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

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



Case Details (Reverse Sorted by Onset Date)

This is page 156 out of 6,867

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VAERS ID: 1544980 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blindness, Hyperhidrosis, Immediate post-injection reaction
SMQs:, Neuroleptic malignant syndrome (broad), Glaucoma (broad), Optic nerve disorders (broad), Retinal disorders (broad), Hypersensitivity (narrow), Hypoglycaemia (broad)

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

Write-up: Pt was very nervous before injection and experienced sweating and loss of vision 2-5 minutes immediately after administration. Patient calmed down after a few minutes and vision returned. Possible anxiety attack.


VAERS ID: 1545003 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002F21A / 2 LA / IM

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

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

Write-up: Mixed series, incorrect second dose given, first dose was Pfizer


VAERS ID: 1545044 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: New York  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Bradycardia, Hyperhidrosis, Hypotension, Pallor, Slow response to stimuli
SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

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

Write-up: Post vaccination of 1st dose COVID-19 Pfizer vaccination patient became pale and diaphoretic, difficulty responding to questions. Laid down flat on the floor, elevated legs, pulse and breathing present during episode. bradycardic and hypotensive. supportive care provided. Rapid Response called. RRT team and EMS arrived quickly. Patient was transported to the emergency department for further observation and evaluation.


VAERS ID: 1545057 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Bell's palsy
SMQs:, Hearing impairment (broad)

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

Write-up: Bells Palsy


VAERS ID: 1545067 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-09
Onset:2021-08-11
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Lymphadenopathy, Nausea
SMQs:, Acute pancreatitis (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: Swollen Lymph nodes, tiredness, nausea


VAERS ID: 1545090 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 1 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: The patient was complaining about her head hurting and feeling as if she needed to throw up, she also stated that she was feeling nausea and feeling as if she was going to faint. The patient was asked if 911 needed to be called and she responded, No. The patient?s vitals were checked by the vaccinator who is licensed as an EMT, all vitals were normal and the patient was asked to stay in the observation area for another 15 min. After time was up the patient left with no further incidents.


VAERS ID: 1545091 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-08-10
Onset:2021-08-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Condition aggravated, Diarrhoea, Eye pain, Headache, Hyperhidrosis, Myalgia, Nausea, Pain in extremity, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Eosinophilic pneumonia (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Headache medication PRN
Current Illness: None
Preexisting Conditions: Headache history
Allergies: Sulfa, iodine products
Diagnostic Lab Data: Pending worsening symptoms
CDC Split Type:

Write-up: Starting at 2 am after vaccine Severe headache, nausea, diarrhea, muscle aches, right arm pain, fever, sweating, bilateral eye pain


VAERS ID: 1545105 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1820095 / 1 LA / IM

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

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

Write-up: Patient was given Janssen without confirmation of age. Patient is 17 yrs 10 months


VAERS ID: 1545107 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: About 10 minutes after getting the vaccine, patient got very pale and fainted forward in his seat. His parents prevented him from falling and held him upright while we gave him a bottle of Gatorade. Patient drank 1/4 bottle and started feeling better. He continued to sit for 10 more minutes before he was feeling well enough to leave.


VAERS ID: 1545111 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: California  
Vaccinated:2021-03-05
Onset:2021-08-11
   Days after vaccination:159
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029A21A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001B214 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood test, Cardiac disorder, Cardiac flutter
SMQs:, Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Tachyarrhythmia 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: Flu vaccine at age 20, health provider said I was allergic to thimerosal
Other Medications: Estradiol and progesterone
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: penicillin, thimerasol
Diagnostic Lab Data: August 2021 went to Urgent care, blood draw, set up for heart monitor on Sept. 1 and need to schedule treadmill stress test
CDC Split Type:

Write-up: Heart problems, a possible arrhythmia, possibly premature ventricular contraction, heart fluttering


VAERS ID: 1545123 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040B21A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: metFORmin (GLUCOPHAGE XR) 500 mg 24 hr tablet insulin glargine (Basaglar KwikPen U-100 Insulin) 100 unit/mL (3 mL) solostar pen Inject 0.22 mL (22 Units total) under the skin nightly.
Current Illness: n/a
Preexisting Conditions: Type 1 Diabetes
Allergies: No known allergies
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: The Moderna Covid Vaccine (Dose 2) was given 1 week earlier than it was supposed to be given. No reactions at the time it was given or 15 minutes after being given.


VAERS ID: 1545137 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 2 LA / IM

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

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

Write-up: Patient had her 1st Pfizer Covid vaccine on 7/22 and was due for her 2nd vaccine on 8/12, but instead received it on 8/11.


VAERS ID: 1545139 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 091D21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood glucose decreased, Eye movement disorder, 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), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (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: n/a
Current Illness: Asthma, high blood pressure
Preexisting Conditions: asthma/ hypertension
Allergies: nkda
Diagnostic Lab Data: EMS checked blood sugar and noted it was low
CDC Split Type:

Write-up: The patient received the vaccine and within 2 minutes of receiving the vaccine he passed out. His eyes rolled in the back of his head and passed out in the chair. The patient was moved to the ground and came to within two minutes.


VAERS ID: 1545149 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-02-01
Onset:2021-08-11
   Days after vaccination:191
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038K20A / 2 RA / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Oxcarbazepine 100mg Humiranpin 40mg
Current Illness: no
Preexisting Conditions: n/a
Allergies: n/a
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Patient report that he received a positive Covid test on 08/10/2021


VAERS ID: 1545160 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: New York  
Vaccinated:2021-08-10
Onset:2021-08-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 2 - / IM

Administered by: Other       Purchased by: ?
Symptoms: Specific gravity urine increased, Urine ketone body present, Vomiting
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Dentinogenesis imperfecta
Allergies: None
Diagnostic Lab Data: UA + ketones , SPGR $g1.030
CDC Split Type:

Write-up: Received vaccine at 8 am excessive vomiting started by 4pm continued $g 12 hours at time of visit


VAERS ID: 1545171 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031B21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Hot flush, Hypoaesthesia, Hypoaesthesia oral, Injection site hypoaesthesia, Injection site reaction, Nausea, Paraesthesia, Paraesthesia oral, Skin tightness
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Atorvastatin 10 mg Flomax 0.4 mg Lisinopril 10 mg Mobic 15 mg Norvasc 10mg ProAir HFA 90 mcg inhaler 2 puffs every 4 hours as needed Tramadol 50 mg every 6 hours as needed Nicotine patch 21 mg
Current Illness: Bronchitis in July
Preexisting Conditions: hypertension
Allergies: Sulfa
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient called the clinic and stated he started having tingling, numbness, and hot to the touch in the left side of the face and lips. Patient also stated that he is also having nausea and the top of his left arm is having numbness and tightness all the way down. Patient received the vaccination at 8:45 AM this morning in the office and sat in our waiting room for 15 minutes per facility protocol and reported to staff was not having any symptoms when leaving. Patient contacted our clinic 30 minutes after leaving facility and started symptoms had started 10 minutes after leaving facility. Our office advised patient to be seen in the nearest emergency room.


VAERS ID: 1545174 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025B21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anxiety, Dizziness, Injection site swelling
SMQs:, Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Vestibular disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: AFTER THE VACCINE WAS ADMINISTER, PATIENT INFORMED THE PHARMACY INTERN THAT SHE WAS IN THE ER THE NIGHT BEFORE FOR ABDOMINAL PAIN AND WAS GIVEN A SINGLE DOSE OF TORADOL AND MORPHINE.
Preexisting Conditions:
Allergies: DEMEROL
Diagnostic Lab Data:
CDC Split Type:

Write-up: BEFORE THE VACCINE, PATIENT STATED THAT SHE WAS VERY ANXIOUS ABOUT GETTING THE VACCINE. PATIENT STATED THAT THE REASON SHE WAS GETTING THE VACCINE WAS BECAUSE HER HUSBAND WANTED HER TO AND SHE WAS VERY SKEPTICAL ABOUT IT. AFTER THE VACCINE WAS ADMINISTERED, PATIENT''S INJECTION SITE BEGAN TO SWELL. PATIENT BECAME VERY ANXIOUS ABOUT THE INJECTION SITE SWELLING AND EXPRESSED THAT SHE WAS FEELING DIZZY. AN ICE PACK WAS PLACED ON THE INJECTION SITE AND A COLD BOTTLE OF WATER WAS PLACE ON THE BACK OF THE PATIENT NECK. SHE DENIED WANTING TO TAKE BENADRYL. 911 WAS CALLED IN THE MEANTIME. WHEN FIRE AND EMS ARRIVED, PATIENT EXPRESSED TO BE FEELING MUCH BETTER AS THE INJECTION SITE SWELLING WENT DOWN. AFTER CHECKING BP, PATIENT STARTED TO FEEL DIZZY AGAIN WHICH RESULTED IN FIRE AND EMS RECOMMENDING PATIENT TO GO TO THE HOSPITAL FOR FURTHER TESTING. PATIENT ACCEPTED AND WAS TAKEN TO HOSPITAL.


VAERS ID: 1545189 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-10
Onset:2021-08-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Bone pain, Ear pain, Fatigue, Injection site pain, Pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Osteonecrosis (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:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Severe debilitating pain in joints and injection site (feels like needle is stuck in my arm and bone radiating up To my ear. Body aches, fatigue.


VAERS ID: 1545207 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-07-30
Onset:2021-08-11
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache
SMQs:

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

Write-up: Customer complained of a headache starting 08/11/2021 at 2:00 am - she doesn''t usually get headaches and was wondering if it could be from the vaccine she received 07/30/2021 at 1:00 pm


VAERS ID: 1545209 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-07
Onset:2021-08-11
   Days after vaccination:126
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Exposure to SARS-CoV-2
SMQs:, COVID-19 (narrow)

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

Write-up: exposure to wife


VAERS ID: 1545211 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-10
Onset:2021-08-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939902 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Fever, fatigue, headache, nasuea


VAERS ID: 1545220 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Mississippi  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007D21A / 1 RA / -

Administered by: Public       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: administration error, patient 17


VAERS ID: 1545224 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-01-26
Onset:2021-08-11
   Days after vaccination:197
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 043L20A / 1 - / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045A21A / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Proair Xarelto Amlodipine Lisinopril Cymbalta Norco Ativan Lasix Magnesium oxide Prilosec Glimpiride Tradjenta Lidocaine patch Vitamin D3
Current Illness:
Preexisting Conditions: hypertension atrial fibrillation diastolic heart failure
Allergies: Sulfa antibiotics
Diagnostic Lab Data: positive covid test
CDC Split Type:

Write-up: positive covid test after vaccination


VAERS ID: 1545226 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA4785 / 3 RA / IM

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

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

Write-up: I verified patient was receiving his first COVID-19 vaccine, to which the patient responded yes. I administered the vaccine after confirming the patient''s identity and gave him his vaccine card. He then pulled out a completed COVID-19 Vaccination Record Card and asked if I could combine the three vaccines on one card. The patient deliberately withheld the truth when saying he had not yet received the vaccine. Patient said he was advised by physician to received a third dose because the patient suffers from diabetes and travels frequently.


VAERS ID: 1545230 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004C21A / 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? 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: NKDA
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: PATIENT UNDER 18 AT TIME OF VACCINATION


VAERS ID: 1545233 (history)  
Form: Version 2.0  
Age: 102.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-08-05
Onset:2021-08-11
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Notified by (Infectious Disease Nurse) that patient received her second dose of the COVID vaccine but it was the correct COVID vaccine. Pt''s first dose was Moderna on 7/9/21. Pt was given Pfizer as her second COVID vaccine on 8/5/21. No adverse event occurred to patient.


VAERS ID: 1545235 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002F21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Loss of consciousness, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: None reported by patient
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: The patient received his 1st COVID-19/Moderna vaccine around 12:00pm, scheduled his 2nd dose, and was instructed to stay 15min for observation. He was later walking around the store and felt dizzy and fainted. We were alerted to his passing out by an associated on the floor around 12:55.


VAERS ID: 1545240 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 AR / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR - / 2 AR / IM

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

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

Write-up: syncope; recovered appropriately with time, VS normal and feeling well by time of discharge from office


VAERS ID: 1545247 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Muscle tightness, Paraesthesia, Tinnitus
SMQs:, Peripheral neuropathy (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Hearing impairment (narrow)

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

Write-up: Patient reports tinkling in her front and back and jaw tightness with pressure pushing her jaw to the side. She also heard a "pop" sound in her head. After about 45 minutes she reported feeling better but still had some symptoms.


VAERS ID: 1545260 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-08-03
Onset:2021-08-11
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Axillary pain, 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: n/a
Current Illness: n/a
Preexisting Conditions:
Allergies: n/a
Diagnostic Lab Data:
CDC Split Type:

Write-up: Woke up with slight arm pain and armpit soreness. Armpit feels like a pulled muscle when arm lifted above head


VAERS ID: 1545264 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Alabama  
Vaccinated:2021-08-10
Onset:2021-08-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH SA7486 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site papule, Injection site warmth
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: no
Current Illness: no
Preexisting Conditions: no
Allergies: no
Diagnostic Lab Data: no
CDC Split Type:

Write-up: next day after receiving the vaccine he took the bandaid off and it off skin off each end of the bandaid it was hot and had pus


VAERS ID: 1545268 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 1 LA / 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: Unknown
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Shortly after receiving the vaccine, patient fainted while sitting in a chair during the 15 minute observation period. He slowly slid off of the chair and landed beneath the chair. EMS was immediately alerted and I went to his aid. He quickly came to and was responsive. EMS arrived and evaluated him and he was released with family members about one-half hour after the event.


VAERS ID: 1545272 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: New Hampshire  
Vaccinated:2021-08-10
Onset:2021-08-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Blood gases abnormal, Cardiac failure congestive, Chest X-ray abnormal, Chest pain, Condition aggravated, Pulmonary oedema, Respiratory acidosis, Respiratory failure
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Lactic acidosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Multiple, including Bumex, insulin for DM, Buprenorphine, Toprol XL, Glipizide, tizanidine, Eliquis
Current Illness: congestive heart failure exacerbation
Preexisting Conditions: COPD CHF/HFpEF Alcohol Abuse Obesity
Allergies: Alkaseltzer Gold, Chlorpheniramine, Heparin (HIT in 2011), hydrocodone, moxifloxacin, Nitroglycerin
Diagnostic Lab Data: Workup for CHF - xray with pulmonary edema, hypoxic respiratory failure. ABG with chronic respiratory acidosis.
CDC Split Type:

Write-up: Presented to the hospital in obvious congestive heart failure, complaining of sternal pain after a car accident 3 7 days before the vaccine dose.


VAERS ID: 1545294 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Adverse reaction, Erythema, Muscle tightness
SMQs:, Anaphylactic reaction (broad), Dystonia (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Methotrexate 2.5mg tabs
Current Illness: n/a
Preexisting Conditions: arthritis
Allergies: bee stings, lamosil
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Vaccine was given and noticed tightening of the neck after 5 minutes post-injection. Within 15 minutes tightening got worse and started developing redness on the chest. 25 mg of Benadryl was given when he notified the pharmacist of the reaction which was within the first 15 minutes. 15 minutes after the first dose of Benadryl was given a second dose of 25mg was administered. He was then observed for an additional 20 minutes and stated he was feeling better. Patient was conscious the entire time and refused epi-pen and the squad. Patient opted drive home and notify the pharmacy or physician of worsening symptoms.


VAERS ID: 1545295 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Vision blurred
SMQs:, Anticholinergic syndrome (broad), Glaucoma (broad), Lens disorders (broad), Retinal 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: Denied
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: Intermittent blurry vision lasting seconds 10 minutes post vaccination. First Response called, transported to ED


VAERS ID: 1545299 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 1 LA / IM

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

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

Write-up: Error: Wrong Vaccine Formulation (ex. different manufact. initial and booster)-


VAERS ID: 1545310 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

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

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

Write-up: Shortly after injection the patient complained he felt dizzy and hot. Per his mother "he always has this reaction with injections/immunization." The patient was provided and ice pack to the back of the the neck and orange juice followed by 3 sets of vitals. 1. 1:10, temp 96, BP 102/72, 0xygen 99%, HR 66 2. 1:20, temp 95.3, BP 126/62, Oxygen 99%, HR 77 3. 1:30, temp 96.9, BP, 120/58, Oxygen 98%, HR 67 patient commented he felt better and based on vitals, verbal communication, and visual ques ...he was cleared by the nurse.


VAERS ID: 1545321 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821287 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hyperhidrosis, Hypoaesthesia, Nausea, Nervousness, Panic attack, Paraesthesia
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypoglycaemia (broad), Sexual dysfunction (broad)

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

Write-up: About 2 minutes after giving patient the vaccination, he started to have a tingling , numbness down the left arm to the fingers. Then patient started to break out in a sweat, almost like a panic attack. He felt very nauseous but never vomited. He told me that he doesn''t get panic attacks but is very nervous about getting shots. I gave him cold water and put an ice pack behind his neck. He did sweat through his T-shirt. You could clearly see it. This lasted about 7 minutes. about the 11th minute sweating stopped. After 4 more minutes he felt fine and the sweating had stopped. He was just a little nauseous when he left. After I asked if he needed a ride, he assured me that he felt fine to drive too.


VAERS ID: 1545331 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 088D21A / 2 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0153 / 1 - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: acetaminophen 325mg 4x daily bupropion 150mg daily vitamin D 2000u daily ibuprofen 100mg PRN fever omeprazole 20mg daily
Current Illness: unknown
Preexisting Conditions: hypertension, hyperlipidemia, GERD, history of colonic polyps, depression, history of alcohol abuse, osteopenia
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: The patient told us that she had gotten her first dose as a Moderna at a different facility, so we gave her the second dose of the Moderna today. Per the patient had received Pfizer as her first dose of the vaccine. The patient had no adverse reaction to either vaccine.


VAERS ID: 1545333 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052E21A / UNK RA / IM

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

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

Write-up: PATEINT WAS GIVEN HIS 2ND DOSE OF THE VACCINE A WEEK EARLIER THAN IT WAS DUE. THE PATIENT WAS MONITORED AND HAD NO REACTIONS.


VAERS ID: 1545334 (history)  
Form: Version 2.0  
Age: 8.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / IM

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

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

Write-up: Under age vaccination


VAERS ID: 1545342 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-08-10
Onset:2021-08-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 2 LA / IM

Administered by: Military       Purchased by: ?
Symptoms: Migraine, Myalgia, Sleep disorder
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Mild muscle soreness, not as intense as the first shot started about 2 hours after the shot. Then, intense migraine that started at 0400 in the morning, about 14 hours after the second dose of the Phizer COVID vaccine. The pain woke me up from my sleep. The pain was so intense that extra strength Tylenol and ibuprofen did not help at. Pain ebbed and flowed throughout the day. As of 1400 in the afternoon, 10 hours after the onset, pain has still not subsided despite taking Excedrin Migraine at about 1230.


VAERS ID: 1545346 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 LA / IM

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

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

Write-up: About five minutes after receiving vaccine, patient experienced dizziness and then syncope. She regained consciousness within seconds. Blurry vision and dizziness persisted for a few minutes then improved.


VAERS ID: 1545349 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037B21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Throat irritation, Throat tightness, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Vestibular disorders (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: Lisinpril, patient not sure what milligram he is taking, he states he does not take it like he should everyday
Current Illness: none that we aware of
Preexisting Conditions: HTN
Allergies: Penicillin is the only known allergy
Diagnostic Lab Data: BP pulse
CDC Split Type:

Write-up: pt was observed for 15 minutes after vaccine administration and stated he felt light headed and dizzy, we watched pt for additional 15 mins he was AAO. He then complained of a "scratchy throat" and had hives on his stomach. Benadryl cc was given IM in RT deltoid (lot # 119314 exp date: 11/2021). Pt was observed for 15 more minutes. He states he was taking Lisinopril for his BP but was not complaint and also stated he was allergic to penicillin, despite answering "no" on our questionnaire regarding any allergies. No signs of facial/tongue/lip swelling, patient complained the tightness in his throat had gotten worse, so EMS was called to further assess patient. EMS arrived at 8:45 am and pt decline going to ED.


VAERS ID: 1545350 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-08-06
Onset:2021-08-11
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052E21A / 2 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Myocarditis, Troponin increased
SMQs:, Myocardial infarction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

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

Write-up: Patient reported with severe chest pain and ended up going to the emergency room. Labs showed elevated troponin and thought to be myocarditis that was eventually ruled out. Patient to have check up with cardiologist every 3 months.


VAERS ID: 1545360 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-08-01
Onset:2021-08-11
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 091D21A / 1 RA / IM

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

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

Write-up: BODY HIVES


VAERS ID: 1545374 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-08
Onset:2021-08-11
   Days after vaccination:125
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal pain, Abnormal loss of weight, COVID-19, Condition aggravated, Diarrhoea, Flatulence, SARS-CoV-2 test positive, Vomiting
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: Patient presented to the ED on 8/11/2021 with abdominal pain that came on suddenly causing emesis. In the last few weeks her postprandial diarrhea has been worsening with excessive diarrhea, flatulence and unintentional weight loss. Tested PCR positive for COVID-19, no previous positive tests.


VAERS ID: 1545377 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-08-02
Onset:2021-08-11
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Dyspnoea
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Atorvastatin, Triamcinolone Acetonide, Hydroquinone 4% topical cream
Current Illness: Reactive airway disease, hyperlipidemia, dyslipidemia
Preexisting Conditions:
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Chest pain and shortness of breath since first dose of vaccine


VAERS ID: 1545389 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: New Hampshire  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 2 LA / IM

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

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

Write-up: PATIENT EXPERIENCE LIGHT-HEADEDNESS AND DIZZINESS 5 MINUTES AFTER RECEIVING VACCINE. PATIENT ALSO FELT LIKE PASSING OUT. EMT WAS CALLED IN AND TOOK OVER CARE OF PATIENT.


VAERS ID: 1545398 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: Nebraska  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808982 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Diabetes
Allergies: None known
Diagnostic Lab Data: Heart rate was read after around 15 minutes after and was 81 bpm.
CDC Split Type:

Write-up: Patient felt twitching and passed out for short time (maybe less then 1 minute) within 5 minutes of receiving vaccine. When he came to he was sweating but reported no shortness of breath or labored breathing.


VAERS ID: 1545400 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-04-02
Onset:2021-08-11
   Days after vaccination:131
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (UNKNOWN)) / UNKNOWN MANUFACTURER - / 1 - / -

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

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

Write-up: Positive Covid test


VAERS ID: 1545403 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 1 LA / IM

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

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

Write-up: Patient received vaccine. Patient and guardian advised to wait in pharmacy for 15 minutes after vaccination. Guardian (grandmother) declined to wait. Within 10 minutes patient''s sister came back to say patient had passed out/blacked out briefly in the front of the check out. Pharmacist found patient to assess. Patient was conscious and sitting down. Sister and grandmother reported patient had fallen suddenly and possibly hit head. Patient was assessed by pharmacist while EMS was called. Patient reported feeling unwell. Patient was able to drink water and communicate. Patient left with EMS to be assessed at the hospital.


VAERS ID: 1545407 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anaphylactic reaction, Dyspnoea
SMQs:, Anaphylactic reaction (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (narrow)

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

Write-up: Customer went into Anaphylactic reaction after receiving the vaccine, there was shortness of breath. We called 911 and they took the customer to the hospital.


VAERS ID: 1545412 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 RA / IM

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

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

Write-up: I gave the Pfizer COVID-19 vaccine to the patient around 10:20 AM and about 5 minutes later the patient began to "not feel well" while sitting in the waiting room. We got the patient water and a wet paper towel. Patient became nauseous so we got her a trash can that she threw up in. Department 50 was paged. Patient expressed needing to stay close to the floor as she has passed out from vaccine before so I got a mat we had and laid it out in the counseling room and assisted patient to floor. Department 50 showed up and talked with patient: EMS service was offered and denied. Department 50 called off when she said she did not need anyone called and was feeling much better. About 20 minutes later, patient felt well enough to walk around, and I walked with the patient out of the store to ensure she was feeling better.


VAERS ID: 1545418 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 035C21A / UNK - / -

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

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

Write-up: facial redness with some itching.


VAERS ID: 1545430 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: New York  
Vaccinated:2021-08-06
Onset:2021-08-11
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 059E21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fall, 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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: knda
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received her second dose of her COVID vaccination after she received her dose she went into the waiting room and fainted and fell on the floor. We called 911 and EMS checked her out she was fine after 15 minutes.


VAERS ID: 1545433 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Immediate post-injection reaction, Presyncope
SMQs:, Anticholinergic syndrome (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Hypoglycaemia (broad)

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

Write-up: Client had a vasovagal episode which occurred immediately after receiving Janssen COVID-19 vaccine. (1 minute). Client was out of it for about 5-10 seconds. Client assessed. Vital signs checked and within normal limits and normal to client range. After episode client alert and oriented x 3. Denied pain, dizziness, headache, lightheadedness, or nausea after event. EMS called and responded. Client assessed by EMS and refused transfer to the ER stating "I feel fine".


VAERS ID: 1545466 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: allergy to tree nuts
Allergies: Tree nuts
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Pt got a pfizer covid vaccine at 117pm on 8/11/21 and at 127pm mom reported to pharmacist that patients throat felt tight. EMS was called and 10 mls of liquid diphenhydramine (25mg) was given and pharmacist remained with patient to observe, during observation patient was alert and responsive, talked fine and even used aps on cellphone. At 138pm EMS arrived and checked patients vitals which were all within normal limits. EMS offered to take patient to hospital and mother and patient declined. Everyone left at 150pm.


VAERS ID: 1545483 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: West Virginia  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 1 UN / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Not Known
Current Illness: None Reported
Preexisting Conditions: None
Allergies: None Reported
Diagnostic Lab Data: NOne
CDC Split Type:

Write-up: Patient dizzy and vomited about 6 times


VAERS ID: 1545493 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 1 AR / IM

Administered by: Work       Purchased by: ?
Symptoms: Hyperhidrosis, Malaise, Pallor, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Pt c/o not feeling well; pt skin was pale and was diaphoretic. RN at side; assisted to lay down with legs raised on chair. Also, EMT at side. Pt. A&Ox3, speech clear and appropriate. VS: 1510: HR 122, SpO2 97% laying down. Pt. admitted to only eating a banana today and not much fluids. Pt. reported feeling better and assisted to chair. VS: 1515:% HR 59 SpO2 99% RA, SBP 84. Pt. given juice, water and crackers which she tolerated. Pt. reported feeling improved but a little shaky; color improved. VS: 1520: HR: 74, SpO2 99% RA, BP: 98/62. Pt continued to sit in chair and monitored. Pt. reported feeling better and able to go home. Pt. was d/c at 1550.


VAERS ID: 1545501 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Female  
Location: Rhode Island  
Vaccinated:2021-08-01
Onset:2021-08-11
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No adverse reaction. Waited 30 minutes with staff after vaccine. Patient accidentally got 2nd vaccine only two weeks after first. Not the 21 days as required. Patient was advised to consult her doctor.
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient got second vaccine too early by one week.


VAERS ID: 1545513 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 2 LA / IM

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

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

Write-up: Fainted (Vasovagal syncope) within one minute of the vaccine injection. Regained consciousness quickly but felt very groggy. Drank orange juice and rested in place for 25 minutes until feeling well enough to slowly get up. Continued to rest sheet getting home and felt fine again within an hour.


VAERS ID: 1545525 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808980 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Nausea, Pallor, Vomiting
SMQs:, Acute pancreatitis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (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: Patient received J&J vaccine. Within a few mins, patient was pale, weak, nauseous, and vomiting. Patient was brought back to the exam room to lay down, evaluated by the physician, given water, and was monitored while resting for approximately 30 mins. Vitals were stable. Patient was alert & oriented. Pt regained facial coloring, stopped vomiting, and felt better after some rest. Pt left the office ambulatory in stable condition.


VAERS ID: 1545529 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-10
Onset:2021-08-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 2 RA / IM

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

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

Write-up: Pt came into the store on 8/11/21 reporting a reaction to her second dose of her covid vaccine. She did not have a reaction on her first dose nor after the 15-20 minute wait period after the shot on 8/10/21. She had a swollen upper lip and believes it is due to the vaccine. We recommended her Benadryl to help with the swelling and advised her to see a doctor to make sure if it was due to the vaccine or if it was something else.


VAERS ID: 1545533 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / N/A RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Presyncope
SMQs:, Anticholinergic syndrome (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: Vasovagal episode for a few seconds. Took vitals but was WNL. Patient lied down on a mat and felt fine after. AOx4.


VAERS ID: 1545538 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Cyanosis, Hyperhidrosis, Nausea, Pallor, Unresponsive to stimuli
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant 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), 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: Has a hx of passing out after previous injections.
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Unkown
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Became diaphoretic, unresponsive for 20 seconds twice, nauseated, pale, cyanotic on forehead and fingertips. Pt was slid to floor and elevated legs, cold compress to head and chest. BP 90/50 pulse 76 after 5 minutes at 10 minutes BP 108/70, Pulse 78, Respirations were unlabored. Pt talking stating feeling better at 13 minutes, at 20 minutes sat pt up and feeling better, redness coming back in cheeks, not dizzy, talking, BP at 25 minutes was 100/70. Sat pt in a chair until 30 minutes past, stated he was fine to walk out with mom and brother. Mom stated pt has a hx of passing out when getting shots after I had given the shot.


VAERS ID: 1545542 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Dizziness, Headache
SMQs:, Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Vestibular disorders (broad)

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

Write-up: Patient felt dizzy, headache, dizzy, chest pain after 2nd Pfizer COVID vaccination. Referred to Urgent Care for further evaluation.


VAERS ID: 1545553 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0169 / 1 LA / IM

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

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

Write-up: passed out, clamy


VAERS ID: 1545560 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fall, Immediate post-injection reaction, Loss of consciousness, Malaise, 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), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? 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: Immunizing technician came out of the vaccination room to inform me (pharmacist) that patient stated he was not feeling well right after the vaccine. As we walked to the room, we heard a falling sound and came rushing. Patient was on the floor, sitting with Dad on his side. Dad stated he fell. Patient was conscious and alert but looked pale. He sat on the floor for 5 minutes then moved to a chair with Dad''s help. He passed out again about 5 minutes later for only a few seconds. Dad stated patient usually had these reactions after blood drawn. Patient was alert and oriented after 30 minutes observation. They stayed for more than an hour before leaving the pharmacy.


VAERS ID: 1545561 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0164 / 2 LA / IM

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

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

Write-up: The vaccine given was expired. This vaccine was drawn up yesterday 8/10/21 morning and the vaccine was given more than 24 hours after it was reconstituted.


VAERS ID: 1545563 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 1 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Auscultation, Chest discomfort, Dizziness, Erythema, Feeling abnormal, Hyperhidrosis, Lip swelling, Pruritus
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: no
Preexisting Conditions: IBS
Allergies: beef, bovine complex, galactose-alpha-1,3-galactose, naproxen sodium, mammal meats, pork, adhesive tape, silicones, sulfacetamide sodium, ampicillin, clarithromycin, sulfa
Diagnostic Lab Data: pending
CDC Split Type:

Write-up: Approximately 25 minutes after administration, patient reported itching all over, lightheadedness, and "feeling bad". This progressed to include chest tightness. Rapid response was activated. VS were taken. PE was performed and notable for lip swelling, diffuse skin redness, and diaphoresis. Lungs were CTAB. One dose of Epi 0.3 mg IM was given with improvement in symptoms within 2 minutes. VS repeated with improvement. Rapid response team arrived and patient was transferred to in-house ER.


VAERS ID: 1545565 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Seizure, Vomiting
SMQs:, Acute pancreatitis (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Pelvic Mass, Light Breathing
Preexisting Conditions: Sickle-cell Traits,
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: After receiving the Pfizer vaccine, the patient was vomiting and placed on her side. She also had a seizure about 20 minutes after receiving the vaccine the vaccine.


VAERS ID: 1545567 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Multivitamins, Vit. D, Iron
Current Illness: NA
Preexisting Conditions: NA
Allergies: Metronidzol oral
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: Pt reported itching sensation 1 hour after getting her injection. The itching sensation is on her chest (front and back), arms, hands and both legs. Pt called her PCP and left a message to his nurse. PCP will return her call. Pt stated she will take Benadryl at home.


VAERS ID: 1545569 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Impaired driving ability, Vaccine positive rechallenge
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: 1st dose of COVID slight dizziness similar to this event
Other Medications: no prescriptions; everything else unknown
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: Blood Pressure Check: 1) 159/106 (initial check) 2) 134/109 (2nd check after 1 minute)
CDC Split Type:

Write-up: Patient got vaccine around 10:06AM reporting minor dizziness regarding to the 1st dose. Around 5 minutes into the next wait period, patient was found sitting on the floor eating snacks. When asked why, patient states that she felt very dizziness to the point of not being able to drive home during the wait period. Patient did report similar conditions after giving blood and not eating (patient reports not eating anything prior to vaccination). Possibly this adverse event could be just the patient not eating, but I''m reporting it just in case.


VAERS ID: 1545572 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Blood glucose normal, Dizziness, Feeling abnormal, Hyperhidrosis, Pallor, Vision blurred
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: allergy medication OTC
Current Illness: h/x of panic attacks in crowds
Preexisting Conditions: pt denied
Allergies: pt denied
Diagnostic Lab Data: glucose finger stick- 137
CDC Split Type:

Write-up: 11:23- Pt father approached RN to check on his daughter. Pt reports blurred vision, feeling dizzy, and feels "everything closing in." RN identifies pallor and diaphoresis and calls for NP and EMT over radio. POD leader and RN assist to lay the patient to the ground with lower extremities elevated on the chair. 11:24-NP and EMT arrive at the scene. NP assesses pt medical h/x, medications, previous meals, current symptoms, menstrual cycle, etc. Pt denies SOB, chest pain, nausea. Pt reports blurry vision and light headedness. Presents with a flat affect. Mental health staff are informed and arrive at scene to speak to father. B/P- 102/62, O2- 94, P- 99. Pt is still on the floor. (Present staff: NP, 2 EMT, POD leader, 3 Observation RNs, safety officer, mental health employees, father. ) 11:30 - diaphoresis and blurry vision is resolved. 11:36- pt is assisted to a sitting position on the floor and denies any abnormal symptoms. BP- 11/3, P- 95, O2- 94%. Pt is warm to touch. Team continues to monitor and pt continues to drink gatorade. 11:41- pt is assisted to chair denies abnormal symptoms. BP- 107/62, P- 98, O2- 98%. NP plans to discharge patient if she continues to feel well. 11:54- NP assesses pt and she reports feeling lightheaded. Pt is assisted to a lying position on the floor with feet elevated on the chair. BP- 106/64. NP notifies team to contact 911 for further assessment. 11:57- Blood glucose reading 137. 12: 10 EMTS arrive and NP endorsed pt care to EMTs, other EMTs assessing and taking report. 12:15- pt is assisted to a sitting position BP- 113/68, P- 94, patient is advised to seek further assessment in the ED 12:24- patient signs AMA form


VAERS ID: 1545575 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0164 / 1 LA / IM

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

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

Write-up: Patient had a covid vaccine today at 1:45 pm and it was discovered at 4:45pm that the vaccine given was expired. It was reconstituted yesterday 8/10/2021 at 9:50 am.


VAERS ID: 1545590 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026C21A / 3 LA / IM

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

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

Write-up: Patient came in with elderly family member asking for COVID vaccine. Filled out the paperwork and spoke about potential side effects and the 15min wait. He stated an understanding. Moderna Vaccine was administered to Left deltoid. Patient waited his 15mintues no reaction. After patient left and this RN was putting immunization it was discovered that he had already received his 3 doses series. Called patient to confirm. He stated he knew it was his 3 vaccine and he wanted a booster and did not tell this RN because he knew he would not be able to get it if he did. Explained the risks and that it is not studied or FDA approved and that adverse effects may not be known. Advised him to contact 911 or his PCP for adverse reactions.


VAERS ID: 1545592 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Electrocardiogram normal, Feeling hot, Non-cardiac chest pain
SMQs:, Anaphylactic reaction (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: EKG on 8.11.21 (remarkable)
CDC Split Type:

Write-up: Patient described chest "tightness" and felt she was getting warm about 15 minutes after the vaccine. She was given water, and felt that she was "feeling less warm" after about 5 minutes (20 minutes after vaccine), but was still experiencing chest tightness. The clinic staff was informed, and they took over care of the patient. They did an EKG which was normal, and thought the chest pain was not cardiac related.


VAERS ID: 1545594 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Immediate post-injection reaction, Syncope, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: at 2 years old
Other Medications: N/A
Current Illness: none
Preexisting Conditions: none
Allergies: None
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Pt fainted while sitting on the chair few seconds after the shot was administered. the fainting lasted few seconds then she came back fully aware of what just happened. she stayed in the room to be monitored then she vomited but felt better after. she was doing fine when she left. she was on the room a total of 40 minutes.


VAERS ID: 1545595 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: Unknown
Diagnostic Lab Data: None
CDC Split Type:

Write-up: The consent form that was filled out by the guardian was misread where the date of birth was filled in. It was misread as 08/20/2008 and not the correct 08/20/2009 that it should have been. During counseling before the vaccination that Pfizer was approved for 12 years old and older but the guardian never disclosed that the child was 10 days younger than 12. The pharmacy discovered the error upon entering the information.


VAERS ID: 1545605 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Immunisation
SMQs:

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: Lymphoma
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: booster dose due to previous 2 doses of Pfizer shows Zero antibodies in his system


VAERS ID: 1545609 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2021-04-30
Onset:2021-08-11
   Days after vaccination:103
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8727 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Cough, Headache, Influenza A virus test negative, Influenza B virus test, Nasal congestion, Pyrexia, Respiratory syncytial virus test negative, SARS-CoV-2 test positive, Sneezing
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Aspirin 81 mg., Atorvastatin, Chlortralidone, ergocalciferol, Glimepiride, Lisinopril, Metformin, Mirtazapine, Nitroglycerin (Nitrostat), Omeprazole, venlafaxine
Current Illness: None
Preexisting Conditions: HTN, Hyperlipidemia, osteoarthritis, Peripheral vertigo, low back pain, DM type 2, PTSD, bilateral knee and ankle pain, GERDS, Morbid obesity
Allergies: Oxycodone
Diagnostic Lab Data: Aug 11, 2021@13:27:55 FLU A NEGATIVE , FLU B NEGATIVE , RSV NEGATIVE Ref: COVID-19 POSITIVEA*
CDC Split Type:

Write-up: 8.11.2021 c/o fever, cough, headache, sneezing and nasal congestion x 1 day. Cairimab/Imdev Infusion done today


VAERS ID: 1545613 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0170 / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Dyspnoea, Fatigue
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: Vitamin c
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Caller called into to report that patient is having trouble breathing and very tired.


VAERS ID: 1545628 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cold sweat, Hyperhidrosis, Palpitations
SMQs:, Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (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: COVID-19 Anxiety
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient stated she had palpitations after her 2nd Pfizer dose. Patient heart rate trending at 120''s. Diaphoretic Clammy


VAERS ID: 1545634 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Syncope, Tremor
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (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: Prior to administration patient had stated no previous fainting to a vaccination. After administration, wife and patient stated
Other Medications: None known
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Paramedics performed blood pressure screening and evaluation immediately after arrival 8/11/21.
CDC Split Type:

Write-up: Patient received the vaccination and was still sitting in the chair. I had returned to the pharmacy and the wife was standing next to the patient. Patient fainted in the chair, I rushed over to help and we called the paramedics. The wife and I moved the patient to the floor. He was shaking for a few seconds then regained consciousness quickly. We lifted legs to help improve circulation. Paramedics came and evaluated the patient, patient had no further symptoms.


VAERS ID: 1545640 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006D21A / 1 LA / IM

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

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

Write-up: Upon administration of first covid vaccine, there was leakage of the vaccine. It was not a large amount and the patient received some of the dose. Upon asking our market manager, the recommendation was not to restart the series and complete the series as previously recommended.


VAERS ID: 1545644 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-08-07
Onset:2021-08-11
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 059E21A / 1 LA / IM

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

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

Write-up: Patient is 17 years old and got the Moderna shot. Spoke with patient, no adverse events.


VAERS ID: 1545649 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Mississippi  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 2 LA / IM

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

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

Write-up: THE PATIENT CAME IN FOR THE 2ND DOSE OF THEIR COVID VACCINE. THEY WERE GIVEN PFIZER. IT WAS DISCOVERED AFTER ADMIN THAT THE FIRST DOSE WAS MODERNA. THE PATIENT WAS TOLD ABOUT THE MISTAKE AND WAS MONITORED FOR THE USUAL TIME AFTER THE SHOT FOR ADVERSE EVENTS. NO ADVERSE EVENTS OCCURRED AT HER TIME AT THE PHARMACY.


VAERS ID: 1545654 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 LA / IM

Administered by: Pharmacy       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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient felt nauseous after vaccine. Patient ate a piece of fruit while seated and symptoms resolved.


VAERS ID: 1545657 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dyspnoea, Hypoaesthesia oral, Paraesthesia oral, Throat tightness, Vision blurred
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Glaucoma (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Hypersensitivity (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: Allergies Amitriptyline Hives High Allergy 10/21/2003 Amlodipine Besylate Shortness Of Breath High Unspecified 9/16/2015 Bee Venom Anaphylaxis High Unspecified 9/16/2015 Butorphanol Tartrate Shortness Of Breath High Unspecified 9/16/2015 Hives, rash, LOC, Carbamazepine Shortness Of Breath High Unspecified 9/16/2015 Mesalamine Shortness Of Breath High Allergy 2/26/2016 Modafinil Shortness Of Breath High Unspecified 9/16/2015 Morphine Shortness Of Breath High Unspecified 9/16/2015 Oxycodone/dilaudid ok Nitroglycerin Other (See Comments) High Allergy 1/3/2019 Phenytoin Hives High Unspecified 9/16/2015 Piper Anaphylaxis, Shortness Of Breath High Unspecified 9/16/2015 Throat tightening Propoxyphene Shortness Of Breath, Hives High Allergy 9/16/2015 Rofecoxib Anaphylaxis, Other (See Comments) High Unspecified 9/16/2015 Other reaction(s): UNKNOWN Shellfish Allergy Anaphylaxis High Unspecified 9/16/2015 Lobster and scallops: Throat closes off, Tongue swelling, Venlafaxine Shortness Of Breath High Unspecified 9/16/2015 Ascorbate Rash Medium Allergy 10/16/2018 Serotonin Reuptake Inhibitors (ssris) Unknown Not Specified Unspecified 10/21/2003 Adhesive Tape Itching Low Allergy 9/16/2015 Do not use Paper tape Only paper tape causes itching Amitriptyline Hcl Rash Low Unspecified 9/16/2015 Other reaction(s): RASH Bupropion Rash Low Unspecified 9/16/2015 Cefprozil Rash Low Unspecified 9/16/2015 Cefuroxime Rash Low Unspecified 9/16/2015 Cephalexin Rash Low Unspecified 9/16/2015 Cephalosporins Itching Low Unspecified 9/16/2015 Chlorhexidine Rash Low Allergy 12/13/2019 Clarithromycin Rash Low Unspecified 9/16/2015 Clindamycin Hcl Rash Low Unspecified 9/16/2015 Only if take it more than a week Dicyclomine Hcl Rash Low Allergy 8/18/2016 Light rash- "intollerance" "I can take it, I just can''t take it for long periods of time" 12/14/15 Doxycycline Rash Low Allergy 6/13/2011 Gemfibrozil Rash Low Unspecified 9/16/2015 Hyoscyamine Rash Low Unspecified 9/16/2015 Loracarbef Rash Low Unspecified 9/16/2015 Losartan Rash Low Allergy 12/20/2017 Lumiracoxib Rash Low Unspecified 9/16/2015 Macrolides And Ketolides Itching Low Unspecified 9/16/2015 Nitrofurantoin Rash Low Unspecified 9/16/2015 Nortriptyline Hcl Rash Low Unspecified 9/16/2015 Penicillin G Rash Low Unspecified 9/16/2015 Quetiapine Rash Low Unspecified 9/16/2015 Quinolones Itching Low Unspecified 9/16/2015 Riboflavin Itching, Rash Low Unspecified 9/16/2015 Other reaction(s): Rash Sertraline Rash Low Unspecified 9/16/2015 Strawberry Extract Rash Low Unspecified 9/16/2015 Sulfa Antibiotics Rash Low Unspecified 9/16/2015 Sumatriptan Rash Low Allergy 6/13/2011 Tomato Itching, Nausea Only Low Unspecified 9/16/2015 Xarelto [Rivaroxaban] Rash Low Allergy 12/19/2017 Zolmitriptan Rash Low Unspecified 9/16/2015 Adverse Reactions/Drug Intolerances Citalopram Hydrobromide Bleeding High Side Effect 9/16/2015 Montelukast Sodium Bleeding High Side Effect 9/16/2015 Bruising Nutritional Supplements Bleeding High Side Effect 9/16/2015 Riboflavin Rosuvastatin Calcium Myalgia/Myopathy High Side Effect 11/8/2016 legs Clobetasol Propionate Other (See Comments) Medium Side Effect 10/19/2007 Other reaction(s): SKIN DISCOLORATION Skin discoloration Ketorolac Tromethamine Nausea And Vomiting Medium Side Effect 9/16/2015 Lactose Nausea And Vomiting Medium Intolerance 10/27/2020 Sucralfate Itching, Nausea And Vomiting Medium Side Effect 9/16/2015 "tore stomach" Ciprofloxacin Other (See Comments) Not Specified Side Effect 3/2/2018 Blurry vision, difficulty swallowing Clobetasol Other (See Comments) Not Specified Side Effect 2/8/2019 Duloxetine Other (See Comments) Not Specified Side Effect 9/16/2015 unknown Esomeprazole Magnesium Other (See Comments) Not Specified Side Effect 9/16/2015 Blurred vision and diarrhea Pregabalin Other (See Comments) Not Specified Intolerance 9/16/2015 Blurred vision Aspirin Nausea Only Low Side Effect 9/16/2015 States also causes bleeding Esomeprazole Diarrhea, Other (See Comments) Low Side Effect 9/16/2015 Tegaserod Diarrhea Low Side Effect 9/16/2015 Zonisamide Other (See Comments) Low Side Effect 9/16/2015 Lightheadedness and fatigue
Diagnostic Lab Data:
CDC Split Type:

Write-up: Symptoms started approximately 20 minutes after inaction was given. Patient first reported blurred vision, tongue and lip tingling and numbness. Patient expressed feeling short of breath, but not observed. SPO@ was at 100%, RR 12-16. She then reported her throat was tight. She was conversational and able to drink water. She was given Benadryl 50 mg and taken by ambulance to the ER incase reaction continued to worsen.


VAERS ID: 1545659 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Mississippi  
Vaccinated:2021-08-10
Onset:2021-08-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205AZ1A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Cymbalta Clonidine Lamictal Estradiol Aldactazide
Current Illness: None
Preexisting Conditions: Rheumatoid Arthritis, Psoriasis, Gout, Depression, GAD, Insomnia
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Nausea, fatigue, joint pain, fever, chills, headache, dizziness


VAERS ID: 1545660 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-04-03
Onset:2021-08-11
   Days after vaccination:130
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: Covid POSITIVE


VAERS ID: 1545662 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037B21A / 1 RA / 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: n/a
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: no allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: inadvertent administration of a first dose of Moderna vaccine to a patient age 12 through 17 years


VAERS ID: 1545666 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Dysphagia, Dyspnoea, Hyperhidrosis, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Hypoglycaemia (broad)

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

Write-up: When pt''s 15min timer was up and nurse checked on pt he reported that he felt like his throat was closing. Pt was taken back to an exam room for this provider to assess. Pt c/o feeling like his throat was tight and he had pain in his chest. VS were obtained and were WNL, POX 98-99% on RA, exam was unremarkable, no stridor/wheezing, and no edema noted to face or tongue. Pt was monitored closely with Q5min VS and sx did not improve. I initially suspected sx were related to anxiety, but pt denied feeling anxious. Pt was given Benadryl 25mg PO X1 at 11:45AM. At 12:00 pt c/o worsening sensation that throat was closing, difficulty swallowing and breathing, chest pain, and was diaphoretic. Pt was given 0.3mg EPI IM X1 dose in R lateral thigh at 12:04PM and EMS was called. Pt''s VS remained stable. Pt left clinic with EMS at 12:15PM to go to the ER for further evaluation.


VAERS ID: 1545675 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037B21A / 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: n/a
Current Illness: none
Preexisting Conditions: none
Allergies: patient reports being allergic to spinach
Diagnostic Lab Data:
CDC Split Type:

Write-up: inadvertent administration of a first dose of Moderna vaccine to a patient age 12 through 17 years


VAERS ID: 1545678 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 3 LA / IM

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

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

Write-up: No adverse event was reported. When processing the vaccination, patient stated multiple times that they were receiving the 2nd dose of the vaccine. After processing through insurance and after administration I logged the dose in the vaccine database and they received their second dose in February of 2021.


VAERS ID: 1545682 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Dyspnoea, Headache, Hypoaesthesia
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Jardiance 10mg, nitroglycerin, atorvastatin, metformin, metoprolol, clopidigrel,,lisinopril, furosemide, potassium, gabapentin
Current Illness:
Preexisting Conditions: Diabetes and heart disease
Allergies: nkda
Diagnostic Lab Data: EMS escorted patient for further evaluatin
CDC Split Type:

Write-up: Shortly after receiving vaccine, patient reported tightness in chest, difficulty breathing, numbness in arm and headache. EMS were called and patient was transported further evaluation


VAERS ID: 1545683 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 3 LA / IM

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

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

Write-up: No adverse event was reported. When processing the vaccination, patient stated multiple times that they were receiving the 2nd dose of the vaccine. After processing through insurance and after administration I logged the dose in the vaccine database and they received their second dose in February of 2021.


VAERS ID: 1545689 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040A21A / 1 - / IM

Administered by: Public       Purchased by: ?
Symptoms: Acoustic stimulation tests, Tinnitus
SMQs:, Hearing impairment (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Multiple medications
Current Illness: No new illnesses, continued with chronic illnesses
Preexisting Conditions: multiple
Allergies: none
Diagnostic Lab Data: has had hearing screen, unknown date or results
CDC Split Type:

Write-up: Tinnitus started at the very beginning of April 2021


VAERS ID: 1545695 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 2 LA / IM

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

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

Write-up: No adverse event. Shot was administered past the recommended 6 week window after first shot. Patient received first shot on 4/20/21 at different location.


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