-19 Pfizer Vaccine and that was administered on 16May2021. Only they did lab testing and blood work when she broke out with rash that was it but other than that no. she has been at the ER (emergency room). They had given antihistamine and steroids but the rash, it only spread, and it''s been prevalent for a week now today and it''s probably getting worse. Outcome of the events unknown. Follow-up attempts are needed. Further information is requested.


VAERS ID: 1384954 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-05-04
Onset:2021-05-16
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0770 / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Fungal infection, Hormone therapy, Menstruation irregular, Night sweats, Weight increased
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Malignancy related therapeutic and diagnostic procedures (narrow), Fertility disorders (broad), 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: Prozac 20mg, estradiol.025, progesterone 200mg
Current Illness: NA
Preexisting Conditions: Depression/anxiety
Allergies: I have a tendency to allergies and food sensitivities and have asthma
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hormonal dis regulation. I am very regular due to hormone therapy. About two weeks after vaccine had night sweats for a week and then started my menses on day 19 in my cycle which has never happened. Also got a yeast infection- haven?t had one of these in many years. I have also randomly gained 10 lbs- I?m guessing due to something with my estrogen. I have also been extremely depleted feeling since the second vaccine, I?m used to low energy but this depletion has been more than normal for me. This second menstral cycle that I?m getting ready for seems like I will start late.


VAERS ID: 1385368 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-05-16
Onset:2021-05-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0165 / 1 LA / IM

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

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

Write-up: This patient was an 11 year old who received the Pfizer COVID-19 vaccine without incident on 5/16/2021. Due to a screening error. unbeknownst to our clinic team, the patient was less than 12 years old. Based on the EUA criteria, this patient should not have been vaccinated, and will be waiting to receive their second dose in the series until their 12th birthday in August (per CDC guidance). Error discovered at time of scheduled second dose. at which point the patient''s mother was notified of the error and rescheduled.


VAERS ID: 1385518 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-05-15
Onset:2021-05-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Autoscopy, Balance disorder, Chest X-ray, Dizziness, Echocardiogram, Laboratory test, Nervousness, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Oral Contraceptive, Vitamin D3, Women''s Multi-Vitamin
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Blood work - May 22, 2021 Chest X-ray - May 22, 2021 More blood work - May 24, 2021 Echocardiogram - May 28, 2021
CDC Split Type:

Write-up: Fainted the morning following the vaccine. Weakness followed. The feeling of being so weak that I would eat yet I wouldn''t gain any energy back. Tried to hydrate and eat nutritious food for the first few days. However, strange feeling of being lightheaded, dizzy, wobbly on my feet, almost feeling faint, continued for a full 2+ weeks after the 2nd vaccine on May 15th.. I went to the ER on May 22nd since that was 1 week past the vaccine and I wasn''t feeling any better. I was getting nervous. I had this "out of body" feeling, like the pressure in my head wasn''t right. I had blood work and was recommended to see a cardiologist. I wore a heart monitor for 2 weeks, all while my symptoms started to slowly improve. I feel mostly completely recovered now.


VAERS ID: 1385885 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-05-16
Onset:2021-05-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039A21A / 1 RA / IM

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

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

Write-up: Patient was 17 at the time of administration of the vaccine. Patient is now calling to obtain 2nd dose and age confirmed of <18. Have noted on website to proceed with vaccine and complete VAERS report. No adverse effects noted from initial dose.


VAERS ID: 1386060 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-05-13
Onset:2021-05-16
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Chest X-ray normal, Dyspnoea, 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: Adrenal supplement, Deep Sleep supplement, vitamin and iron
Current Illness:
Preexisting Conditions: Rheumatoid Arthritis
Allergies: No
Diagnostic Lab Data: Chest x ray and EKG...both ok
CDC Split Type:

Write-up: My symptoms are shortness of breath which may mirror symptoms of Myocarditis or Pericarditis...not every day, but sporadic and gets worse at night in bed.


VAERS ID: 1386630 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-16
Onset:2021-05-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site erythema, Injection site pain, Lymphadenopathy, Pain
SMQs:, Extravasation events (injections, infusions and implants) (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt has enlarged lymph nodes and redness at site, says there is pain coming from the red site under the arm that makes it hurt to lift arm high , no pain in shoulder or top of arm per mother


VAERS ID: 1387346 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-05-15
Onset:2021-05-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006C21A / 1 RA / IM

Administered by: School       Purchased by: ?
Symptoms: Atrioventricular block, Heart rate increased, Heart rate irregular, Rash, Rash pruritic, Vaccination complication
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Conduction defects (narrow), Cardiac arrhythmia terms, nonspecific (narrow), 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Endometriosis
Allergies: Augmentine & penasylin
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Heart started beating really fast & then would beat really slow. I felt intense anxiety & felt like I was dying with my heart going back & forth. I had covid arm for 2 weeks, on & off again rashes all over my body that would itch. I do not go seek treatment. I am now feeling better after the 2 week period


VAERS ID: 1387723 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-05
Onset:2021-05-16
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Other       Purchased by: ?
Symptoms: Increased appetite, Peripheral swelling
SMQs:, Cardiac failure (broad), Angioedema (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: JARDIANCE
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Allergic reaction; Blood pressure high; Corneal opacity (beginning stage); Diabetes; Hay fever; Kidney transplant; Sinusitis
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021599586

Write-up: eating out a lot; Swelling in legs and feet; This is a spontaneous report from a contactable consumer (patient) received from a Pfizer-sponsored program. A 74-year-old male patient received his first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; lot number and expiration date not reported), via an unspecified route of administration on 05May2021 (at an unspecified age) at 1st dose, single dose for COVID-19 immunization. Medical history included diabetes, blood pressure high, kidney transplant patient, allergic reactions, hay fever, sinusitis, and beginning stage of leukoma. Concomitant medications included empagliflozin (JARDIANCE) for diabetes, and unspecified 18 to 27 medications. The patient previously took diphenhydramine HCl (BENADRYL) for allergic reactions. The patient received his first dose on 05May2021 and was scheduled to receive the second dose on 26May2021, however, he reported that he received his second dose a day earlier than he was scheduled. The patient got confused since he thought that today was Wednesday, 26May2021, so he panicked and received his second dose today, 25May2021. The patient walked in panic at the vaccination site because he thought that it was closed down. The patient did not realize that he was a day early until after the injection was already given. The patient reported that on 16May2021, he had swelling in legs and feet but thinks that it was from one of his medical conditions. The patient stated that the swelling in his feet has been going on for about a week and he does not think that it has anything to do with the vaccine, and that maybe he ate too much salt. The patient further clarified that he probably ate too much salt as he was eating out a lot, and the salt from that might have added to the swelling. The patient was thinking if he could get some diuretic medication for this. The patient did not receive treatment for the event swelling in legs and feet. The patient did not go to the doctor for the swelling in legs and feet. Outcome of the events was unknown. Information on the lot/batch number has been requested.; Sender''s Comments: The event peripheral swelling is considered not related to BNT162B2, but intercurrent medical condition.


VAERS ID: 1387733 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: New York  
Vaccinated:2021-05-15
Onset:2021-05-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW1051 / 1 - / -

Administered by: Military       Purchased by: ?
Symptoms: Pain in extremity, Rectal haemorrhage
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Gastrointestinal haemorrhage (narrow), Ischaemic colitis (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:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Allergy to fermented products; Diarrhea; Drug allergy (she does not know the name of the medication, just that it was a generic); Food allergy; Head pressure; Rectal bleeding; Stomach pain; Vomiting
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021600408

Write-up: rectal bleeding; sensation/pain in her right arm; This is a spontaneous report from a contactable consumer (patient). A 79-year-old female patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, Batch/Lot Number: EW1051), dose 1 via an unspecified route of administration, administered in Arm on 15May2021 17:30 (at the age of 79years) as 1st dose, single for Covid-19 immunization. Medical history included allergic to lemons, vinegar and white wine, severe reaction to some eye drops 4-5 years ago, vomiting, and diarrhea, rectal bleeding, stomach hurt, and felt like her head was going to explode. The patient''s concomitant medications were not reported. The patient reported that she was allergic to lemons, vinegar and white wine and can''t take any pills because they make her stomach hurt, she now only takes natural medicines. She had a margarita the week before the vaccine that had some lemon juice in it, and she had rectal bleeding for a few days. She also had a severe reaction to some eye drops 4-5 years ago, she does not know the name of the medication, just that it was a generic. Half an hour after putting it in one eye she said it felt like her head was going to explode and thought she was going to die. The ambulance was called but refused to go in and had her friend take her in. She also experienced vomiting and diarrhea. On 16May2021, the day after the shot (Covid vaccine) she had some rectal bleeding similar to a light period but only for one day. She also had the shot in the left arm but had a sensation/pain in her right arm that went away quickly. The patient was unsure if that happened because she also had 2 margaritas and they made it with lemons which she is allergic to so it might have been that. The patient asked if the vaccine have any vinegar or wine in it. The patient also asked if she could get the second dose of the vaccine if she''s had a severe reaction to some eye drops 4-5 years ago. She doesn''t remember name of medication but had severe side effects including her head felt like her head was going to explode, vomiting, and diarrhea. The outcome of event rectal bleeding was recovered on 17May2021, while the outcome of event sensation/pain in her right arm was recovered on an unspecified date.


VAERS ID: 1388147 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-14
Onset:2021-05-16
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002C21A / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Thrombosis
SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad)

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

Write-up: patient received the Moderna covid-19 vaccine and two days later states she was admitted to the ER with blood clots. patient did not report the even to the pharmacy until the week of June 1st


VAERS ID: 1388271 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-05-15
Onset:2021-05-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Thrombosis
SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad)

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

Write-up: Blood clot in the leg


VAERS ID: 1388491 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-05-15
Onset:2021-05-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Thrombosis
SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad)

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

Write-up: Pt called pharmacy on 06/10/2021 to report he suffered a blood clot of unknown etiology on 05/16/2021.


VAERS ID: 1388543 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-16
Onset:2021-05-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Pain, Pain in extremity
SMQs:, 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: No
Current Illness: No
Preexisting Conditions: No
Allergies: No
Diagnostic Lab Data:
CDC Split Type:

Write-up: I got my second dose of the Covid vaccine on 5-16-21 and my right arm is still sore weeks after and it has gone away as of today 6-10-21. I can?t lift anything heavy with out it hurting.


VAERS ID: 1388938 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: New York  
Vaccinated:2021-05-15
Onset:2021-05-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022B21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Disturbance in attention, Feeling abnormal, Hypoaesthesia, Pyrexia, Somnolence
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Depression (excl suicide and self injury) (broad), 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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: lisinopril
Current Illness: n/a
Preexisting Conditions: none
Allergies: erythromycin
Diagnostic Lab Data: unsure. Advised her to call her primary MD
CDC Split Type:

Write-up: Had a fever, then started having numbness in her leg and just not feeling right. Started following day when she reported it. She didn''t want to go to ER or Urgent Care, it was late in the evening when she called. No redness or swelling on leg. I called in the morning and it felt better. As of 6/9, she still says she doesn''t feel right. Sleeping 10-12 hours a night, which she never has, and she can''t concentrate when she is working.


VAERS ID: 1389056 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-05-16
Onset:2021-05-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017C21A / 2 LA / SC

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache, Injection site induration, Injection site swelling, Injection site warmth, Post herpetic neuralgia, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (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: Already reported
Other Medications: Daily multi vitamin, sertraline 25mg
Current Illness: None
Preexisting Conditions: Psoriasis
Allergies: Sulfa drugs, cross over pollen allergy
Diagnostic Lab Data:
CDC Split Type:

Write-up: Severe swelling of left shoulder, hard and hot to touch for 4 days. Developed high fever for 30 hours. Developed severe headache - postherpetic neuralgia - along same path/location as previous shingles outbreak from 11 years ago. This pain lasted for 7 days


VAERS ID: 1390203 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: New York  
Vaccinated:2021-05-12
Onset:2021-05-16
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

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

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

Write-up: Bilateral swollen lymph nodes in armpits. Painful. Large swollen left supraclavical lymph node.


VAERS ID: 1390925 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-05-13
Onset:2021-05-16
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-06-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Angina pectoris, Asthenia, Chest discomfort, Discomfort, Dyspnoea
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Other ischaemic heart disease (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: USPFIZER INC2021607174

Write-up: This is a spontaneous report from a contactable consumer (patient). A 24-year-old male patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, lot number and expiration date not provided), 1st dose via an unspecified route of administration, administered in Arm Left on 13May2021 13:00 at age of 24 years old as a single dose for covid-19 immunisation. The patient''s medical history and concomitant medications were not reported. The patient experienced heart pain, pushing down on the chest, and being very heavy, feels really weak, short of breath, he can''t get deep breaths in, uncomfortable, all on 16May2021. The outcome of all events was not recovered. Clinical course: Caller stated he got the vaccine 13May2021, the first dose. Caller states he had bad heart pain, that he was 24 years old and it was like it was not sharp but it was like it felt heavy all the time, like his chest was heavy like somebody was pressing on it (on Sunday he began to have heart pain that he describes as being worse in the morning, pushing down on the chest, and being very heavy). Stated he felt really weak. Caller stated these started on Sunday, 16May2021 last week and it was pretty uncomfortable. Caller stated he wanted to know what to do next, should he reported to his doctor or got it checked and was it normal. Caller stated he was also short of breath, he can''t get deep breaths in and that started the same day 16May2021. Caller provided all his symptoms were persisting. States they all started in the afternoon. Caller stated it was the Pfizer Covid 19 vaccine. Stated the 1st dose was 13May2021 in his left arm at 1pm. Caller does not have dose, NDC, lot or expiry date to provide as he does not have his card. Events were not required to visit emergency room or physician''s office. There had no evets occurred I following prior vaccinations. There had no any other vaccinations within four weeks prior to the first administration date of the suspect vaccine. Patient''s Medical History and relevant test were none. Vaccine was not administered at Military Facility.


VAERS ID: 1390945 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-04-21
Onset:2021-05-16
   Days after vaccination:25
Submitted: 0000-00-00
Entered: 2021-06-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0164 / 2 LA / -

Administered by: Unknown       Purchased by: ?
Symptoms: SARS-CoV-1 test, Thrombosis
SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (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: PRISTIQ
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Blood pressure high; COVID-19 (Prior to vaccination, was the patient diagnosed with COVID-19?:Yes)
Allergies:
Diagnostic Lab Data: Test Name: Prior to vaccination, was the patient diagnosed with COVID-19?:Yes; Result Unstructured Data: Test Result:Positive
CDC Split Type: USPFIZER INC2021610105

Write-up: Blood clotting; This is a spontaneous report from a contactable consumer (patient). A 44-year-old male patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, Batch/Lot Number: EW0164), via an unspecified route of administration, administered in arm left on 21Apr2021 at 09:00 (at the age of 44-years-old) as 2nd dose, single dose for COVID-19 immunisation. Medical history included high blood pressure and COVID-19 from an unknown date and unknown if ongoing. Concomitant medication included desvenlafaxine succinate (PRISTIQ) taken for an unspecified indication, start and stop date were not reported. The patient previously received the first dose of BNT162B2 (Batch/Lot Number: FR2613), administered in arm left on 25Mar2021 at 09:30 AM, for COVID-19 immunisation. The patient experienced blood clotting on 16May2021 at 22:00. The patient underwent lab tests and procedures which included sars-cov-1 test: positive on an unspecified date (prior to vaccination). There was no treatment received for the event. The outcome of the event was recovering. No follow-up attempts are possible. No further information is expected. Information on lot number already obtained.


VAERS ID: 1390969 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-05-14
Onset:2021-05-16
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0164 / 1 LA / -

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain lower, Abdominal pain upper, Blood test, Computerised tomogram, Gastrointestinal inflammation, Henoch-Schonlein purpura, Malaise, Pain, Petechiae, SARS-CoV-2 antibody test, SARS-CoV-2 test, Vomiting
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific inflammation (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad), Vasculitis (narrow), Hypersensitivity (narrow), Noninfectious diarrhoea (broad), Immune-mediated/autoimmune disorders (narrow), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210522; Test Name: a lot of blood work; Result Unstructured Data: Test Result:came back good; Test Date: 20210524; Test Name: CAT scan; Result Unstructured Data: Test Result:inflammation in his intestines and his stomach; Test Date: 20210522; Test Name: Covid Antibodies; Result Unstructured Data: Test Result:Not specified; Test Date: 20210517; Test Name: Covid test; Test Result: Negative ; Comments: home kit for covid just to double check; Test Date: 20210522; Test Name: Covid test; Test Result: Negative
CDC Split Type: USPFIZER INC2021616090

Write-up: inflammation in his intestines and his stomach; petechial rash on his legs, which is still getting a little bit worse; HSP; stomach pain/extreme stomach pain started again and so on/intermittent stomach pain/lower left abdominal pain; lower left abdominal pain and he doubled over in pain and started vomiting; Caller states again he had intermittent pain throughout the day; vomited about three times in total, it wasn''t like excessive vomiting; didn''t feel well/feel sick again; This is a spontaneous report from a contactable consumer (patient''s parent). A 13-year-old male patient received the first dose of BNT162B2 (PFIZER COVID-19 VACCINE, lot number: EW0164, expiration date: 31Aug2021), at the age of 13 years old, in left arm on 14May2021 16:00 at single dose for covid-19 immunisation. The patient medical history was not reported. The patient was a normal 13 years old, he doesn''t take anything, he''s active. The patient did not receive any other vaccines within 4 weeks prior to vaccination. The vaccines administered on same date with BNT162B2 was none. The previous immunization with the Pfizer vaccine was none. The patient previously received the flu shot every year and experienced no adverse event. On 16May2021, about 48 hours after the vaccination, the patient started having stomach pain in the middle of the night. It began 16May2021 in the evening and into 17May2021, the patient was having stomach pain and not feeling well. Reporter stated the patient woke her up. Reporter stated they thought it was some food he ate. Reporter stated they tested his covid antibodies and they also personally at home on 17May2021 night, they tested him with a home kit for covid just to double check because nobody really brought it up and it was negative also. Reporter confirmed the home covid test was done on 17May2021. Reporter stated there was no known exposure, they just did it to make sure he didn''t have covid. The patient was taken to the emergency room on 18May2021. Reporter stated they were waiting because patient felt good during the day and they thought nothing was wrong, but then the extreme stomach pain started again and so on 18May2021, she took him to the local emergency room. Reporter stated they didn''t do much other than push on his stomach, she was worried about appendicitis. Reporter stated they didn''t worry too much, but she thought maybe it was his appendix. The doctor examined him and said he had a stomach issue and released him with medicine and that was the 18May2021. On 19May2021 and 20May2021, the patient would get intermittent stomach pain, again thinking it was a stomach bug or something. On 20May2021, the patient experienced petechial rash on his legs. Reporter called the pediatrician and again the patient was having intermittent stomach pain and kept having it intermittently. The patient would feel fine then feel sick again then on the 22May2021, the patient had more bad stomach pain and some vomiting so he wound up back in the emergency department, it was a different one than the first on 22May2021. The patient did a lot of blood work, his labs came back good, but he did not do a CAT scan, but reporter tried to do everything else, tested patient for covid, antibodies and everything and they sent him home again on the 22May2021. The patient had intermittent pain again throughout 23May2021 then on 24May2021, he went to visit the pediatrician just for a visit and they were thinking its Henoch-Schonlein purpura (HSP) which is an autoimmune response and they still didn''t have a diagnosis for his stomach. Reporter stated patient was perfectly fine at the pediatrician, then when they got home, he started having lower left abdominal pain and he doubled over in pain and started vomiting. The patient vomited about three times in total, it wasn''t like excessive vomiting. Reporter stated the pain would bring it on, he does have a rash, which is still getting a little bit worse. Reporter stated they took him back to the emergency room, they did a CAT scan and that showed he had inflammation in his intestines and his stomach so they kept him in the hospital. The patient was admitted on 24May2021 when he visited the emergency room for the third time. Reporter stated because patient was in pain, they admitted him to watch him. Reporter stated they were worried about the patient having intussusception with the bowel, where his bowel can go inside each other and can create a blockage, so they wanted to admit him to make sure that didn''t happen. Reporter stated the worst of the stomach pain was on 25May2021, which would have been at 19:00. The patient had not had an episode since then, he hadn''t had an attack like that since. The whole week before from 17May2021, or the 16May2021 when it started through 25May2021, it was very intermittent of a lot of pain. So far, knock on wood, the patient hadn''t had it since 25May2021 at 19:00 and hopefully tonight it won''t happen. Reporter stated it will be about 48 hours of not having the bad pain. Reporter stated he still has some pain, but not like where she had to rush him to the emergency room. The patient''s vomiting ended on 24May2021 or 25May2021. He had recovered completely from vomiting so far. The patient was released on 26May2021 with a diagnosis of HSP, which was an auto immune response, and he''d never had this happen before. Reporter stated if she googled HSP, it said it can still get worse, but it was not the worst case of HSP. Reporter stated the patient has never had anything like this before, he was perfectly fine, they made it through covid and didn''t get covid and he is a healthy kid so she thought Pfizer should know. The outcome of the events HSP, stomach pain, petechial rash was not recovered. The outcome of vomiting was recovered on 24May2021 or 25May2021. The outcome of the events inflammation in intestines and stomach, didn''t feel well/feel sick, intermittent pain and lower left abdominal pain was unknown. No follow-up attempts are needed. No further information is expected.


VAERS ID: 1391031 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: New York  
Vaccinated:2021-05-15
Onset:2021-05-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Asthma (Gotten better in the past year or so but had it almost her whole life Investigation Assessment: No)
Preexisting Conditions: Medical History/Concurrent Conditions: Cold
Allergies:
Diagnostic Lab Data: Test Name: Body temperature; Result Unstructured Data: Test Result:102 Fahrenheit
CDC Split Type: USPFIZER INC2021655822

Write-up: Patient slept for about 16 hours a day; Severe fatigue; Vomiting; Nausea; Fever; This is a spontaneous report from a contactable consumer (patient''s mother). A 16-year-old female patient (daughter) received first dose of BNT162B2 (PFIZER-BIONTEC COVID-19 mRNA VACCINE, Solution for injection, lot number and expiry date were not reported), via an unspecified route of administration, on 15May2021, as a single dose for COVID-19 immunization. The patient''s medical history included ongoing asthma (gotten better in the past year or so but had it almost her whole life investigation assessment: No) and cold. Concomitant medications were not reported. The patient''s mother reported that on 16May2021, the patient (daughter) developed nausea and vomiting for about 12 hours and treated with dramamine and went away, completely resolved. She also had fever of up to 102 Fahrenheit for about 3 days that went away and also presents severe fatigue that lasted from 9 to 10 days that started on 18May2021 and was only improving now and wanted to know if that would that be an allergic reaction, when she presented fatigue the patient slept for about 16 hours a day. The hours that she was awake she was normal, she was nor weak. Caller wants to know what can they expect "fatigue wise" with the second dose and why do patients develop fatigue. She also wants to know if a "severe fatigue" could last several days. A higher incidence was reported with the second dose of the vaccine with adults and adolescents. No information on how long the fatigue would last. The outcome of the events nausea and vomiting was resolved on 16May2021 and fever was resolved on an unknown date. Outcome of the severe fatigue was recovering and for the event patient slept for about 16 hours a day, it was unknown. Follow-up attempts are needed. Information on Lot/Batch number is requested.


VAERS ID: 1391040 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Unknown  
Location: Massachusetts  
Vaccinated:2021-05-15
Onset:2021-05-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0171 / 1 RA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Dizziness, Nausea, Pain in extremity
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (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:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Chronic pain; Mastectomy bilateral
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021656618

Write-up: I felt fine other than a sore arm and applied essential oils to my feet and immediately felt nauseated and dizzy; I felt fine other than a sore arm and applied essential oils to my feet and immediately felt nauseated and dizzy; I felt fine other than a sore arm and applied essential oils to my feet and immediately felt nauseated and dizzy; This is a spontaneous report from a contactable consumer. A 52-years-old patient of an unspecified gender received first dose of BNT162B2, (PFIZER-BIONTECH COVID-19 mRNA VACCINE, solution for injection; lot number: EW0171), via an unspecified route of administration, administered in Arm Right on 15May2021 13:00 as 1st dose, single for covid-19 immunisation. Medical history included Chronic pain, bilateral mastectomy. Patient known allergies to nystatin. The patient''s concomitant medications was post op Pain medication, essential oils. On 16May2021 14:00 the patient reported I felt fine other than a sore arm and applied essential oils to my feet and immediately felt nauseated and dizzy. The patient did not receive any other vaccines within 4 weeks prior to the COVID vaccine. Prior to vaccination, the patient did not diagnosed with COVID-19. Since the vaccination, the patient had not been tested for COVID-19. Patient did not receive any treatment for event. The outcome of the events were recovered. Follow-up attempts are needed. Further information is expected


VAERS ID: 1391587 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-05-14
Onset:2021-05-16
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / -

Administered by: Other       Purchased by: ?
Symptoms: Arrhythmia, Electrocardiogram
SMQs:, Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (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: Atorvastatin 20 mg, Rybelsus 14 mg
Current Illness: none
Preexisting Conditions: none
Allergies: hay fever - seasonal allergies
Diagnostic Lab Data: EKG 5/16/2021 Pending stress test 6/28/2021
CDC Split Type:

Write-up: Began experiencing heart arrhythmia the Sunday adn Monday after my second shot. (Never experienced previously) I had another two day episode on Thursday and Friday of that same week. Went to cardiologist, got an ekg which showed the abnormal heartbeat. I am currently scheduled for stress test on the 28th of June. Dr. said it is not too worrisome but I am still experiencing the arrythmia occasionally.


VAERS ID: 1391644 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-04-01
Onset:2021-05-16
   Days after vaccination:45
Submitted: 0000-00-00
Entered: 2021-06-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0153 / 2 LA / SYR

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

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

Write-up: Numbness and tingling in left arm


VAERS ID: 1341657 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-05-16
Onset:2021-05-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Blood culture negative, Computerised tomogram thorax abnormal, General physical health deterioration, Intensive care, Myalgia, Pneumonia, Pyrexia, Skin wound, Staphylococcal sepsis, Staphylococcus test negative
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Sepsis (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? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: NA
Current Illness: No
Preexisting Conditions: No
Allergies: No
Diagnostic Lab Data: CT Scan and blood samples on every day oh hospitalization since last tuesday.
CDC Split Type:

Write-up: Patient started with high fever, muscular pain and abrupt worsening of general health 8 hours after vaccination. Patient was hospitalized on tuesday. By the time of this report, patient is still hospitalized. Intensive care Unit. Today. Dr. from ID Department talked over the phone to me (I am in another country and I am GP and Pulmonologist of the patient in that country. Dr. reported negative blood cultures for Staphilococcus aureus. Nevertheless, a bilateral pneumoniae was evidenced on the CT SCAN, with high oxygen flow requirement, and ICU need, and as of today, oxygen flow has been decreased to 2 liters per minute. Antibiotic therapy was used starting with vancomycin and rotated yesterday to Cefarolime. Suspected staphilococcus aureus sepsis, was suspected due to a skin wound on right elbow.


VAERS ID: 1228471 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-05
Onset:2021-05-15
   Days after vaccination:40
Submitted: 0000-00-00
Entered: 2021-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP9605 / 1 LA / UN

Administered by: Private       Purchased by: ?
Symptoms: Erythema, Herpes zoster, Irritability, Pain in extremity, Peripheral swelling, Tooth infection
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Hostility/aggression (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Osteonecrosis (broad), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: VIT C/ VIT D3/ CALCIUM/MAGNESIUM/ZINC/BERRY EXTRACT
Current Illness: NONE
Preexisting Conditions: BREAST CANCER SURVIVOR SINCE 2009
Allergies: YES, MEDICATIN AND FOOD (SEE COMPLEMENTATION FORM)
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: AFTER 11 DAYS, I''VE GOT A STRANGE TEETH ROOT INFECTION (HAD AN URGENT ROOT CANAL TREATMENT) FOLLOWED BY A HERPES ZOSTER OUTBREAK AND A "COVID ARM" WITH REDNESS, SWOLLEN AND PAIN. THE HOTLINE CORONAVAX IN SWITZERLAND, GAVE ME THE ADVISE TO GO TO THE PHARMACY, EXPLAIN MY EVENT TO THE PHARMACIST. HE LOOKED AT MY "COVID ARM" GAVE ME A POMADE AND GAVE THE ADVISE TO GO THE URGENCY IF IT DOES NOT GET BETTER AFTER 3 DAYS. NOW AFTER 14 DAYS, I AM STILL FEELING A LITTLE CRANKY. MY HEALTH PROFESSIONAL DOCTOR WITH HOMEOPATHIC APROACH, GAVE ME THE ADVISE NOT TO TAKE THE 2ND SHOT. WHAT SHALL I DO?


VAERS ID: 1319633 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-05-12
Onset:2021-05-15
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / N/A RA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Axillary mass, Lymphadenopathy, Pain in extremity
SMQs:, Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Swelling under arm, when I woke up Friday I noticed under my arm is pretty painful , I can feel what I would describe as a lump right in my armpit. Just started Friday . I am going to see how it is over the weekend.


VAERS ID: 1319999 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-13
Onset:2021-05-15
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 023C21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Back pain, Immobile, Nausea, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: High fever 102.3F ~15hrs after injection Severe back pain, to the point of immobilization ~30hrs after injection Nausea ~30hrs after injection


VAERS ID: 1320223 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-05-12
Onset:2021-05-15
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA UNKNOWN / 2 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Back pain, Neck pain
SMQs:, Retroperitoneal fibrosis (broad), Arthritis (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: See side effect description above
Other Medications: Wellbutrin 20 mg daily
Current Illness: None
Preexisting Conditions: None
Allergies: Amoxicillin
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Woke up with extreme pain lower right side of neck and I to my upper back. This happened two and a half weeks after my first shot and lasted a week. Also last time the tops of my hands felt strange, like the blood inside was hot and tingling. Lasted a day or two.


VAERS ID: 1320449 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-05-13
Onset:2021-05-15
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1816022 / UNK RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Dysstasia, Gait disturbance, Joint stiffness, Joint swelling, Mobility decreased, Pain in extremity
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (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: Sertraline, topiramax, omeprasole, ferrous sulfate, levothyroxine, acetaminophen, omega 3 complex, multi-vitamin.
Current Illness:
Preexisting Conditions: Anemia, acid reflux, primary sclerosing colongitis, migraines, hypothyroidism, Crohns disease, anxiety/depression
Allergies: Ibuprofen, gluten
Diagnostic Lab Data:
CDC Split Type:

Write-up: Awoke two days after with severely swollen, stiff, and painful knees. Practically impossible to bend. Other minor unusual sore spots, base of left index finger, we''re tolerable, but I am having trouble standing, sitting, and walking because of the extreme state of my knees! No history of arthritis, but every appearance of sudden onset!


VAERS ID: 1320460 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Blood test abnormal, Condition aggravated, Neck pain, Pain in extremity, Rheumatoid arthritis
SMQs:, Arthritis (narrow), Tendinopathies and ligament disorders (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: rovastation, metformin, equivan,
Current Illness: none
Preexisting Conditions: diabetes, lymes disease 15 years ago
Allergies: sulfas,, pennacillian
Diagnostic Lab Data: diagnosed with rhematoid arthritis, from blood work.
CDC Split Type:

Write-up: extreme joint pain, shoulders, neck, hands, brought on rheumatoid arthritis, 2n shot excellarated it more.


VAERS ID: 1320531 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Paraesthesia, Paraesthesia oral
SMQs:, Peripheral neuropathy (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad)

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

Write-up: Tingling of checks and lips.


VAERS ID: 1320533 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-04-24
Onset:2021-05-15
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Patient sustained miscarriage. G1P0, Due Date 11/1/2021


VAERS ID: 1320535 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-05-06
Onset:2021-05-15
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0151 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Unevaluable event
SMQs:

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

Write-up: unknown


VAERS ID: 1320542 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-05-07
Onset:2021-05-15
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0151 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Unevaluable event
SMQs:

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

Write-up: unknown


VAERS ID: 1320548 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-05-14
Onset:2021-05-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: 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: no
Current Illness: no
Preexisting Conditions:
Allergies: no
Diagnostic Lab Data: NO
CDC Split Type:

Write-up: NAUSEA,VOMITING AND SWEAT


VAERS ID: 1320572 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003C21A / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Joint swelling
SMQs:, Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: TESTOSTERONE 1.62% GEL
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: After the fifteen minute mark after receiving vaccine, he noticed swelling at his wrist near his right hand. It is unknown if that was already there before receiving the vaccine. No other marks or bumps or reactions aside from the swelling at his right wrist. Spoke with patient 45 minutes after receiving vaccine and he said the swelling has gone down, no new reactions.


VAERS ID: 1320574 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: unknown
Diagnostic Lab Data: HR: 96 RR:16 Bp: 111/75
CDC Split Type:

Write-up: Patient complained of nausea; patient did not eat breakfast


VAERS ID: 1320580 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lamictal 200mg
Current Illness: None
Preexisting Conditions: Epilepsy
Allergies: None
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Patient presented with copious rash on the left arm, more prominent around the injection site that occurred 10 minutes after the administration of the vaccine. 25 mg of diphenhydramine IM were administered. Patient recovered after 15 minutes after the diphenhydramine was administered. Patient was observed for 1 hour.


VAERS ID: 1320584 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Rhode Island  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dizziness, Pallor, Vomiting
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad)

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

Write-up: pt had just received vaccine and found by ems crew with father at check out station. pt was seated with head in hands with complaints of light headedness and dizziness. pt was pale. pt was brough to evaluation area. pt suffered brief vomiting event. initial vitals were bp 85/50 hr 69 spo2 100% ra rr 18. pt was believed to ave been suffering from vaso vagal event.pt apperaed to recover quickly. pt second vital set were 90/60 hr 69 spo2 100%RA RR 18. pt skin color returned to a pink color. pt began to "feel much better" pts father gave consent to all evaluation and treatment. pt was believed to be stable. pt care was released. pt father was informed to contact emergency services if any symptoms returned and/or worsened.


VAERS ID: 1320586 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21 A / UNK LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Unevaluable event
SMQs:

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

Write-up: None stated.


VAERS ID: 1320590 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / UNK LA / -

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Flushing, Hyperhidrosis, Nausea, Vital signs measurement
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypersensitivity (broad), Hypoglycaemia (broad)

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

Write-up: Patient found to laying on her husband''s lap. Was asked by RN if patient felt okay. Patient stated she felt dizzy. Face noted to be flush and diaphoretic. Legs elevated. EMS called. Alcohol and ammonia applied. Patient then felt nauseated. Emesis bag was given. Vital signs obtained. Patient was given water and powerade. Patient felt better after treatment .


VAERS ID: 1320593 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain, Blood pressure decreased, Chest discomfort, Chest pain, Dizziness, Immediate post-injection reaction
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Dehydration (broad)

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

Write-up: Immediate light headedness 1 minute post administration progressing to chest pain and tightness along with abdominal pain/cramping approximately 2 minutes later. EMT''s contacted. Checked patient''s blood pressure which had dropped to 96/50 mmHg. Provided water to patient 2 minutes later to re stabilize cardiovascular stability. Chest pain and lightheadedness ceased within 1 minute after providing 16 ounces of water. Checked blood pressure again which returned to 110/69 mmHg. EMT''s arrived approximately 20 minutes after administration and patient was assessed. Blood pressure noted at 126/70 mmHg. Patient was allowed to go home with slight, residual abdominal pain.


VAERS ID: 1320597 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dizziness, Hypotonia, Skin exfoliation, Visual impairment
SMQs:, Severe cutaneous adverse reactions (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NA
Current Illness: NA
Preexisting Conditions: NA
Allergies: NA
Diagnostic Lab Data: VS: BP 90/50, P 70, R 17
CDC Split Type:

Write-up: Patient feel dizzy, light headedness, vision changes, observe peel, muscles relax. Did not loose consciousness during brief event, was alert and oriented there after. Escorted by nurse and family member to observation area. observed for 30mins.


VAERS ID: 1320635 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Oklahoma  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blindness, Immediate post-injection reaction, Incoherent, Pain in extremity, Seizure, Skin discolouration
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Psychosis and psychotic disorders (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Glaucoma (broad), Optic nerve disorders (broad), Retinal disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none on file
Current Illness: none
Preexisting Conditions: none
Allergies: pt states no allergies and no previous reactions to vaccines
Diagnostic Lab Data: none
CDC Split Type:

Write-up: pt received the shot and immediately felt according to him, intense pain in arm and began to loose sight. Patient then seized and went limp. We put the patient flat on the ground to protect from a fall injury and his seizing stopped. His color was very ashy and he was not responding properly to questions we asked. In about 2 minutes, he became more coherent and began talking and responding to our questions. Paramedics were immediately called and they arrived 30 minutes later after 3 phone calls to follow up. Father was with patient.


VAERS ID: 1320642 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Connecticut  
Vaccinated:2008-07-02
Onset:2021-05-15
   Days after vaccination:4700
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: unknown
Diagnostic Lab Data: BP: 96/58 HR" 72
CDC Split Type:

Write-up: light headed, -s


VAERS ID: 1320664 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: unknown
Diagnostic Lab Data: BP: 97/56; HR:50; RR: 20; 02stat:100 at 11am lying down
CDC Split Type:

Write-up: Patient was nervous with anxiety complained of being dizzy


VAERS ID: 1320686 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-05-14
Onset:2021-05-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Pain in extremity
SMQs:, 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: Sore arm
Other Medications: AM 300mg Gabapentin 1800mg NAC 2mg Doxazosin 25mg Metoprolol 20mg Lexapro 100mg Amantadine 10mg Lithium Orotate 1 scoop OptiMag Neuro 250mg Vitamin C 750mg Glutathione 30mg Zinc PM 10mg Lexapro 1800mg NAC 2mg Doxazosin 25mg Metoprolol 100mg
Current Illness: Cold about 3.5 weeks prior
Preexisting Conditions: Autism, Anxiety, Depression, PANS - Bartonella
Allergies: None
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: First day after sore arm


VAERS ID: 1320691 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: New York  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypoaesthesia, Hypoaesthesia oral
SMQs:, Peripheral neuropathy (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad)

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

Write-up: Patient returned to pharmacy approximately 30-45 minutes after receiving the vaccine, stating their lower lip and nose are numb to the touch. When assessed, no other symptoms were identified. Patient reported no weakness on one side of body or face. Facial movements observed appeared symmetrical. I recommended the patient get in touch with their primary care doctor to discuss the reaction.


VAERS ID: 1320693 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood pressure measurement, Confusional state, Dizziness, Head titubation, Heart rate increased, Somnolence
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Atorvastatin 20mg Tradjenta 5mg Ramipril 10mg Metformin ER 500mg Levothyroxine 200mcg
Current Illness:
Preexisting Conditions: Diabetes Hyperlipidemia Hypertension Sleep Apnea
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient became sleepy, light-headed, and confused within minutes after vaccination. He was nodding off in the observation area. He was difficult to wake up and confused when he did. We called 911 and paramedics came to check him out. They monitored his blood pressure and pulse. His pulse was high (120-130bpm), so they thought it would be best to take him to the hospital so he can be checked out.


VAERS ID: 1320702 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 10:24 HR 56 O2 97% BP 143/80
CDC Split Type:

Write-up: Itchy Throat 10:20 25mg Benadryl PO given 10:30 no longer itchy throat


VAERS ID: 1320706 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Loss of consciousness, Muscle rigidity, Tremor
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), Parkinson-like events (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

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

Write-up: Approx 2 minutes after receiving dose, patient became dizzy. Per pt''s father, patient became stiff and tremored some. He lowered patient to the floor at which time there was LOC. Reaction clinician used smelling salts which brought patient to (pt was out for approx 1 min per staff) No loss of bowel/bladder. Pt was brought to med obs 1 via stretcher. Vitals taken, water and crackers given Pt feeling well and discharged to home with father and sister Vitals: 11:46 HR 82, Resp 16, BP 109/70, O2 100 12:02 HR 86, Rep 16 BP 102/70, O2 100


VAERS ID: 1320710 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NA
Current Illness: NA
Preexisting Conditions: NA
Allergies: NA
Diagnostic Lab Data: VS. BP: 100/60, P. 80, R 20
CDC Split Type:

Write-up: Nauseated after receiving vaccine, patient asked to sit in the wheel chair and accompanied by nurse to observation area. Patient feels better. Patient was observed for 30mins


VAERS ID: 1320750 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: New York  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038C21A / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Coordination abnormal, Dizziness, Dysstasia, Feeling hot, Hyperhidrosis, Muscular weakness, Nausea, Respiration abnormal, Vision blurred
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Respiratory failure (broad), Hypoglycaemia (broad)

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

Write-up: Patient experienced perspiration, dizziness, lack of strength, lack of coordination, over heated, blurred vision, breath restriction ?could not get a rhythm to my breath, muscle weakness ?could not stand?, nausea


VAERS ID: 1320755 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: localized rash on right arm and chest


VAERS ID: 1320770 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 1 LA / IM

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

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

Write-up: Patient arrived to post vaccine area after first dose of Pfizer COVID 19 vaccine. Patient reported feeling some throat "fullness". No rash/hives/redness/swelling, airway clear and patent. Vital signs 144/91 hr 66 O2 100%. Patient reports taking 50mg PO Benadryl 3 hours prior to arrival. Patient seen by MD on site, given additional 25mg PO Benadryl by physician. MD discussed plan of care with primary care provider. Prescription for PO prednisone arraigned with PCP. Patient monitored for one hour post Benadryl by post vaccine nurse. Reported improvement of symptoms, refused EMS/emergency care/911 services. Confirmed he will be picking up prednisone prescription and will call 911/ seek emergency care if symptoms worsen. Reported to VAERS by supervisor


VAERS ID: 1320773 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821286 / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Blood pressure measurement, Face injury, Skin abrasion, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Syncope. Pt sustained abrasion to right forehead. BP 140/90 initially, 120/80 when released form recovery area.


VAERS ID: 1320776 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: penicillin
Diagnostic Lab Data: BP 139/58, pulse 53
CDC Split Type:

Write-up: A 14-year-old female received her COVID vaccine. After about 5 minutes of sitting in the chair for her 15 minute observation, her mom said she felt nauseous and like she was going to pass out. She was laid her back in the chair. The patient''s mother went to get orange juice. She was pale and her eyes were rolling back in her head. She did pass out for a few seconds, and I checked the patient''s pulse and blood pressure. BP 139/58, pulse 53. By that point she was coming back around. After she sat for several minutes and had orange juice and water, she was feeling much better.


VAERS ID: 1320781 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / IM

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

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

Write-up: Syncope caused patient to lose consciousness and fall out of chair hitting her head. Paramedics were called to the scene but patient did not require additional medical assistance at the time. Follow up with PCP recommended.


VAERS ID: 1320785 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: New York  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Erythema, Hypoaesthesia, Skin warm
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: C/O arm numbness. Color of both arms=, pink and warm to touch. Able to move arm. After 10 minutes complained of left wrist and fingers numb on L arm. Able to move digits of fingers. Left hand slightly cooler than right, and color the same. Denies any other symptoms. Bandaid at site of injection indicates given in deltoid. After 20 minutes, symptoms did not improve and patient willing to go to hospital ER.


VAERS ID: 1320786 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blepharospasm, Hypoaesthesia, Loss of consciousness, Tremor
SMQs:, Torsade de pointes/QT prolongation (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Periorbital and eyelid disorders (narrow), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

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

Write-up: Administered Pfizer COVID vaccine #1 to 15 year old patient. During his 15 minute wait time, patient''s eyes began to flutter and he slumped over. Pharmacist responded and lowered patient to floor and elevated legs. He regained consciousness and was able to repeat his name and his location. First BP was 108/68. Pt was able to sit in chair and drank an orange juice, but began to shake and tremble and stated his extremities were numb. Repeat BP was 80/48 and EMS was called. Upon EMS arrival, his pulse and BP had returned to normal. EMS evaluated and advised that he was ok to return home.


VAERS ID: 1320808 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Not known
Current Illness: Not Known
Preexisting Conditions: Not Known
Allergies: Pets, Peanuts, Almonds, Seasonal
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient said that he sometime faint when receiving a vaccination, but proceed with the Janssen Covid-19 shot at 9:50a. Then, had a syncope episode at 9:52a. EMS at Amazon was called to tend to the patient while 911 was called. Patient left with the ambulance service.


VAERS ID: 1320810 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039B21A / 2 AR / IM

Administered by: Public       Purchased by: ?
Symptoms: No adverse event
SMQs:

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

Write-up: Patient received their first Moderna COVID-19 vaccine dose on 4/24/2021. Second dose was administered on 5/15/2021 (7 days prior to scheduled 2nd dose). No adverse reactions were observed during the 15 minute monitoring period.


VAERS ID: 1320835 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 1 LA / IM

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

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

Write-up: Patient brought to medical tent after collapsing after he got vaccinated. Nursing reports he has been unconscious for 2 minutes after standing up and was caught by nurse. Pt was sweaty which got better when supine. Pt felt weak, headache, dizziness and pale. no difficulty swallowing. attempted to sit up and dizziness worsened. Pt''s symptoms did not improve so EMS initiated.


VAERS ID: 1320839 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Asthenia
SMQs:, 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Weakness. Seen by EMS on site. Discharged home with father at 12:50 p.m.


VAERS ID: 1320859 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 1 LA / IM

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

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

Write-up: pt fainted roughly five minutes after shot. She came to shortly after and was helped back into her chair. Pt complained of dizziness and numbness in her arms. Blood pressure was taken 79/56. Paramedics came and checked pt out . Pt was released to mom after being given water and sitting for 10 more minutes.


VAERS ID: 1320863 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-05-13
Onset:2021-05-15
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: School       Purchased by: ?
Symptoms: Dysarthria, Fatigue, Vomiting
SMQs:, Acute pancreatitis (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypoglycaemia (broad)

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

Write-up: Tiredness, slurring of words, vomiting,


VAERS ID: 1320865 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: PATIENT ADMITTED AFTER THAT HE SOMETIMES GET DIZZY AFTER VACCINE OR WHEN BLOOD IS DRAWN BUT IT HAD BEEN A WHILE SINCE HE LAST H
Other Medications: n/a
Current Illness: NONE REPORTED TO PHARMACY BUT TOLD EMS HAD CARDIO ISSUES IN THE PAST
Preexisting Conditions: UNKNOW
Allergies: BANANNA
Diagnostic Lab Data: N/A.
CDC Split Type:

Write-up: VACCINE WAS ADMINISTERED PRIOR TO PATIENT LOSING CONSCIOUSNESS. CAME ROUND AFTER A FEW SECONDS. REPORTED DIZZINESS, DENIED SHORTNESS OF BREATH, OR SWELLING. 911 WAS CALLED. EMS ATTENDED TO PATIENT.


VAERS ID: 1320871 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Feeling abnormal, Product administered to patient of inappropriate age
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Vestibular disorders (broad), 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: Lightheaded, fuzzy feeling. Seen by EMS on site. Discharged home at 12:38 p.m.


VAERS ID: 1320875 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805020 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal discomfort, Hyperhidrosis, Malaise, Pallor
SMQs:, Neuroleptic malignant syndrome (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: don''t know
Current Illness: diabetes,high blood pressure, high cholesterol
Preexisting Conditions: diabetes,high blood pressure,high cholesterol
Allergies: shrimp
Diagnostic Lab Data: don''t know
CDC Split Type:

Write-up: the customer just received a janssen covid 19 vaccination . lesser than 5 minutes he came up to the counter to let me know that he felt sick to his stomach (tight), sweat, looked pale but alert . I did not fall or injury. I called 911 and the he was taken to the hospital. He felt better at this time.


VAERS ID: 1320882 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: New York  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? 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: Pt developed hive on his L Forearm. Pt given 25 mg Bendryl


VAERS ID: 1320891 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Anxiety, Nervousness
SMQs:, Hypoglycaemia (broad)

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

Write-up: Nervous, anxiety. Seen by on site EMS . Discharged home at 12:15 p.m.


VAERS ID: 1320893 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 1 LA / IM

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

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

Write-up: Patient went to sit 15 minutes for recovery post-vaccine with her mom. All of a sudden she said "My arm feels funny," then laid her head on her mom. Her mom said her eyes rolled back and she passed out and slid down the chair onto the floor. 911 was called, pharmacist ran to scene. Patient remained on floor, started puking. Told her to breath deep, offered water. She slowly started feeling better. Paramedics arrived and examined her. After about 30 minutes, patient left with mom. No ER needed.


VAERS ID: 1320911 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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 become light headed, lost consciousness and struck head. He rest under observation, ice pack and drunk juice. He recovered and discharged home Pulse : 67 SPO2 : 99% BP: 110/58


VAERS ID: 1320919 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 1 RA / IM

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

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

Write-up: Patient was waiting for the 15min and at about 5 min in started to pass out. Got her on the ground and called 911. Never lost consciousness, but was transported to hospital to be looked at.


VAERS ID: 1320921 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 1 LA / IM

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

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

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


VAERS ID: 1320931 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (UNKNOWN)) / UNKNOWN MANUFACTURER 203A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hyperhidrosis, Hypoacusis, Syncope, Vision blurred
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Glaucoma (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Hearing impairment (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? 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. fainted while walking from counseling room to observation area. Was able to get up and walk to chair, but did develop sweating, blurred vision, difficulty hearing for 5-10 minutes. Pt improved after drinking water, apple juice, and doing deep breathing. Paramedics called to assess pt. Pt. had past vaccine syncope reactions and BP was <120/80 when taken by paramedics. Pt was fine after 30 min and was picked up by his girlfriend to go home together.


VAERS ID: 1320935 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NA
Current Illness: NA
Preexisting Conditions: NA
Allergies: NA
Diagnostic Lab Data: VS: BP. 102/64, P 60, R 22
CDC Split Type:

Write-up: Patient fainted after vaccination. Patient was put into the wheel chair by the nurse and taken to observation area. Patient wake up and was alert and oriented. Patient was asked to sit for 30mins observation. Patient feels better.


VAERS ID: 1320937 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: 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, as per patients guardian.
Current Illness: History of Syncopal Episodes
Preexisting Conditions: None
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt was nervous prior to vaccine administration. After receiving vaccine patient experienced pre-syncopal episode and became dizzy. Reaction nurse evaluated Pt and laid Pt in Trendelenburg pos. Pt began to feel better and was given pretzels and water and then moved to wheelchair. Pt received eval from clinician. VS were appropriate for Pt age and improved after 2nd set of VS. Pt released @ 1408 hrs.


VAERS ID: 1320939 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821286 / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? 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: Fainted


VAERS ID: 1320946 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-05-13
Onset:2021-05-15
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

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

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

Write-up: My period has begun unexpectedly. I should not be getting it for 2 more weeks, but I suddenly started bleeding today.


VAERS ID: 1320950 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / IM

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

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

Write-up: no adverse effect but the patient was 16 years of age and I missed it when the vaccine is indicated only for 18 years of age


VAERS ID: 1320956 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Na
Current Illness: NA
Preexisting Conditions: Anxiety
Allergies: sulfa
Diagnostic Lab Data: VS. 100/66, HR 84, R 18
CDC Split Type:

Write-up: Patient hands felt tingly, head felt tingly, got light headedness. patient was put into a wheelchair and taken to observation room by nurse. Patient was alert and oriented. Patient feels better after drinking some water.


VAERS ID: 1320962 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-05-14
Onset:2021-05-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Erythema, Peripheral swelling, Pruritus, Urticaria
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Amoxicillin
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Swelling of both hands and arms. Hives presenting on both arms and wide spread itching and redness. Referred to physician. Outcome unknown at this time.


VAERS ID: 1320970 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: n/a
Current Illness: Covid Shot on 04/24/2021, no ADE
Preexisting Conditions: n/a
Allergies: n/a
Diagnostic Lab Data: Pfizer covid vaccination only.
CDC Split Type:

Write-up: Within approx. 5 minutes of receiving vaccine another patient (not related) alerted pharmacy staff to a patient "having a reaction" in our waiting area. When I approached the patient, he was staring ahead at his mother while she informed me that he experiences similar reactions when at the doctors office when he receives any shot. Before I approached he was passed out, but he was coming to when I arrived. He was able to speak, look at me, and move without delay within a minute and showed no further symptoms.


VAERS ID: 1320991 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006C21A / 2 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: Patient states she has fainted for every vaccination she has ever been given.
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: The patient informed me before giving the second dose of Moderna that she has fainted for every single vaccine she has ever been given including the first dose of Moderna. She stated it usually happens one to two minutes after receiving the vaccine and that she comes to within 10-15 minutes. Her father has been with her for every vaccination, and she just rests her head on his stomach. I informed the other pharmacist on duty of this and had EpiPen and smelling salts on hand just in case. We were all ready to react in case of any emergency. The patient did faint after sitting for a couple of minutes. She knew it was about to happen and her father stepped in to let her rest her head. We had her feet raised on a chair. She was still breathing the entire time, so we used smelling salts to bring her to which worked. She was out for close 10 minutes, but still breathing normally. The smelling salts enabled her to respond and nod that she was okay. When she came to, she asked for water and a sticker, which we gave her, and she acted as if nothing had happened and was all smiles. We did get a member of management to come fill out a report.


VAERS ID: 1320993 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047C21A / 2 RA / IM

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

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

Write-up: Given under age recommended


VAERS ID: 1321005 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8735 / 2 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: unknown
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 fainted right after getting vaccinated - she has a history of fainting with needles


VAERS ID: 1321009 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Rhode Island  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Head injury, Headache, Hyperhidrosis, Nausea, Pallor, Peripheral coldness, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Pt had just received vaccine, was walking to waiting area and experienced a syncopal episode, head stuck floor. Pt appeared to posture, skin was cool, pale, and diaphoretic. C collar applied by ems, PT TF to stretcher from floor and TF to EMS room. Vitals obtained, BP 150/90, HR 76, RR 20, SpO2 98% RA, pupils PEARL. Pt complaint of head pain and nausea. Pt''s father advised that Pt needs to be TP to hospital by Rescue and father agreed. PT care TF to Rescue crew.


VAERS ID: 1321018 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dizziness, Flushing, Nausea, Skin warm
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypersensitivity (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: unknown
Diagnostic Lab Data: bp: 108/74 HR 84: 02stat 99%; felt better after lying down
CDC Split Type:

Write-up: Flushed/warm skin, nausea and dizzy after 15mins of the vaccine.


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