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

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



Case Details (Reverse Sorted by Onset Date)

This is page 163 out of 3,524

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VAERS ID: 1319226 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / N/A UN / IM

Administered by: Other       Purchased by: ?
Symptoms: Drooling, Mental impairment, Postictal state, Seizure
SMQs:, Systemic lupus erythematosus (broad), Dementia (broad), Convulsions (narrow), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

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

Write-up: At approximately 1505 this 38 yo white female displayed seizure type activity while sitting in the observation stating at the mobile vaccine clinic. Staff safely lowered her from chair to side lying position. Seizure activity observed for less than one minute, drooling noted. Post-ictal for approximately 5 min AEB delay in response to questions, following directions and formulating complete sentences. Neuro: PERRLA, hand grips equal, lower extremity strength strong and equal bilat. EMS services arrived, took charge, assessed and put pt on transport gurney but she declined transport. EMS staff stated familiarity with pt and seizure history. She remained in observation for 30 min longer VSS with BP 120/82, R 20, P 90.


VAERS ID: 1319250 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: New Mexico  
Vaccinated:2021-05-06
Onset:2021-05-14
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-05-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 LA / IM

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

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

Write-up: none


VAERS ID: 1319274 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: New Mexico  
Vaccinated:2021-05-06
Onset:2021-05-14
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-05-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 RA / IM

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

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

Write-up: none


VAERS ID: 1319347 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

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

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

Write-up: Patient received improperly diluted Pfizer covid vaccine. The vaccine was diluted with 1.4ml of sodium chloride instead of the required 1.8ml so it was more concentrated than indicated. No adverse events reported at this time.


VAERS ID: 1319364 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 008C21A / 1 RA / IM

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

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

Write-up: The Moderna Covid-19 vaccine was given today to an adolescent 15yrs old at 3:30pm on 5/14/2021. At 10pm on the same day I called the grandmother and she stated that there were no adverse symptoms thus far.


VAERS ID: 1319477 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 1 RA / IM

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

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

Write-up: This writer was drawing up 2 doses of Pfizer for this patient and their sibling. For one of these patients, I had to open a new Pfizer vial, but accidentally drew up the whole vial without reconstituting with 1.8 mL of water. As a result, one of the two siblings received a dose that was supposed to be worth 6 doses of the Pfizer vaccine. I contacted the patients'' father 15 minutes later, who stated that the patients were doing okay and reported no symptoms. I also reported this incident to a district manager. Per my manager, I informed the patients'' father about what happened, asked him to monitor his children for symptoms, and report to the ED if the experience anything severe. I also told them that this dose would not be valid and they would have to return to the pharmacy to have their 1st dose dose again. He understood and accepted this information. Bottom line, there was no actual symptoms reported, but I am concerned about the higher dose either of these kids (12 year-old female & 15 year-old male) may have received and pray they will be okay.


VAERS ID: 1319485 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 LA / IM

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

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

Write-up: 3:45pm pt received pfizer covid-19 vaccine in L deltoid. denies any allergies other than penicillin. 4pm c/o slight pressure in throat, chills, oriented x3, sitting in chair 4:05 diphenhydramine 50mg/ml administered to pt @ 1ml IM in right deltoid HR 70 R 18 non-labored, non audible, no wheezing, BP 114/78 4:15 HR 70, R 18 non-labored/non audible/ says pressure om throat is gone, still feels a little cold, HR 105/74 4:30 feels abou the same, resp not labored, sitting in chair relaxed, HR 68 BP 117/78 (last ate at 1:30 pm) 4:35 feels tired, relaxed, sitting calmly in chair, no new sx BP 106/73 4:40 relaxed and tired. taken home by father via car. HR 68 non-labored breathing. no new sx


VAERS ID: 1319487 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

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

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

Write-up: Patient received improperly diluted Pfizer covid vaccine. The vaccine was diluted with 1.4ml of sodium chloride instead of the required 1.8ml so it was more concentrated than indicated. No adverse events reported at this time.


VAERS ID: 1319503 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 LA / IM

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

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

Write-up: Patient was walking around the pharmacy approximately 10 minutes after receiving her first COVID vaccine where she felt lightheaded and passed out into a shelf. By the time pharmacist and technician were with the patient, the patient was awake and oriented. Offered to call 911, both patient and mother refused. Gave patient a Gatorade and a chair to relax before leaving the store. Patient was able to walk out on her own and felt fine.


VAERS ID: 1319517 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-05-13
Onset:2021-05-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 1 RA / SYR

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

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

Write-up: Fatigue and mild severe pain in the right armpit. A little pain at the injection site. Been feeling the armpit pain since the morning after the vaccine.


VAERS ID: 1319560 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Dizziness, Feeling hot, 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: 45 minutes after vaccine patient got dizzy and felt like he was about to faint. Felt nauseous and had to lie down. Then he felt very hot but no fever. Three hours later he felt better but said he would have crashed a car if he had been driving..


VAERS ID: 1319593 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / IM

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

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

Write-up: This writer was drawing up 2 doses of Pfizer for this patient and their sibling. For one of these patients, I had to open a new Pfizer vial, but accidentally drew up the whole vial without reconstituting with 1.8 mL of water. As a result, one of the two siblings received a dose that was supposed to be worth 6 doses of the Pfizer vaccine. I contacted the patients'' father 15 minutes later, who stated that the patients were doing okay and reported no symptoms. I also reported this incident to a district manager. Per my manager, I informed the patients'' father about what happened, asked him to monitor his children for symptoms, and report to the ED if the experience anything severe. I also told them that this dose would not be valid and they would have to return to the pharmacy to have their 1st dose dose again. He understood and accepted this information. Bottom line, there was no actual symptoms reported, but I am concerned about the higher dose either of these kids (12 year-old female & 15 year-old male) may have received and pray they will be okay.


VAERS ID: 1319620 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-05-09
Onset:2021-05-14
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033C21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site pruritus, Injection site rash, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (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: Day after the Moderna Vaccine Injection, I had a severe headache, chills, fatigue, and an overall feeling of physical weakness.
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Vaccination Injection was conducted on May 9th, 2021 at approximately 1:45ish PM.
CDC Split Type:

Write-up: May 14th, 2021 at approximately 23:00 I started getting a rash/raised lesion on my left arm at the injection site, which wasn''t painful-just itchy. It went away after a while and is fine now.


VAERS ID: 1319623 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-05-13
Onset:2021-05-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041L20A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Erythema, Pain in extremity, Peripheral swelling, Pruritus, Skin warm
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Ativan: 1mg daily at night Paxil: 37.5mg daily in morning
Current Illness: None
Preexisting Conditions: None
Allergies: Omnicef, Demerol, Morphine, Latex
Diagnostic Lab Data: None
CDC Split Type:

Write-up: The first day, I had slight arm soreness with nothing more. When I woke up on day two, I noticed my arm had swelled more than usual (basing off my previous dose in my right arm) and was extremely hot, tender, and had two circular red patches. That night, the redness and swelling had spread into a medium sized circle, and began to itch and still be very hot upon touch. Upon looking later that night, at approximately 11pm EST, the swelling and redness had gotten larger. On day three, the redness only got worse, and is slowly spread more over the area, with intense itching, but no longer is as sore as it was the day prior. I have iced the area, moved my arm around more to help the swelling go down, taken a hot shower, and about 600mg of Ibuprofen each day since the second dose. The only outcome to those treatments has been a significant decrease in pain level, but the swelling and redness still continues. This has all been over about a 48-72 hour time period


VAERS ID: 1319626 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-05-05
Onset:2021-05-14
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

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

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

Write-up: Covid arm. Swelling, itching, heat at site of injection.


VAERS ID: 1319627 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-05-13
Onset:2021-05-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006C2IA / 2 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Injection site induration, Injection site reaction, Injection site swelling, Injection site warmth, Rash macular
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Atorvastatin 10 mg, nightly Vitamin D, 800 IU, nightly Biotin, 800 mcg, nightly
Current Illness: none
Preexisting Conditions: none
Allergies: Cats & pollen
Diagnostic Lab Data:
CDC Split Type:

Write-up: Left upper arm has raised reddish blotches beneath the vaccination site (shoulder). They do not itch, but they are warm to the touch. Arm beneath them is slightly hard and swollen. I noticed them the night of 5/14, but it''s possible they were present earlier - I wasn''t looking at the arm from a few hours after the vaccination (afternoon of 5/13) until now.


VAERS ID: 1319636 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-05-07
Onset:2021-05-14
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 80777-0273-10 / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Erythema, Pain, Pruritus, Skin warm, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), 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: None
Current Illness: None
Preexisting Conditions: None
Allergies: Penicillin
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Very swollen itchy red hot and painful


VAERS ID: 1319640 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-05-08
Onset:2021-05-14
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Angiogram pulmonary abnormal, Atelectasis, Blood potassium decreased, C-reactive protein increased, Computerised tomogram head abnormal, Computerised tomogram thorax abnormal, Cough, Full blood count, Hypogeusia, Hyposmia, Hypoxia, Impaired driving ability, Lung infiltration, Lung opacity, Magnetic resonance imaging head, Malaise, Mediastinal mass, Nausea, Neutrophil percentage increased, Platelet count normal, Postictal state, Respiratory viral panel, Respirovirus test positive, SARS-CoV-2 test negative, Scan with contrast abnormal, Seizure, Subdural haematoma, Tachycardia, Tachypnoea, Vomiting, White blood cell count increased
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Asthma/bronchospasm (broad), Haemorrhage terms (excl laboratory terms) (narrow), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Haemorrhagic central nervous system vascular conditions (narrow), Convulsions (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Generalised convulsive seizures following immunisation (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Dehydration (broad), Hypokalaemia (narrow), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Losartan, Omeprazole
Current Illness: None
Preexisting Conditions: Hypertension, Thymoma
Allergies: No known allergies
Diagnostic Lab Data: CT Brain (repeat on 5/14): Mild asymmetric hyperdense thickening of the posterior falx measuring approximately 4 mm compatible with known subdural hematoma. CTA Chest (5/14): Multifocal groundglass type nodular infiltrates throughout the right lung involving the upper lobe, middle lobe, and lower lobe, minimal left lower lobe patchy infiltrate; known thymoma present CT Chest w/ contrast (4/10/2021): Subsegmental opacities involving the left lung likely representing atelectasis. Additional nodular and patchy opacities which may represent infectious or inflammatory process and less likely malignancy. Heterogeneous large anterior mediastinal mass which is partially calcified measuring approximately 90 x 136 mm with mass effect on the aortic arch and extending to the anterior chest wall. There is mass effect on the left pulmonary artery which is likely encased. Additionally, there is mass effect on the left mainstem and upper lobe bronchus. The anterior left upper lobe is partially collapsed. Additional left lower lobe subsegmental opacities likely representing atelectasis. MRI Brain 5/15: Pending Viral Resp Panel + COVID 5/14: Negative CBC w/ WBC 25.4; 88% neutrophils; plt 245 CRP 3.5 Potassium 2.7
CDC Split Type:

Write-up: On 5/13/2021 patient developed a cough in the evening. Patient woke up not feeling well on 5/14/2021, and also had nausea and vomiting. Patient was driving a vehicle when he had a seizure. No prior history of seizures. Drifted off the road, no significant damage to vehicle. Patient post-ictal following seizure, seizure activity was witnessed by bystanders. CT brain showed small subdural hematoma. A CTA chest performed due to hypoxemia and tachycardia at Hospital showed Multifocal groundglass type nodular infiltrates throughout the right lung involving the upper lobe, middle lobe, and lower lobe, minimal left lower lobe patchy infiltrate, as well as patient''s known thymoma. These multifocal groundglass infiltrates were not previously mentioned on a CT chest performed on 4/10/2021. Patient was transferred to this facility for evaluation by neurosurgery. Patient was mildly tachycardic, hypoxemic to 88% on room air, and tachypneic. Patient reported decreased sense of taste & smell for 1 month, which he attributed to his losartan use. A covid/flu/rsv PCR on 4/10/2021 was negative, and a viral respiratory pathogen panel with covid PCR was negative on 5/14/2021, as was an antigen & NAAT for COVID on 5/14/2021. Patient was treated with antibiotics and admitted for further management.


VAERS ID: 1319738 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-04
Onset:2021-05-14
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Rhabdomyolysis
SMQs:, Rhabdomyolysis/myopathy (narrow), Neuroleptic malignant 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? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions:
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Rhabdomyolysis


VAERS ID: 1319826 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-05-14
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Body temperature, Fatigue, Hypersomnia, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Depression (excl suicide and self injury) (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data: Test Date: 20210514; Test Name: Body temperature; Result Unstructured Data: 100 degree
CDC Split Type: USJNJFOC20210525711

Write-up: FELL ASLEEP; FEVER; VERY TIRED; This spontaneous report received from a patient concerned a patient of unspecified age and sex. The patient''s weight, height, and medical history were not reported. The patient received covid-19 vaccine (suspension for injection, route of admin, and batch number were not reported) dose was not reported, administered on 12-MAY-2021 15:00 for prophylactic vaccination. The batch number was not reported and has been requested No concomitant medications were reported. On 14-MAY-2021, the subject experienced fever. On 14-MAY-2021, the subject experienced fell asleep. On 14-MAY-2021, the subject experienced very tired. Laboratory data included: Body temperature (NR: not provided) 100 degree. Treatment medications (dates unspecified) included: oxycodone/paracetamol. The action taken with covid-19 vaccine was not applicable. The outcome of the fever, very tired and fell asleep was not reported. This report was non-serious.


VAERS ID: 1319871 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026C21A / 2 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: 15 mg Dextroamp-Amphetamin (~8:45 AM, ~1 hour before 2nd dose) 10 mg Dextroamp-Amphetamin (~12:30 PM, ~3 hours after 2nd dose) 200 mg Ibuprofen (~11:30 PM, ~14 hours after 2nd dose)
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Took a sip of water around 23:45. Found there was a strange tingling sensation on my tongue (specifically the tip area) after swallowing. Quickly fades/is not persistent after swallowing. Not unpleasant: think fizzy drink sensation but toned down by a tenfold, almost muted. As of writing (00:26) sensation still occurs when I drink water.


VAERS ID: 1319872 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Puerto Rico  
Vaccinated:2021-05-06
Onset:2021-05-14
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Work       Purchased by: ?
Symptoms: Injection site pruritus, Injection site swelling, Injection site warmth, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Flu vaccine 2018
Other Medications: Vitamin d, protonix, cranberry pills, Colestyramine
Current Illness: None
Preexisting Conditions: Gastritis
Allergies: Squid
Diagnostic Lab Data:
CDC Split Type:

Write-up: Swelling on injection site. swelling feels warm and itchy. Fever the day after vaccine and pain in body.


VAERS ID: 1319997 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-05-12
Onset:2021-05-14
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Chills, Electrocardiogram PR segment depression, Electrocardiogram ST segment elevation, Fatigue, Myalgia, Pleuritic pain, Troponin increased
SMQs:, Rhabdomyolysis/myopathy (broad), Myocardial infarction (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Other ischaemic heart disease (broad), Tendinopathies and ligament disorders (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Cholecalciferol and Calcium tablets
Current Illness: None
Preexisting Conditions: Left sinonasal adenocarcinoma s/p chemotherapy and radiation in 2012, surgical removal of recurrence in 2019. Now in remission.
Allergies: None
Diagnostic Lab Data: 05/14/2021 high-sensitivity troponin $g 1700 05/14/2021 EKG with diffuse ST elevations and PR depressions
CDC Split Type:

Write-up: Patient received a Moderna vaccine at another facility on 05/12/2021. On 05/13/2021, he had chills, fatigue, and myalgias. These symptoms resolved on 05/14/2021. However on 05/14/2021 at 10 AM he developed pleuritic chest pain. He was admitted to hospital on the evening of 05/14/2021 with dramatic elevations in high-sensitivity troponin to 1700 and EKG with diffuse ST elevations and PR depressions, concerning for myopericarditis. He was initially treated with ibuprofen and colchicine. We have ordered an echocardiogram and a cardiac MRI. Workup and treatment are ongoing.


VAERS ID: 1320036 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Dizziness, Dyspnoea, Throat tightness
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), Cardiomyopathy (broad), Vestibular disorders (broad), Hypersensitivity (broad)

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

Write-up: Upon administering the vaccine , patient. Became very dizzy , and we had her lie down . She then complained of chest tightness , throat tightness , and difficulty breathing . An epipen was administered and paramedics were called . She was taken to the hospital where she was monitored and released . I spoke with her husband when they were home , and he indicated that she was fine


VAERS ID: 1320213 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / IM

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

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

Write-up: Shivers, high fever of 102 F, mild headache


VAERS ID: 1320222 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032B21A / 2 LA / IM

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

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

Write-up: Systemic: Dizziness / Lightheadness-Medium, Systemic: Fainting / Unresponsive-Medium, Additional Details: Patient described feeling dizzy about 15 min after the vaccine. We had her lie down, offered her water & gatorade, monitored her. We took her BP and heart rate. We asked her if she could breathe- she said she could breathe ok. BP was 135/85 and heart rate was 79bpm which was normal. We had her continue lying down and complained that she was feeling worse after another 15min and wanted us to call 911. We did, 911 showed up, took her vitals again which were normal. No hospitalization reqd.


VAERS ID: 1320225 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003C21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Chest pain, Dysphagia, Dyspnoea, Headache, Throat tightness
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), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypersensitivity (broad)

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

Write-up: Systemic: Allergic: Difficulty Breathing-Mild, Systemic: Allergic: Difficulty Swallowing, Throat Tightness-Mild, Systemic: Chest Tightness / Heaviness / Pain-Mild, Systemic: Headache-Mild, Additional Details: Patient reports sudden onset of headache, chest tightness and labored breathing. Pt declined benadryl and epi pen on site to treat with benadryl at home. follow up in progress.


VAERS ID: 1320399 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033B21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anaphylactic reaction, Chest discomfort, Chest pain, Dizziness, Dysphagia, Dyspnoea, Throat tightness
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Anticholinergic syndrome (broad), Anaphylactic/anaphylactoid shock conditions (narrow), 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), Vestibular disorders (broad), Hypersensitivity (narrow)

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

Write-up: Systemic: Allergic: Anaphylaxis-Severe, Systemic: Allergic: Difficulty Breathing-Severe, Systemic: Allergic: Difficulty Swallowing, Throat Tightness-Severe, Systemic: Chest Tightness / Heaviness / Pain-Severe, Systemic: dizziness-Medium, Additional Details: patient was taken to the er after receiving the epipen. She was monitored for a couple of hours and released. I spoke with husband, when they were home, and was informed that she was feeling well.


VAERS ID: 1320401 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025C21A / 1 LA / IM

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

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

Write-up: Systemic: Dizziness / Lightheadness-Mild, Additional Details: PATIENT REPORT FEELING LIGHT HEADED AFTER VACCINATION, PATIENT EXPLAINED THAT SHE HAS A HISTORY OF FEELING FAINT WHEN GIVING BLOOD AND OTHER VACCINATION. PATIENT LAID DOWN AND ELEVATED LEGS, AND IMPROVED WITHIN A FEW MIN. PROVIDED PATIENT WITH OJ TO HELP WITH SUGAR. MONITORED FOR 30 MIN. FOLLOW UP CALL WITH PATIENT AT END OF THE DAY, PATIENT REPORT NO SYMP AND BACK TO NORMAL


VAERS ID: 1320402 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 035C21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anxiety, Dizziness, Feeling hot, Flushing, Hyperhidrosis
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypersensitivity (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Dizziness / Lightheadness-Mild, Systemic: Flushed / Sweating-Mild, Additional Details: few minutes after shot got warm , then her anxiety kicked in so she had a feeling of faintness---had her lie on floor, put fan on her for cooling & gave cold bottle of water--after a few more minutes felt well enough to sit back in chair--then waited remianing of 30 min & was ok after that to leave


VAERS ID: 1320405 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest discomfort, Dyspnoea, Flushing, Hypertension, Nausea, Tachycardia, Throat irritation, Throat tightness
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (narrow), Cardiomyopathy (broad), Hypersensitivity (broad), Dehydration (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Flu vaccine
Other Medications: Zyrtec 10mg. D3 125mcg Multivitamin Microzide 12.5 mg Protonix 40mg Cozzaar 50 mg Fiorinal prn
Current Illness:
Preexisting Conditions: Hypertension Asthma Migraine
Allergies: Formaldehyde Bee venom Cobalt dichloride Clobetasol-17-propionate Dimethylaminopropylamine Disperse blue 106 Fragrance mic PCMX
Diagnostic Lab Data:
CDC Split Type:

Write-up: Itchy throat body Body flushed Chest tightness Throat tightness Tachycardia Hypertension Nausea SOB


VAERS ID: 1320406 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041C21A / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Chest pain, Dysphagia, Dyspnoea, Flushing, Hyperhidrosis, Injection site pain, Tachycardia, Throat tightness
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (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), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Hypoglycaemia (broad), Dehydration (broad)

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

Write-up: Site: Pain at Injection Site-Mild, Systemic: Allergic: Difficulty Breathing-Medium, Systemic: Allergic: Difficulty Swallowing, Throat Tightness-Medium, Systemic: Chest Tightness / Heaviness / Pain-Medium, Systemic: Flushed / Sweating-Severe, Systemic: Tachycardia-Medium


VAERS ID: 1320407 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 035C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Nausea, Syncope, Unresponsive to stimuli
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), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Dizziness / Lightheadness-Medium, Systemic: Fainting / Unresponsive-Medium, Systemic: Nausea-Medium, Additional Details: paramedics came to check out patient and he was ok


VAERS ID: 1320408 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 035C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Nausea, Tremor
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Dizziness / Lightheadness-Medium, Systemic: Nausea-Medium, Systemic: Shakiness-Medium


VAERS ID: 1320409 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 035C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Hypertension, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Hypertension (narrow), Hypoglycaemia (broad)

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

Write-up: Systemic: Chills-Mild, Systemic: Hypertension-Medium, Systemic: Shakiness-Medium


VAERS ID: 1320411 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022C21A / 1 LA / IM

Administered by: Work       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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Systemic: Allergic: Itch Generalized-Medium, Additional Details: Patient began to experience generalized itchiness within 15 minutes post vaccination. Gave Benadryl 25 mg po at 7:15pm. Patient began to improve after 15 minutes and was released with directions to return or seek medical care if condition worsened.


VAERS ID: 1320414 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: New York  
Vaccinated:2021-05-12
Onset:2021-05-14
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 2 LA / IM

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

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

Write-up: Site: Redness at Injection Site-Mild, Systemic: Headache-Mild, Additional Details: Rash presented at injection site to top of shoulder, the size of a deck of cards.


VAERS ID: 1320417 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 2 RA / IM

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

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

Write-up: Systemic: Dizziness / Lightheadness-Medium, Systemic: Fainting / Unresponsive-Medium, Systemic: Flushed / Sweating-Medium, Systemic: Hypotension-Medium


VAERS ID: 1320419 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 1 LA / IM

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

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

Write-up: Systemic: Fainting / Unresponsive-Severe, Additional Details: while patient was waiting out in the waiting area for their 15 minute monitoring session the patient passed out and fell to the floor. The patient did not injure himself with falling to the floor and woke up immediately after he passed out. We immediately put ice packs on him and had him drink a bottle of water while sitting on the floor and made him stay in the waiting area until his color came back in his face and felt fine to go home. He was extremely nervous about getting the vaccine.


VAERS ID: 1320422 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 1 LA / IM

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

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

Write-up: Systemic: Fainting / Unresponsive-Mild


VAERS ID: 1320424 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033C21A / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Injection site bruising, Injection site haemorrhage, Injection site reaction, Pyrexia
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lo loestrin, 10mg lexapro, 75mg synthroid
Current Illness: None
Preexisting Conditions: Hashimoto''s
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: First shot: tired, low grade fever Second shot: I bled from vaccine immediately and had blood running down my arm before he could put the bandaid on. I woke up the next day with a big bruise at vaccine site


VAERS ID: 1320427 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Hypotension, Syncope, Tremor, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), 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? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Systemic: Dizziness / Lightheadness-Medium, Systemic: Fainting / Unresponsive-Medium, Systemic: Hypotension-Medium, Systemic: Shakiness-Medium


VAERS ID: 1320429 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0170 / 1 UN / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Dyskinesia, Loss of consciousness, Nausea, Pruritus, Syncope, Tremor, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dyskinesia (narrow), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Allergic: Itch Generalized-Mild, Systemic: Dizziness / Lightheadness-Mild, Systemic: Fainting / Unresponsive-Mild, Systemic: Nausea-Mild, Systemic: Shakiness-Mild, Additional Details: 5 Minutes after the vaccine, pt lost consciousness for a few seoncds. pt showed some jerking motion. Pt was given water and benadryl. About 30 minutes after the shot, pt fully regained consciousness and back to normal


VAERS ID: 1320431 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 1 LA / IM

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

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

Write-up: Systemic: Dizziness / Lightheadness-Severe, Systemic: Fainting / Unresponsive-Severe, Additional Details: 13 year old female fainted when sitting during her 15 minute observation. she fainted when her mom was standing next to her. we put her on the floor and raised both of her feet. she became concious after 15 seconds. We gave her water and chocolate. we took her blood pressure and her reading was 95/71 with pulse of 78. we had her sit for an addiotional 15 minutes. After feeling ok she left with her parents.


VAERS ID: 1320432 (history)  
Form: Version 2.0  
Age: 9.0  
Sex: Female  
Location: Unknown  
Vaccinated:2012-05-14
Onset:2021-05-14
   Days after vaccination:3287
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: 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: Syncope, drunk water and been under observation. Looks great and let home with her father. Pulse 92 SPO2 98 BP 102/66


VAERS ID: 1320434 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8736 / 1 LA / IM

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

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

Write-up: Systemic: Dizziness / Lightheadness-Severe, Systemic: Fainting / Unresponsive-Severe, Systemic: Weakness-Medium, Additional Details: patient felt dizzy and lightheaded and fainted off the chair. never lost consciousness. recovered after staying in laying down position with knees bent, then had a bottle of water and another drink. walked out after 40 minutes with mom


VAERS ID: 1320439 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Confusional state, Dizziness, Fatigue, Flushing, Hyperhidrosis, Hypotension, Lethargy, Pain
SMQs:, Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Hypersensitivity (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

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

Write-up: Systemic: Body Aches Generalized-Medium, Systemic: Confusion-Medium, Systemic: Dizziness / Lightheadness-Medium, Systemic: Exhaustion / Lethargy-Medium, Systemic: Flushed / Sweating-Medium, Systemic: Hypotension-Medium, Additional Details: CALLED 911. AMR MONITORED PT FOR 30 TO 40 MINS AND RELEASED HER TO GO HOME AFTER THEY DID TALK TO HER MOM.


VAERS ID: 1320440 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 1 LA / IM

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

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

Write-up: Dizzy, anxiety. Drunk orange juice. Improved to normal. Left with her father. Pulse 52 SPO2 96 BP 110/60


VAERS ID: 1320442 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Loss of consciousness, Nausea, Syncope, Thirst, Unresponsive to stimuli
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), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad), Dehydration (broad)

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

Write-up: Systemic: Fainting / Unresponsive-Severe, Systemic: Nausea-Mild, Additional Details: Patient received injection and got up from chair. After standing for a few minutes he fainted and lost conciousness. His mom and I got him to the floor and he regained conciousness within a minute. He said he felt thirsty and nauseated. His mom gave him water. He laid on the floor for 20 minutes and then sat up for a few minutes. Then he walked out of the dressing room and left the store.


VAERS ID: 1320448 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Anxiety, Dehydration, Dizziness, Feeling cold, Heart rate abnormal, Hypoaesthesia, Nausea, Pallor, Paraesthesia, Peripheral coldness, Respiration abnormal, Tremor, Visual impairment
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (broad), Hypoglycaemia (broad), Dehydration (narrow)

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

Write-up: Patient is a 14 YO male with no previous medical history that received the Pfizer vaccine administered into his left Deltoid at 1406. He was sent to the observation area where the nurse noted him looking pale at 1410. His mother was present during this whole event. He was taken over to the medical tent for privacy and further evaluation. He was complaining of being light headed. He was given apple juice and crackers as he had stated that he had not eaten or drank anything all day. At 1430 his VS read BP 132/80, HR 145, O2 99%. At this time he was lying down and feet elevated, shaking, pale, and cold. Lung sounds clear. Nausea but not needing to throw up he was covered up to try and keep him warm. At 1440 his blood pressure was 130/82, HR 130, 02 98% At this time he was lying flat with feet elevated, shaking, pale, and cold. His lung sounds clear. Nausea, but not needing to throw up. At 1450 BP 138/74, HR 120-135, 02 98%. Symptoms had not changed at this point except he mentioned his ears felt cold, although they were warm to touch. He was laid on his left side at this point to try and lower his HR, which did come down to 115-125 when on his L side. We did not take a BP at this point as we wanted him to be on his back when taking them. At 1515 he was laid back on his back to see how his HR would do and how his BP was. BP 138/60, HR 135, 02 98%. Again symptoms were the same except he was complaining of colors being more ?dull?, and his teeth being numb. At this point his pupils were noted to be +8, equal and reactive. 1521 VS read 138/50, HR 135, 02 98%. Vision still dull and pupils unchanged from 1515. He was laid on his R side to see if this would lower his HR. It was brought down to 120-130 on his R side. We gave him a cookie to snack on to see if that would help with any of the paleness, shakiness, and light headiness. He was able to take a few small bites. Hands pale and washed, with +1 bilateral radial pulses. 1529 he was sat up slowly to try to get him to hydrate, as it was apparent he needed fluids onboard. His BP read 142/80, HR 124, 02 98%. He was still complaining of lightheadedness. After sitting up and drinking half a bottle of water and some cookie, he stated that colors were becoming more vibrant. He noticed my eyes were very blue, which previously he had stated they were grey. He stated his lightheadedness had improved and that he was feeling better. We had him sit up for a while and his color started to come back, although his L arm was still pale, of note this was the Vaccinated arm. At 1546 his VS read 150/82, HR 117, O2 99% while sitting. His only complaint was feeling like the air he was breathing ?was cold?. At 1607 he was stood up and when doing so his HR went to 140. After standing for about 4 minutes his BP read 120/82, HR 114, O2 98%. His pupils +6 , equal, round, and reactive. He was feeling way better and his color in his L hand was back equal to his right. He was slowly walked around a chair just to see how he would do with activity. His HR was anywhere from 94-120 when walking around the chair, he complained of no dizziness, or other symptoms. At this point he had finished 2 apple juices, crackers, a cookie, and a bottle of water for a total of 1.5 L of fluid. He was sat back down in the chair to rest and see how things went for a while. His HR was anywhere from 109-120 when in the chair, although he did appear very anxious through this whole process. When he was given a task it appeared that his HR was a few points lower. His final HR was 109, BP 130/82, O2 98%. Of note he did complain of his feet and fingers feeling tingly a few times during this process. Sometimes his feet would be tingly when elevated and then when the garbage can holding them up was readjusted it resolved. These were intermittent complaints. At this point it is 1630. He has responded to fluids and is stable to go home with his mom. It was recommended for him to increase his fluids tonight, and to eat something. He was sent with a bottle of water. It was also recommended to get a pulse ox machine from a pharmacy so that his HR could be monitored and if it does not come down under 100 by tomorrow to make an appointment with his MD to follow up. If any of these symptoms were to come back or if his mom had any concern at all it was recommended to take him to the ED for observation. It was also recommended to follow up with his primary even though he left stable. Throughout this process, I considered administering Epinephrine. The problem was his BP was not low and we could not get his HR to come down. I did not want to increase his HR any more than it already was unless I was absolutely necessary. Given that he responded to fluids, it was decided not to administer it. Given that it took him 2.5 hours to recover from this vaccine, I strongly recommend that he does not get his second dose. I consider this to be an adverse reaction, and his mom was in agreement.


VAERS ID: 1320450 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Hawaii  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 1 LA / IM

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

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

Write-up: Systemic: Fainting / Unresponsive-Mild, Additional Details: Patient fainted 5 minutes after administration during 15 minute post-vaccine observation period. Per witnesses he slumped over to his left side and fell onto the floor to his left side loosing consciousness briefly. He was assessed by immunizing pharmacist and nurse practitioner and was found to have normal regular pulse & was pale in color. He regained consciousness shortly after a few seconds, EMS came over and assessed him later and was deemed ok to go home after 30mins.


VAERS ID: 1320452 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: New York  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 LA / IM

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

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

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


VAERS ID: 1320465 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 2 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Flushing, Heart rate increased, Paraesthesia, Vaccine positive rechallenge
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad), Hypersensitivity (broad), Dehydration (broad)

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

Write-up: About 5 minutes after the injection I get a tingling feeling all over my body. That quickly subsides. Then my heart rate jumps from 75 to 140. My face goes flush and I feel like I am going to pass out. This happened on the first shot so I purchased a blood oximeter for my second and watched it closely. My blood oxygen never went below 96 and mostly remained at 98. Once my pulse hit 140 it immediately began to fall back to 75. About the time the nurse I alerted got there is was back to normal. I do not feel sick at all after either shot. Sure wish I knew what this reaction I am having was.


VAERS ID: 1320471 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-05-13
Onset:2021-05-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046B21A / 2 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Work       Purchased by: ?
Symptoms: Back pain, Chills, Myalgia, Spinal pain
SMQs:, Rhabdomyolysis/myopathy (broad), Retroperitoneal fibrosis (broad), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: 11:20am 5/13 Received vaccination. 1:22am 5/14 Intense pain and uncontrollable chills. 1:30am 5/14 400mg of Ibuprofen taken. 1:50am 5/14 Chills subside, muscle pain continues. 8:30am 5/14 Muscle soreness in cervical spine, lumbar spine, and thighs. 100.1?F fever. 10:30am 5/14 Intense back and spinal pain and chills. No fever. 11:30am 5/14 500mg of Acetaminophen taken. 12:30pm 5/14 Chills subside. Sore back for rest of day.


VAERS ID: 1320508 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-05-13
Onset:2021-05-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Public       Purchased by: ?
Symptoms: Pain in extremity, Peripheral swelling, Pyrexia
SMQs:, Cardiac failure (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Very swollen armpit Fever 100.5 Sore arm


VAERS ID: 1320511 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 180525 / 1 LA / IM

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

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

Write-up: Adverse Reaction Notes: Per NP. Patient had a brief syncopal episode after receiving Johnson and Johnson vaccine , his vital signs remained stable BP 121/76,P68,O2 sat 99%. Patient was awake ,alert, oriented x4,he left vaccination site via ambulance with paramedics to hospital for further evaluation.


VAERS ID: 1320545 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: New York  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site pain, Product dispensing error
SMQs:, Extravasation events (injections, infusions and implants) (broad), Medication errors (narrow)

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

Write-up: Patient accidentaly received a dose of 0.3ml of concentrated vaccine instead of reconstituted vaccine. At the time the error was caught, we contacted Pfizer who said that it is not harmful but that they are more likely to experience pain in the injected arm and should be monitored for symptoms. A claim was filed with rite aid corporate and the patient was contacted. At that time she was reporting pain at the injection site. The patient''s pediatricians office was contacted and when the pediatrician spoke to the family they reported arm pain as well.


VAERS ID: 1320567 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Corneal reflex decreased, Dyspnoea, Emotional distress, Lip swelling, Panic attack, Somnolence
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Corneal disorders (narrow), Depression (excl suicide and self injury) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: WITHIN 5 MINUTES OF ADMINISTERING VACCINE, PATIENT WAS SEATED AND COMPLAINED THAT HE COULD NOT BREATHE.. HE BEGAN TO PANIC AND BECAME INCREASINGLY ALARMED, CRYING AND WAS HOLDING ONTO HIS CHEST. HE WAS CONSCIOUS BUT DID NOT RESPOND TO ME WHEN I KEPT ASKING IF HE WAS OKAY. I CALLED 911 AND GRABBED THE EPI PEN IN ANTICIPATION OF ADMINISTERING IT. PATIENT WAS DROWSY, CLOSING EYES AND SUDDENLY OPENING THEM. NO SIGNS OF BLUE LIPS. WHEN PARAMEDICS ARRIVED, IT LOOKED LIKE PATIENT''S BOTTOM LIP STARTED SAGGING TO RIGHT SIDE AND WAS SWOLLEN. PATIENT WAS TAKEN TO LOCAL ER AND WAS GIVEN EPI AND BENADRYL IN ER DEPARTMENT.


VAERS ID: 1320583 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: New York  
Vaccinated:2021-05-13
Onset:2021-05-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache, 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: Neem, Guggul, Triphola, Yucca
Current Illness: none
Preexisting Conditions: none
Allergies: brussel sprouts
Diagnostic Lab Data:
CDC Split Type:

Write-up: Sore left arm, also felt like I had a fever of 101 deg but was actually normal. Headache and body aches


VAERS ID: 1320591 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Deafness, 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), Hearing impairment (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

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

Write-up: Daughter passed out after 5 minutes of receiving vaccine. She said she couldn''t hear for a little bit as well.


VAERS ID: 1320594 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / UNK RL / IM

Administered by: Other       Purchased by: ?
Symptoms: Periarthritis
SMQs:, Arthritis (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: PT HAS HX BILAT FROZEN SHOULDERS, ENDOCRINOLOGIST SUGGESTED INJECTION TO THIGH. RN GAVE PT INJECTION TO RIGHT THIGH. PT IS DOING WELL.


VAERS ID: 1320606 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 LA / -

Administered by: Other       Purchased by: ?
Symptoms: Blindness, Dizziness
SMQs:, Anticholinergic syndrome (broad), Glaucoma (broad), Optic nerve disorders (broad), Retinal disorders (broad), Vestibular disorders (broad)

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

Write-up: C/O DIZZY, CANT SEE ANY THING, CODE GREEN CALLED, TRANSFFERED TO COT, SX RESOLVED, REFUSED TRANSPORT


VAERS ID: 1320616 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-05-13
Onset:2021-05-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Nausea, Pain, Somnolence
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: exhaustion and chills after shot 1. As well as a rash on the injection site one week later
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Whole body aches, dizziness, nausea from the pain Took Advil, laid in bed, slept for almost 24 hours.


VAERS ID: 1320634 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-05-13
Onset:2021-05-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Chills, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever, chills, body and joint pain


VAERS ID: 1320678 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-05-13
Onset:2021-05-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / IM

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

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

Write-up: Fever, fatigue, body aches and headache


VAERS ID: 1320720 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: New York  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Musculoskeletal stiffness
SMQs:, Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (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: tylenol, meloxicam
Current Illness: left foot injury
Preexisting Conditions:
Allergies: nkda
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Pt s/p pfizer vaccine 5/14/2021 to Left deltoid, pt reports 10 min later left 4-5 th finger stiffness, Staff brought her to EMS, who evaluated her, elevated blood pressure checks at the time, unclear cuff size. Improved and DC and overall improved today without further ssx. To Urgent care for further evaluation. Pt in NAD, no limitations in full arom, no angioedema, no urticaria, lungs cta, regualr rate/rhythm. Left deltoid site c/d/i no erythema or streaking. 5/15/2021 VS at urgent care: Temp 97.5 F, HR 85 /min, BP 124/81 mm Hg large cuff needed, RR 16 /min, Oxygen sat % 99 %, Ht 5 ft 7 in, Wt 250 lbs, Wt-kg 113.4 kg, BMI 39.15 Index, Ht-cm 170.18 cm Will continue to monitor and will follow up with pcp on Monday


VAERS ID: 1320731 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: 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), 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: vomiting
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient vomited and fainted after vaccination within 20 minutes of vaccination Patient was checked out by EMS and referred to hospital, but patient refused and went home


VAERS ID: 1320751 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-05-13
Onset:2021-05-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site pain, Lymph node pain, Lymphadenopathy, Pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Just soreness at injection site when getting flu shots
Other Medications: Xyzal
Current Illness: None
Preexisting Conditions: None
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Swollen and very sore lymph nodes in left axilla starting the day after the injection. It has only been 2 days so I do not know how long this will last. You can feel the nodes are swollen and my son is complaining that it is very sore especially when he is lifting or using the arm.


VAERS ID: 1320765 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-05-13
Onset:2021-05-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 AR / IM

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

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

Write-up: bilateral knee pain and swelling 24 hours after first dose


VAERS ID: 1320774 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / UNK - / IM

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

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

Write-up: Client is a 57-year-old male with a history of experiencing dizziness when given an injection. Client was vaccinated with 0.5 ml of Janssen vaccine. At 10:57 am the client stated that he began to feel dizzy. The client was assisted from the chair to a cot, and assisted into a supine position with both legs elevated. The client denied any other symptoms. A set of vital signs were taken at 10:58; Blood pressure 134/78, pulse: 72 and strength was +3; 02 sat 98%; RR: 16; Anterior lung sounds were clear bilaterally. Pt was instructed to lay down until he feels well enough to sit up. The client was instructed to change positions slowly from lying to sitting, then sitting to standing. Pt was advised to stay under observation for 30 minutes . At 11:10 am, the client was able to sit down in a chair in the observation tent and have a drink of water. At 11:30 vital signs were reassessed. Vital signs were blood pressure 122/76, Pulse 64, 02 sat: 98% and client reported feeling fine, and thanked the staff for their help. The client then walked out of the event.


VAERS ID: 1320800 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: Nevada  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Contusion, Laboratory test, Loss of consciousness, Road traffic accident
SMQs:, Torsade de pointes/QT prolongation (broad), Haemorrhage terms (excl laboratory terms) (narrow), 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? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: No
Current Illness: No
Preexisting Conditions: No
Allergies: No
Diagnostic Lab Data: Multiple tests done at the trauma center.
CDC Split Type:

Write-up: I got my first shot of Pfizer at pharmacy, I sat for the recommendation of 15 minutes. I then got in my car to drive home when within 3 minutes of driving on the road I lost consciousness and crashed my car into a pole totalling my sedan. I was rushed to the hospital by ambulance and did various test but thankfully I ended up with only bruises and scrapes.


VAERS ID: 1320825 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022C21A / 2 LA / IM

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

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

Write-up: Administration of second dose was given 3 weeks after first dose instead of 4 weeks.


VAERS ID: 1320857 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-05-13
Onset:2021-05-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Exposure during pregnancy, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (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: Prenatal vitamins, sertraline
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever and vomiting for an estimated 12 hours. Currently 16 weeks pregnant, due date 10/30/21.


VAERS ID: 1320927 (history)  
Form: Version 2.0  
Age: 93.0  
Sex: Male  
Location: New York  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 006C21A / 1 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Dementia
Preexisting Conditions: Dementia
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient presented to pharmacy alone requesting a COVID vaccine. Unknown to us patient had a hx of dementia. J&J vaccine was administered. Shortly after vaccine administration we received a call from the patient''s son stating he had already completed a Pfizer COVID vaccine series in January through the VA. We advised the son to watch for any unusual signs or symptoms and f/u with the patients care provider if anything unusual occurs.


VAERS ID: 1320975 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-04-12
Onset:2021-05-14
   Days after vaccination:32
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Amnesia, Angiogram, Aphasia, Computerised tomogram head normal, Computerised tomogram neck, Diplopia, Dysarthria, Facial paralysis, Hemiparesis, Magnetic resonance imaging head abnormal
SMQs:, Dementia (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow), Hearing impairment (broad), Ocular motility disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Trospium chloride tablets, estradiol cream, triamcinolone ointment, ascorbic acid tablets, esomeprazole capsule, magnesium oxide, potassium supplement, cholecalciferol tablet, received denosumab injection 2/3/21
Current Illness:
Preexisting Conditions: Barrett''s esophagus, PFO
Allergies:
Diagnostic Lab Data: CT of head 5/13: no acute findings, CT-angiogram: No evidence of intracranial large vessel occlusion. MRI Brain 5/14: Left thalamus 2 subcentimeter small regions of recent ischemic infarct. No hemorrhagic transformation. No evidence of acute hemorrhage. Significant periventricular and subcortical T2 weighted hyperintensities likely from chronic microvascular disease.
CDC Split Type:

Write-up: Patient had been working all day in her flower gardens. At 4:30 p.m. she felt like she had double vision and difficulty talking. She does not remember much of what happened after that, but her husband said she had sudden onset of right arm weakness, leg weakness and drooping of the right side of her face. Denies having numbness. He immediately called 911 and EMS took her the Hospital. She had a CT scan of the head that was negative. When she arrived at the emergency room her symptoms had resolved, but she had recurrent episode of her symptoms in the emergency room with an NIH score of 5 scoring a point for level of consciousness, best language, and dysarthria and 2 points for facial droop. She was given tPA and her symptoms resolved. A CT angio of her head and neck did not show any large thrombus. She was transferred for ongoing care and neurology evaluation. Neuro deficits resolved. Patient was discharged the second day after the event on Aspirin, Plavix and Lipitor. Hospitalist (Dr) asked me to file VAERS report given recent Janssen vaccine administration.


VAERS ID: 1321022 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: New York  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 1 LA / IM

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

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

Write-up: PATIENT''S PARENT ADVISED TO PHARMACIST PATIENT HAD FAINTING/PASSING OUT SYMPTOMS IN PAST WITH AN HPV VACCINE. PHARMACIST HAD PATIENT REMAIN SITTING AFTER VACCINATION. WITHIN A COUPLE MINS, PATIENT''S MOM FLAGGED DOWN PHARMACIST, REPORTING EXTREME SWEATING, NAUSEA, TROUBLE SEEING. PHARMACIST CALLED 911 AND EMS ARRIVED WITHIN 10 MINUTES TO MONITOR VITALS. PATIENT WAS RELEASED FROM EMS CARE AND ABLE TO WALK/LEAVE PHARMACY WITHOUT AN ISSUE.


VAERS ID: 1321031 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0171 / 1 LA / IM

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

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

Write-up: Patient fainted after immunization. EMS was called and responded to evaluate the patient. No treatment was needed. The patient recovered consciousness within one minute but remained altered for 30 minutes then was fully back to normal.


VAERS ID: 1321086 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-05-12
Onset:2021-05-14
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown by [atient''s mom who reported HA to me
Current Illness: none reported
Preexisting Conditions: Migraine headache Hx
Allergies: Latex-causes rash
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Patient woke up with a bad headache at 4am 5/14/21, she took usual meds for her migraines and several hours later her headache was no better. Her mom who reported this to me didn''t know what her migraine meds were. She did say the headache was more severe than she usually gets (gets migraines approx 10x/month normally). I recommended she call her migraine doctor to ask their opinion. If she feels she needs to see a doctor at ER or urgent care due to the severity of the heachache that is also an option. I told her heachaches were normal with the Janssen vaccine (30-44%) but I wasn''t sure if her migraine condition would contribute to the severity of the headache she was having. I followed up with patient today 5/15 to see if improved by no answer, I left a voice mail for her to call me back.


VAERS ID: 1321089 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hyperhidrosis, Loss of consciousness, Nausea, Pallor
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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 reported
Preexisting Conditions: None reported
Allergies: No known allergies
Diagnostic Lab Data: None reported
CDC Split Type:

Write-up: After patient received vaccine, another patient shouted that he needed help. Came back out of pharmacy to find patient passed out but he came to quickly. He was very pale, sweating and complaining of nausea. Got patient ice packs, water and Gatorade and after about 20 minutes patient was feeling well enough to leave with his father.


VAERS ID: 1321127 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 - / SYR

Administered by: Work       Purchased by: ?
Symptoms: Rash macular
SMQs:, 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: sertraline, unknown dose QHS trazodone, unknown dose QHS
Current Illness: none reported
Preexisting Conditions: none reported
Allergies: none reported
Diagnostic Lab Data:
CDC Split Type:

Write-up: Vaccine given on right arm. After 5 minutes the patient reported hive-like spots on left forearm/wrist/knuckles (diffuse and approximately 6-7 red spots). After another 5-10 minutes a few more spots appeared on the left arm as well. No itching or pain or tingling was related. No signs of anaphylaxis noted (no trouble swallowing/breathing, no laryngoedema, no dizziness or weakness, no cough, no tingling or redness on skin other than spots. Patient was lucid and calm. Patient was offered 50 mg diphenhydramine IM as per clinic protocol and refused. Patient was observed for a total of 40 minutes after injection and spots did not spread further, and no new spots formed. Patient was advised to go to the nearest pharmacy and get liquid diphenhydramine and take 50 mg immediately. No follow-up or final outcome available.


VAERS ID: 1321131 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-05-13
Onset:2021-05-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045B21A / 2 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Fatigue, Feeding disorder, Feeling hot, Headache, Insomnia, Pain in extremity, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Omeprazole, 40 mg
Current Illness: None
Preexisting Conditions: Eosinophilic Esophagitis
Allergies: Dairy, Beef, Tree nuts, Tomato, Watermelon, Strawberries
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Sore arm, Fever, Headache, Fatigue, Trouble sleeping, Feeling very hot, Unwillingness to eat


VAERS ID: 1321144 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Hx of fainting with injections, unknown if it was with a vaccine injection
Other Medications: Antibiotic for acne, drug name and dosage unknown
Current Illness: None
Preexisting Conditions: None
Allergies: NKDA
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient received the 1st COVID vaccine (Pfizer lot # EW0182 use by 5/15/2021) at 1455. The client had a history of fainting (x3) with intramuscular injections. The client reported eating lunch prior to arriving for her appointment. The client was vaccinated in the anti-gravity chair at 1455 by EMT. The client became very pale about 1 minute following the vaccination administration and she loss consciousness for 5 seconds, during this time she had 2 myoclonic contractions. RN and EMT immediately placed the patient in Fowler''s position in the anti-gravity chair during the syncopal episode. The patient immediately regained consciousness and was alert and oriented to person, place, time, and situation. The patient remained in Fowler''s position and vitals were taken at 1456: BP 125/95 (R arm), HR 45, RR 18, and oxygen saturation at 95%. The patient denied experiencing lightheadedness, shortness of breath, dizziness, nausea, headache, or blurry vision. The patient was given a juice box. The patient''s color slowly returned. Vitals were retaken at 1505: BP 123/82 (R arm), RR 20, HR 50, oxygen saturation at 98%. The patient stated, " I usually feel really bad after I faint but this time I feel fine." Vitals at 1510 were as follows: BP 130/70, RR 18, HR 67, oxygen saturation at 100%. The patient was speaking in full sentences and laughing with her friend. Vitals taken at 1515: BP 125/ 68, RR 16, HR 68, oxygen saturation at 99%. The patient was positioned from a Fowler''s position to sitting upright. The patient''s color returned to her face and she denied any nausea, dizziness, blurred vision, double vision, or chest pain. Vitals were taken at 1520: BP 125/70, HR 82, RR 16, oxygen saturation at 99%. At 1524, the patient''s blood pressure was 125/68 and HR was 58. The patient continued to deny any shortness of breath, dizziness, nausea, or vision changes. The patient''s heart rate was taken at 1531, HR 55 and again at 1536, HR 62. The patient''s mother stated her daughter was currently taking an antibiotic for acne (dosage and name unknown) and denied having any drug allergies or chronic medical conditions. RN instructed the patient and her mother about emergency precautions and to follow up with their primary care provider. RN, also educated the patient and her mother about the importance of informing the healthcare provider about her history of fainting with injections when receiving the second COVID Pfizer vaccine. Gave the patient''s mother V-safe information and reported the occurrence in VAERS. The patient had a steady and even gait when leaving the site with her mother at 1537.


VAERS ID: 1321185 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0171 / 1 LA / IM

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

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

Write-up: syncope with bilateral tonic/clonic movements. per parents, patient has history of vasovagal syncope following exposure to needles or lancets (vaccines, finger prick). approx 2 minutes following injection, patient lost consciousness, followed by several clonic movements bilaterally of upper and lower extremities. patient was transfered from chair to floor, legs were elevated. She regained consciousness quickly, was given water. When she felt better, she once again sat in a chair. After another 5 minutes (approx), she had another episode of loss of consciousness with increased tone of UE and LE bilaterally and also several clonic movements. She was again transferred to the floor, regained consciousness. She was more shaky and diaphoretic following the second episode but was otherwise aware and oriented. She was observed for another 30 minutes at the pharmacy and then left.


VAERS ID: 1321251 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Unknown  
Location: Texas  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Fall, Feeling abnormal, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Vestibular disorders (broad)

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

Write-up: during injection patient said his arm felt tingly, shortly after injection patient said he didn''t feel right, said he felt dizzy, light headed, I offered him water, before getting water he fell down at pharmacy counter, I offered to call EMS but patient refused, I helped him to waiting room, gave him water, he sat for 20 minutes for further observation, said he felt better after drinking water, offered to call someone to pick him up but he refused, said he felt better, patient decided he was ok to leave, I called to check on him and he had made it back to work ok and was feeling normal again, patient then came by store later around 6 pm to shop and said he was still feeling ok


VAERS ID: 1321255 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / UNK - / -

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

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

Write-up: pt was very scared before vaccine, after vaccine passed out, i suspect syncope , came back fast sat and was fine


VAERS ID: 1321289 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 1 AR / IM

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

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

Write-up: Attendee received first dose Pfizer vaccine at 15:30. Attendee was directed to observation area. At 15:40 voiced complaints of mild feeling like his throat was closing. Placed supine on the floor with feet elevated on a chair. Alert and oriented skin without pallor, sweating or rash. Denies any difficulty with breathing and respirations are even and not tachypneic. 15:45 ? No change in symptoms. Attendee was administered epinephrine. 15:50 ? Continues to deny any shortness of breath. HR: 68 BP: 134/86 O2Sat%: 99 15:53 ?Starting to feel better feel of throat closing sensation almost gone. Skin continues to be warm and dry. 16:05 -No voiced complaints- skin warm and dry. HR: 70 BP: 116/80 O2Sat%: 98 16:20 - EMS arrived assessed attendee and did repeated VS and offered to take him to the Emergency Room and mom declined and said she would transport. 16:30 Attendee stated that he felt better and was released to his mother, who stated that she was going to take him to the emergency room as recommended by the paramedics. Attendee was able to walk out of clinic independently with his mother.


VAERS ID: 1321312 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: 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 6 months, not the approved emergency use authorized age of 18 for the Moderna shot.


VAERS ID: 1321340 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0170 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Cold sweat, Hyperhidrosis, Pallor
SMQs:, Neuroleptic malignant 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: Pt has history of fainting with previous vaccines (NOT COVID vaccine)
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt presented pale, diaphoretic, with cold clammy skin @ 12:18 PM, approx. 3 minutes after receiving her first Pfizer dose. Pt positioned changed to supine with her feet elevated. Vitals @ 12:18 are: BP: 90/67 P: 85 RR: 17 O2: 100% T: 97.3. At 12:21 Pt reported feeling better and no longer presented with any previously mentioned symptoms. Pt vitals @ 12:21 are: BP: 129/67 P: 97 RR: 20 O2: 100% T: 97.1. Pt remained in supine positioned and RN continued to monitor. At 12:36 pt position changed to sitting up, water was given upon pt request. Last set of vitals before discharge at 12:45 are BP: 113/67 P: 74 RR: 20 O2: 98% T: 98. Pt was discharged with her mom.


VAERS ID: 1321352 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 AR / IM

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

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

Write-up: Patient was given a J&J dose that has been outside of 2 hours window period.


VAERS ID: 1321376 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Drainage, Dysphagia, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), 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: UNKNOWN
Current Illness: NONE
Preexisting Conditions: SEASONAL ALLERGY
Allergies: UNKNOWN
Diagnostic Lab Data: bp 132/84 at 12:48 bp 130/84 at 12:56 both on 5-14-2021
CDC Split Type:

Write-up: reports "throat feels a little tight " and "hard to swallowing". Brought to observation area. Vss ( baseline HTN per his report). reports seasonal allergies. Oropharynx red upon inspection and drainage noted at back of throat. Able to drink fluids with difficulty. Reports immediate improvement of symptoms after PO fluids. Discussed symptoms of anaphylaxis with him. Released him to home after discussion of serious symptoms and what to contact ems for


VAERS ID: 1321378 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808609 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Cold sweat, Hypotension, Malaise, Nausea
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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: Isosorbide mononitrate 10 mg Cilostazol 50 mg Tramadol 50 mg
Current Illness: Thyroid
Preexisting Conditions: Thyroid Heart - Triple by-pass in 2019
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Nausea Feeling sick Low blood pressure Clammy skin Signs and symptoms started 5 minutes after the administering the vaccine. Vaccine administered at 12:22. At 12:27, the consumer complaints of nausea and feeling sick. Consumer remained awake, alert, and oriented. The consumer denies shortness of breath, chest pain, or difficulty breathing. Vital signs checked: BP 80/50 (manually), 86/50 (electronically), heart rate 65, oxygen saturation 94-97%. Consumer admitted taking her cardiac medications 10 to 15 minutes before we arrived for the in-home vaccine administration. The EMS arrived around 1:00 pm, assessed the consumer, BP remains low. At 01:40 pm, the consumer was transported to the hospital by the EMS. NOTE: Consumer states, she took cardiac medication 10-15 minutes before the vaccine was administered. She verbalized, the medication has not been take for a while (about 6 weeks), just resumed medication on 5/14/2021. BP reading 12:28 80/50 manually, 86/50 electronically 12:48 - 60/45 Called 911, fluid offered 12:55 - 161/87 1:00 - 104/54 EMS Arrived 1:05 - 106/54 1:06 - 108/70 1:15 - 77/45 1:40 - Consumer transported to the hospital by the EMS. Consumer remains awake, alert and oriented. Denies shortness of breath, chest pain, or difficulty breathing.


VAERS ID: 1321423 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Dysstasia, Hyperhidrosis, 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), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

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

Write-up: Patient passed out for a few seconds 2-3 minutes after the vaccine. Complained of dizziness , sweating and unable to stand up. Patient''s father, was with him at time of accident. His after caught him and prevented him from falling. Patient did not get hurt. Patient sat in front of vaccination room for about 20 minutes and left. I called to check on the patient the following morning at 9 AM and was told by patient father that patient is ok now.


VAERS ID: 1321448 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: New York  
Vaccinated:2021-05-13
Onset:2021-05-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0169 / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Epistaxis, Haemoptysis
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Infective pneumonia (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: Ritalin
Current Illness: No
Preexisting Conditions: No
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: One day after shot bloody nose for a few minutes Two days after shot bloody nose again for a few minutes and also spitting up blood from mouth


VAERS ID: 1321454 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-05-01
Onset:2021-05-14
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Male teen daily vitamin
Current Illness: None
Preexisting Conditions: None
Allergies: Penicillins
Diagnostic Lab Data: No tests were done.
CDC Split Type:

Write-up: 5 minutes after receiving the injection his mouth was itching. 7 minutes after his throat started closing up. 8 minutes after the pharmacist gave him one Benadryl and at 9 minutes 911 was called. He was given meds and oxygen then taken to the emergency room where he was monitored for 4 hours.


VAERS ID: 1321471 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Vermont  
Vaccinated:2021-05-13
Onset:2021-05-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 2 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Injection site erythema, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad)

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

Write-up: injection site redness...4"x2.5" oval patch...HOT to touch


VAERS ID: 1321486 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-05-13
Onset:2021-05-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Confusional state, Dehydration, Dyspnoea, Fatigue, Headache, Injection site pain, Nausea, Presyncope, Pyrexia
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (narrow), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (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: asthma
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Injection site: pain/tenderness General side effects: Nausea, weakness (full body), nearly fainting multiple times, headache, some confusion, dehydration, some difficulty breathing, tired even with rest, low fever


VAERS ID: 1321489 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-05-10
Onset:2021-05-14
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045B21A / 2 LA / SYR

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

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

Write-up: Scalp numbness after the 96 hours of injection. The numbness takes place 5-6 times per day.


VAERS ID: 1321505 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

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

Write-up: Allergic reaction. Throat closed.


VAERS ID: 1321515 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Ohio  
Vaccinated:2020-03-24
Onset:2021-05-14
   Days after vaccination:416
Submitted: 0000-00-00
Entered: 2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH PFIZERN6202 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Alopecia
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: Lantus 60 mg novolog 13mg losartan 20 mg/ HTCZ 12.5 mg Vit B12
Current Illness: Diabetes II HTN
Preexisting Conditions: Diabetes HTN
Allergies: Citrus Ibuprophen
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: large amount of hair loss..globally since the second jab


VAERS ID: 1321520 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-05-13
Onset:2021-05-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 RA / SYR

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

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

Write-up: Headache, high fever, dizziness, nausea, sore arm


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