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

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



Case Details (Reverse Sorted by Onset Date)

This is page 164 out of 6,867

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VAERS ID: 1558429 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / -

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, Chest pain, Chills, Electrocardiogram abnormal, Headache, Pain, Palpitations, Pyrexia, Sinus tachycardia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Propolis
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Sinus tachycardia as a result of ECG.(13/08/2021)
CDC Split Type:

Write-up: High fever, chills and short term chest pain on the first night after vaccination. Pain everywhere, severe in the headache and abdomen pain the next day. And palpitations.


VAERS ID: 1672282 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-08-04
Onset:2021-08-11
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052C21A / 1 - / IM

Administered by: Other       Purchased by: ?
Symptoms: Chest pain, Dizziness, Dysgeusia, Dyspnoea, Feeling abnormal, Muscular weakness, Nausea
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (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: zinc b-12
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: none
CDC Split Type:

Write-up: week 1 - weakness in legs, short sudden jabs of pain in chest. few seconds. few times a day. week 2 - metallic taste in mouth, legs weak. legs felt disconnected from body at times. would voluntarily choose to move legs to test mobility. mobility was fine but felt like i had to choose to move legs at times. shortness of breath , short lasting on two occasions. slight nauseous feeling. week 3 - increased lightheadedness. most of day, slightly dizzy. some moments felt legs wobble. week 4 - metallic taste, slight lightheadedness.


VAERS ID: 1540100 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-01
Onset:2021-08-10
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dyspnoea, Headache, Nausea
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad)

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

Write-up: Headache, shortness of breath, nausea. Started several hours after vaccine. No treatment used so far


VAERS ID: 1540333 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-08-09
Onset:2021-08-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Eye irritation, Heart rate increased, Myalgia, Sensory disturbance
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (narrow), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Corneal disorders (broad), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Dehydration (broad)

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

Write-up: Burning eyes Extreme muscle and joint pain through body Feeling rapid heart rate Whole body throbbing Treatment: rest, warm epsom bath, Tylenol and ibuprofen


VAERS ID: 1540365 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-05-19
Onset:2021-08-10
   Days after vaccination:83
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0170 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, COVID-19, Continuous positive airway pressure, Dyspnoea, Infection, Malaise, Oxygen saturation decreased, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Respiratory failure (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: unknown
Preexisting Conditions: abdominal aortic aneurysm, atrial fibrillation, arthritis, Barrett''s esophagus, hyperlipidemia, depression, coronary disease, diabetes mellitus type 2, GERD, essential hypertension
Allergies: codeine (itching)
Diagnostic Lab Data: 8/10/21 SARS-CoV-2 detected
CDC Split Type:

Write-up: Patient presented to ED with breakthrough COVID infection, presented with 3 day history of worsening generalized malaise, weakness, and increasing shortness of breath. SpO2 80% on room air, subsequently placed on CPAP with improving SpO2 90%


VAERS ID: 1540376 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 RA / IM

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

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

Write-up: Patient did not report his age to the nurse until after he received the vaccine. Patient is 17 years old. Patient was monitored for the full 15 minutes and discharged without any symptoms.


VAERS ID: 1540387 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-08-06
Onset:2021-08-10
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood pressure increased, Feeling hot, Flushing, Sensory disturbance
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (narrow), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Hypertension (narrow), Hypersensitivity (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: some swelling for a flu vaccine. Was told she received a bad lot number.
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: Sulfa
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient began to feel warm and flushed about 5 minutes after vaccination. Stated she could feel it going through her veins. Ambulance was called and 1st responders first arrived 10 minutes after call. No treatment was given. BP was elevated to 170/90. Water was given to patient. Patient was told to go to the local clinic for further evaluation.


VAERS ID: 1540389 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: Maine  
Vaccinated:2021-07-20
Onset:2021-08-10
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / UNK - / IM

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

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

Write-up: PATIENT SHOWED UP TODAY FOR HIS SECOND PFIZER DOSE AND UPON LOOKING AT IMMPACT REGISTRY, I SAW THAT HE HAD PREVIOUSLY RECEIVED 2 DOSES OF THE MODERNA VACCINE IN APRIL AND MAY 2021


VAERS ID: 1540407 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 RA / IM

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

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

Write-up: Nurse reported 35 minutes after vaccine administration the patient began to have nausea and vomited.


VAERS ID: 1540416 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-08-06
Onset:2021-08-10
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0164 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Abdominal pain, Diarrhoea
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (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: Adderall - 30mg Hydroxyzine - 10mg
Current Illness:
Preexisting Conditions: Lower back pain
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Abdominal cramps and numerous visits to the toliet for loose diarrhea.


VAERS ID: 1540444 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-08-09
Onset:2021-08-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Military       Purchased by: ?
Symptoms: Dizziness, Dyspnoea, Fatigue, Headache, Loss of personal independence in daily activities, Nausea, Somnolence
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (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: None
Current Illness: None --- COVID positive on 10MAY21
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Headache (8/10 on pain scale; interferes with normal daily activities), Light headedness, Nausea, Drowsiness, shortness of breath, significant fatigue (interferes with normal daily activities)


VAERS ID: 1540446 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-08-09
Onset:2021-08-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0169 / 2 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypoaesthesia, Injection site erythema, Injection site swelling, Lip swelling, Pruritus
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), 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), Sexual dysfunction (broad)

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

Write-up: swollen lips itchy body swollen and red at the injection and arm is numb


VAERS ID: 1540449 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cold sweat, Dizziness, Drooling, Hypopnoea, Tremor, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Patient reported becoming very ill after receiving her flu shot back in 2004
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Between 10-15 minutes after receiving her first dose of the Moderna vaccine the patient became unresponsive and shaky. She began to drool slightly started shaky breaths and became clammy. Emergency services was called immediately. After a minute or two the patient started breathing normally again. She asked to be laid down because she was feeling very dizzy and shaky. She began to calm down and only complained of being slightly dizzy when the paramedics arrived.


VAERS ID: 1540461 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-08-09
Onset:2021-08-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 2 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Body temperature increased, Chills, Headache, Impaired work ability, Injection site pain, Pain in extremity, Sleep disorder
SMQs:, Neuroleptic malignant syndrome (broad), Extravasation events (injections, infusions and implants) (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: I had chills at 3:30 a.m which woke me up but temp was only at 98.8 a degree higher than normal for me. My left arm ached at the injection which I know is normal. But my upper legs felt achey and upper arms felt achey on both sides near the shoulder. My temp slowly went up to 99.9/99.8 to 100.1. I took a shower trying to get ready for work at 5:45 am when I took it again and it was normal. around 6:20 I took it again and it was 100.1 and I called work. to call off. I had a headache so i took some over-the-counter headache medicine and the headache subsided. I put on fleece blankets over my legs and my upper body and my temp went up to 101.2. I use a digital thermometer behind my ear to take the temprature. It has been holding at 101.2 since 6:40 or so. It did go up to 101.9 but I wrapped tight one of the blankets around my upper body closed, so I loosened it and it went back to 101.2 Probabaly a lot of info you don''t need , sorry.


VAERS ID: 1540466 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: New York  
Vaccinated:2021-04-27
Onset:2021-08-10
   Days after vaccination:105
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Feeding disorder, Injection site mass, Injection site pain, Injection site swelling, Lethargy, Malaise, Pain, Palpitations, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: flu shot, age 40s? dont know name of shot
Other Medications: vitamin C, D, New Earth multivitamin, Advil
Current Illness: none
Preexisting Conditions: allergies
Allergies: Erythromycin, Biaxin, Keflex, Ceclor
Diagnostic Lab Data: none
CDC Split Type:

Write-up: after 1st shot on 4/27/21 , low grade fever 99 and aches. and lethargy which lasted 2 days. After the 2nd shot on May 18, became pretty ill with higher fever and racing heart and was unable to eat which lasted two days. okay after that. Today, 8/10/21, i felt a swelling on my arm where injection site was and it is painful and feels like a lump under there.


VAERS ID: 1540502 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011D21A / 2 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Body temperature decreased, Chills, Feeling cold
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: B12 and melatonin
Current Illness: No
Preexisting Conditions: No
Allergies: No
Diagnostic Lab Data:
CDC Split Type:

Write-up: About 7 hours after vaccine I began shivering. I assumed it was a fever (normal side effect). I became so cold my teeth were chattering. I put on thermal fleece long Johns and was wrapped in 2 down comforters and a fleece blanket. A couple of hours later when I stopped shivering I took my temperature and it was 96.1. thinking the thermometer wasn?t reading right, I used a 2nd thermometer and it read 96.2. I took one Tylenol hours before when I started shivering (forgot to note that on the previous screen). This morning my temperature was back to normal.


VAERS ID: 1540504 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-08-09
Onset:2021-08-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Diarrhoea, Dizziness, Headache, Nausea, Pain
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Noninfectious diarrhoea (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: Reflux meds
Current Illness: Bronchitis
Preexisting Conditions: Post colectomy dumping syndrome, fibromyalgia
Allergies: Codine, sequin, nubane, ipamadol
Diagnostic Lab Data:
CDC Split Type:

Write-up: Nausea, pain, diarrhea, dizziness, headache


VAERS ID: 1540516 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026C21A / 1 LA / SYR

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

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

Write-up: Patient was given Moderna at age 16. Moderna is not approved for patients under 18 years of age.


VAERS ID: 1540520 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Dry throat, Dysarthria, Oropharyngeal discomfort, Pruritus, Tongue discomfort
SMQs:, Anaphylactic reaction (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad)

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

Write-up: Janssen vaccine administered at 10:15 AM. Patient complained of heavy tongue and "feeling funning back of the throat" after a minute or two of the vaccine. On or about 5 minutes after, patient continued to complain of heavy tongue and back of throat dry and "getting worse". Nurse Stat called then transferred to ED. Speech became slurred and had a fearful disposition stating her throat was getting worse. She also complained of feeling itchy.


VAERS ID: 1540528 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 1 LA / IM

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

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

Write-up: Patient fainted in the waiting area approximately 5-10 minutes after administration. Did not lose consciousness. Patient did not sit in the chair in waiting room and mother reported that he had not eaten today.


VAERS ID: 1540534 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Condition aggravated, Fall, Seizure
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

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

Write-up: Pt received vaccine and 13 minutes after began having seizure and fell to floor. Vitals were taken and ambulance called for transport to hospital


VAERS ID: 1540537 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-09
Onset:2021-08-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Angina pectoris, Chest pain, Pyrexia, Throat irritation
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Other ischaemic heart disease (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Left side of chest in sever pain. Throat is burning, fever. Heart pain.


VAERS ID: 1540554 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 RA / SYR

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

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

Write-up: P/T stated she need to throw up. ( symptom: nausea). 9:29 bag 3 cold packs to neck area. No vomiting, 02 Sat 99% BP 110/80 R20 T 96.6. 9:36 pt without nausea ,vomit or dizziness, no headache. 02 Sat 99% pulse 81 BP 100/80 R20 9::45 BP 110/78 P 86, R 86, R20, 02 Sat 100% Pt left with no symptoms at 10:16 a.m.


VAERS ID: 1540562 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-08-09
Onset:2021-08-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 049E21A / 1 LA / IM

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

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

Write-up: adverse events: this morning the patient woke up with swollen eyelids and swollen lips


VAERS ID: 1540566 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 1 - / IM

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

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

Write-up: Pt came in for first dose Covid vaccination. Due to allergy history pt was instructed to wait in observation area for 30 mins. Roughly 35 mins into observation time, pt reported feeling itchy and having a scratchy throat. Pt notified writer she took her own dose of 25mg of oral benadryl. Continued to monitor pt - pt reported no improvement but no worsening of symptoms. 30 min after dose of benadryl pt stated she did not want additional medication at this time. Pt stable. Pt instructed to follow up with PCP/allergist and knows to not come back to clinic if she thinks she needs additional medical attention.


VAERS ID: 1540582 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-08-09
Onset:2021-08-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052C21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Back pain, Musculoskeletal stiffness, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Retroperitoneal fibrosis (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: muscle stiffness and soreness including arms , shoulders, and back


VAERS ID: 1540593 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 2 LA / IM

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

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

Write-up: Patient had Moderna for 1st vaccine on 7/13/2021 at the Health Department. She came in today for her 2nd dose and was inadvertently given Pfizer instead. Patient monitored, seemed to be okay. No adverse effects during time of monitoring.


VAERS ID: 1540596 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-03
Onset:2021-08-10
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 2 LA / SYR

Administered by: Unknown       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: zyrtec
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Tickling both hands left and right. Left hand is more than the right hand. This tickling I felt it on my first dose which was on 7/12/2021 on my left arm and hand but in 2 hours was gone but today 8/10/2021 at 1am my left hand started the tickling and also my right hand. Moreover as of now 12:30 pm on 8/10/2021 I still feel the tickling.


VAERS ID: 1540599 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH WE0167 / 1 LA / IM

Administered by: Military       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: N/A
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: L arm/hand paresthesia (tingling sensation) - no loss of motor strength, sensation intact. No respiratory sxs, no rash.


VAERS ID: 1540603 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blindness transient, Condition aggravated, Dizziness, Fear, Loss of consciousness, 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), Embolic and thrombotic events, arterial (narrow), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Glaucoma (broad), Optic nerve disorders (broad), Retinal disorders (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: has passed out after a vaccine before.
Other Medications: propranolol, gabapentin
Current Illness: "nerve disorder" that makes him scared of shots
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Paramedics were called. Checked heart rate and blood pressure, all were normal. Patient declined any further medical treatment.
CDC Split Type:

Write-up: Patient became light headed and passed out. He was moved to the floor when he came to, because he started shaking. Patient reported it was because he was scared that he couldn''t see. He reported feeling much better after about 10 minutes, and said it was because he was very scared of needles.


VAERS ID: 1540618 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA 7485 / UNK LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dyspnoea, Rash, Swelling face, Wheezing
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Asthma/bronchospasm (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: He has a history of severe allergic reaction in the past that have required intubation and hospitalization. The last episode ha
Other Medications: Metformin, Lipitor
Current Illness: unknown
Preexisting Conditions: Diabetes
Allergies: Penicillin
Diagnostic Lab Data: Transferred to hospital
CDC Split Type:

Write-up: Covid vaccine given and patient requested to be monitored at the Urgent Care. Approximately 15 minutes post vaccine admission, patient have shortness of breath, rash, face swelling, wheezing. Chart reviewed showed patient received epi pen, solumedrol, pepcid, benadryl, zofran and fluids.


VAERS ID: 1540649 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: California  
Vaccinated:2021-01-12
Onset:2021-08-10
   Days after vaccination:210
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3249 / 2 LA / IM

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

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

Write-up: COVID + on 8/9/2021


VAERS ID: 1540684 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025C21A / 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: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: vaccine not indicated for under 18 yrs.


VAERS ID: 1540688 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-08-09
Onset:2021-08-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Mastitis
SMQs:, Functional lactation disorders (narrow)

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

Write-up: I am currently nursing and after both doses I developed a clogged milk duct roughly 24 hours later. With continued nursing and pumping the duct did get relief


VAERS ID: 1540689 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Blood pressure increased, Condition aggravated, Hypertension, Hypoaesthesia, Limb discomfort
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Hypertension (narrow), Sexual dysfunction (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: c/o Right arm numbness and heaviness. BP 190/96, P 80, R Patient states that is she prescribed blood pressure medicine (amlodipine) but cannot afford it so she does not take it in weeks. Patient denies HA, SOB or chest pain. Nurse advise
Current Illness: none
Preexisting Conditions: High BP
Allergies: Possible allergic reaction in the past to Motrin
Diagnostic Lab Data: none
CDC Split Type:

Write-up: c/o Right arm numbness and heaviness. BP 190/96, P 80, R Patient states that is she prescribed blood pressure medicine (amlodipine) but cannot afford it so she does not take it in weeks. Patient denies HA, SOB or chest pain. Nurse advised patient to report to medical facility immediately because BP is not declining. Vaccine site(left deltoid) not affected


VAERS ID: 1540718 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: South Dakota  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011J20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025L20A / 2 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 3 RA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: HydroCHLOROthiazide 25 mg PO QD multivitamin 1 tablet PO QD Fish OiL 340-1,000 mg 1 capsule PO Every other day omeprazole 20 mg 1 tab PO QD as neeeded vitamin E 400 unit 1 tab PO every other day zinc 50 mg 1 tablet PO QD
Current Illness:
Preexisting Conditions: Hypertension
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received 3 vaccines; no reactions at this time


VAERS ID: 1540722 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-07-19
Onset:2021-08-10
   Days after vaccination:22
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 1 LA / IM

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

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

Write-up: no adverse event reported after the vaccination. The reportable error is actually that the patient received the Moderna Covid-19 vaccine 3/24/21 at a different pharmacy, and then was subsequently given a dose of the Pfizer Covid-19 vaccine on 7/19/21. The error was realized when processing the rx for the patient''s scheduled 2nd Pfizer Covid-19 vaccine on 8/10/21.


VAERS ID: 1540727 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: D.C.  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EY0584 / 2 LA / IM

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

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

Write-up: Patient did not disclose he received a COVID-19 vaccine by another manufacturer, Janssen, before receiving the Pfizer COVID-19 vaccine.


VAERS ID: 1540746 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-08-06
Onset:2021-08-10
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003C21A / 2 LA / IM

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

Write-up: Patient received 2nd dose of Moderna COVID-19 Vaccine on Friday (8/6/21). Saturday (8/7/21) night patient reported fever chills requiring the patient to take 3-4 tablets of acetaminophen 325mg around the clock until Sunday (8/8/21) morning when symptoms subsided. Patient reports symptoms of fatigue aggressive enough to not report into work on Monday (8/9/21). At the time of this report, Monday afternoon, then patient states that they are not fully recovered from symptoms but are feeling better than past weekend.


VAERS ID: 1540754 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Diarrhoea, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Fever and diarrhea


VAERS ID: 1540755 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Louisiana  
Vaccinated:2021-04-21
Onset:2021-08-10
   Days after vaccination:111
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808982 / UNK LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030B21A / 1 - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Patient did not disclose.
Current Illness: Patient did not disclose.
Preexisting Conditions: Patient did not disclose.
Allergies: Patient did not disclose.
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient received Dose 1 of Moderna on April 21st 2021. Patient did not disclose this information. Patient was given the Johnson and Johnson one shot vaccine on August 10th at 13:07 as he requested. When patient was input into database his first dose of Moderna was discovered.


VAERS ID: 1540757 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 UN / IM

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

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

Write-up: Client came in for a Pfizer Dose 2 with a POV card with Dose 1 from another facility. First dose information matches the POV card. The EMR shows first dose Pfizer on 07/20, which client attests is his only vaccine. The nurse vaccinated the client prior to checking There was an additional Pfizer dose on 04/15, which the client denies receiving.


VAERS ID: 1540769 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Disorientation, Muscle rigidity, Posture abnormal
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Dystonia (broad), Parkinson-like events (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Hypoglycaemia (broad), Dehydration (broad)

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

Write-up: Patient received vaccine, sat in vaccination room for about 90 seconds then walked over to the waiting area. Patient sat next to his uncle and within 3 minutes leaned his head back, became rigid. Rph and patient''s uncle lowered him to the ground, rolled him to his side and patient started to resist help. Patient appeared to be disorientated for a moment. Paramedics arrived and assesed patient thereafter.


VAERS ID: 1540771 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: New York  
Vaccinated:2021-08-04
Onset:2021-08-10
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dysmenorrhoea, Headache, Menstruation irregular
SMQs:, Fertility disorders (broad)

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

Write-up: Early onset of menses with headache, increased dysmenorrhea


VAERS ID: 1540776 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 2 RA / IM

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

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

Write-up: Patient had received the Moderna vaccine for her 1st shot on 7/13/21 and was inadvertently given Pfizer today as her 2nd shot by the vaccinator.


VAERS ID: 1540785 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: allergy to sulfa
Diagnostic Lab Data: Tests were conducted in the ems vehicle. after they released her to her car to go home they did not come back inside to tell us all that they did so I am not certain the specific tests that were done to check on the patient. Probably standard tests like checking blood pressure, pulse, vitals, etc
CDC Split Type:

Write-up: Patient came in for 1st pfizer covid shot. Prior to getting the shot she mentioned that she has fainted before when getting her blood drawn but not from vaccines so we went ahead and administered the shot in her left arm. She did say shortly after that she kind of felt it go down her arm so we watched her closely as she waited her 15 minutes. We then noticed she got kind of pale and sweaty so we went out to check on her then before we could check her pulse she passed out for about 15 seconds then regained consciousness. We then gave her some bottled water and called ED so they could check to see if she needed to go to the hospital which they ended up coming over, they ran tests in the back of the ems vehicle and they released her so she didn''t end up needing to go to the hospital. This happened from between 12 and 1230pm


VAERS ID: 1540795 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Oklahoma  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052E21A / 2 LA / IM

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

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

Write-up: pt who had not had a seizure in 10 years suffered a seizure after 2nd moderna vaccine


VAERS ID: 1540816 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 LA / IM

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

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

Write-up: No adverse events. Vaccine was given to a 17 year, 7 month old patient. Vaccine is only approved for 18 years old and above.


VAERS ID: 1540818 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal discomfort, Condition aggravated, Malaise, Syncope, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Patient was seated in waiting room after receiving vaccine she is over 18 but her mother was with her and said she has a history of fainting after vaccines. She fainted while seated for a few seconds and then came to then she said she felt sick to her stomach we brought her a trash can patient vomited she said she then felt much better we watched her in waiting area for next half hour gave cold water patient said she felt fine after 30 minutes of observation


VAERS ID: 1540827 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Asthenia, Dyspnoea
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: UNKNOWN
Current Illness: REPORTED HAVING CELLULITIS ON FEET-
Preexisting Conditions: DIABETES
Allergies: PCN
Diagnostic Lab Data: NONE KNOWN
CDC Split Type:

Write-up: Covid vaccine was given approximately at 9:15 am. Symptoms started approximately 5 minutes after injection. Patient stated that it was hard for him to breath. Stated he felt weak. Patient continued to talk to nursing team and was alert. BP was 150/84- . 0.3mg Epinephrine was given in left thigh. Ambulance was called at 9:25 am. Ambulance arrived at approximately 9:40 am and left with patient approximately 9:50 to transport to ER.


VAERS ID: 1540834 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Agitation, Anxiety, Chest discomfort, Discomfort, Electrocardiogram normal, Hypersensitivity, Hypoaesthesia oral, Paraesthesia
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Dementia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (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? No
Hospitalized? No
Previous Vaccinations: patient reports an allergy to one of the ingredients in the flu vaccine
Other Medications: Benadryl Aspirin
Current Illness: na
Preexisting Conditions: anxiety
Allergies: KNDA
Diagnostic Lab Data: 8/10/21 pulsox EKG Blood Pressure heart rate
CDC Split Type:

Write-up: Patient was waiting in post-vaccine area and started to develop chest tightness and tingling in right arm. She reported no shortness of breath. She was visibally distraught and uncomfortable with her symptoms so I moved her to the vaccine room for privacy and called 911 for an ambulance. She continued to complain of chest tightness and the tingling is now in both arms and spreading to her legs. She also mentioned numbness around her mouth. The 911 dispatcher kept me on the phone until the paramedics arrived. The 911 dispatcher instructed me to give the patient #4 81mg Aspirin. The paramedics arrived and checked her vitals (heart rate, pulsox, EKG, blood pressure) and all results were normal. The patient started to feel better and did not leave with the paramedics. The paramedics recommended follow-up with an ER or Urgent Care for further monitoring. The paramedics discussed the reaction being either a slow allergic reaction to the vaccine or an anxiety attack.


VAERS ID: 1540845 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 019B21A / 2 LA / IM

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

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

Write-up: Patient is under 18 and administered moderna


VAERS ID: 1540849 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Fall, Haemorrhage, Head injury, Suture insertion
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Anticholinergic syndrome (broad), Accidents and injuries (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: UNKNOWN
CDC Split Type:

Write-up: PATIENT WAS GIVEN VACCINE AT APPROX 1030AM. PATIENT''S VAR DID NOT INDICATE ANY TROUBLE WITH PREVIOUS VACCINES. PATIENT WAS TOLD TO SIT IN WAITING ROOM FOR 15 MIN. APPROXIMATELY 10 MIN LATER PATIENT HAD FALLEN AT FRONT OF STORE AFTER FEELING LIGHT HEADED. PATIENT''S FRIEND HELPED HER LAY DOWN. WHEN PATIENT GOT UP SHE FELL FORWARD WITH HER GLASSES ON AND HIT HER FOREHEAD. PATIENT WAS BLEEDING EXCESSIVELY . 911 WAS CALLED AND PATIENT WAS TRANSPORTED BY EMS TO HOSPITAL FOR STITCHES.


VAERS ID: 1540851 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Maine  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006D21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dyspnoea, Immediate post-injection reaction, Paraesthesia
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (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? No
Hospitalized? No
Previous Vaccinations: same reaction to the TB vaccine.
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: Penicillin
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Patient experienced tingling in arm, faintness, difficulty breathing immediately after vaccine administration. We had the patient lay down on the ground gave water. Patient experienced sweating and we gave him a cold compress to cool him down. At his request, we did not call for emergency help and epi administration was not necessary. Patient has a history of fear of needles and may think that it played a part in his reaction.


VAERS ID: 1540859 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenopia, Dizziness, Somnolence
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Corneal disorders (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: patient felt light headed and was unable to keep eyes open. he never did completely pass out but was struggling to stay awake


VAERS ID: 1540862 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 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: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient felt very dizzy within a few minutes of vaccination. We had patient lie on floor for 15 or so minutes until he was feeling better. He drank a sunny d and ate ritz peanut butter crackers.


VAERS ID: 1540870 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-09
Onset:2021-08-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808986 / 1 LA / SYR

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

Write-up: 39 degree fever, chills, headache, aches. Feels every bit as bad as when I had COVID 19 in March 2021


VAERS ID: 1540875 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dizziness, Dyspnoea, Hyperhidrosis, Hypophagia, Pallor
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Patient received the 1st COVID vaccine (Janssen Lot #201A21A expiration date 09/21/2021) at 1035. At 1050 patient alerted PHN that he was feeling "shortness of breath and feeling dizzy." PHN responded and helped patient transfer to the zero gravity chair and raised the feet of the chair. Patients skin was pale and diaphoretic. PHN black out for about two to three seconds. I''m starting to feel normal again though." Vital signs were taken by PHN at 1052 (blood pressure 120/70, heart rate 68, oxygen 95%). At 1053, color had returned to the patients face. Patient was alert and oriented times four. Patient stated, "I haven''t eaten yet today, and I had coffee this morning." At 1056 PHN offered the patient a snack which he accepted and ate. At 1056, patient said, "I''m feeling much better. I feel normal now. I have no shortness of breath." Vital signs taken at 1103 (blood pressure 128/70, heart rate 65, oxygen 97%). Vital signs taken at 1111 (blood pressure 130/80, heart rate 59, oxygen 99%). Vital signs taken at 1119 (blood pressure 130/78, heart rate 58, oxygen 99%). Patient denied any medical issues, or medications, and stated that he is allergic to penicillin. PHN provided education to patient on life threatening symptoms and advised the client to follow up with his primary care provider. At 1120, patient stated, "I feel fine," and left the building unassisted with a steady gait.


VAERS ID: 1540877 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Kansas  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 2 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Euphoric mood, Hemianaesthesia
SMQs:, Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (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 describes that the right side of his body feels "high". Right side numbness, no pain


VAERS ID: 1540879 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-08-02
Onset:2021-08-10
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chills, Computerised tomogram head normal, Dizziness, Fatigue, Fibrin D dimer increased, Headache, Influenza like illness, Pain, Pain in extremity, Pyrexia
SMQs:, Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Multivitamin Fish Oil
Current Illness: Skin Cancer History
Preexisting Conditions:
Allergies: N/A
Diagnostic Lab Data: d-dimer blood test result was elevated on Thursday, 08/05/2021.
CDC Split Type:

Write-up: Flu like symptoms occurred on 8/2 (fever, body aches, chills, headache). On 8/3 flu like symptoms decreased in severity, but severely painful headache remained. Severe throbbing headache was a pain level 10. Throbbing pains worsened when bending over or moving head in any direction. Throbbing pain location was felt all over head, but mainly felt behind the eyes. No vision changes. Severe headache did not respond to medications. Two 500mg acetaminophen were taken on 8/3 around 3:30am, and the pain did not resolve. The throbbing pain occurred for the duration of the following dates: 8/2, 8/3, 8/4, and 8/5. On 8/5, there was an onset of lightheaded/dizzy sensation. Healthcare team was contacted on 8/5, and recommended going to the emergency room. Lightheadedness is felt for the entirety of the day, with random spells of dizziness. Legs feel slightly sore. Was advised to go to the emergency department on 08/05. Given 1L IV fluids. Blood test results: abnormal result -- $g d-dimer level was elevated. Because d-dimer level was elevated, healthcare team was concerned about a blood clot in the brain. CT scan was necessary to check for clots in brain. Brain CT scan came back normal, displaying no blood clot in brain. Discharged, still feeling lightheaded and fatigue, and it has been over a week since receiving the vaccination.


VAERS ID: 1540885 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025CZIA / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Immediate post-injection reaction, Nausea, Vision blurred
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Hypoglycaemia (broad)

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

Write-up: Immediately nausea followed by lightheadedness and blurred vision. Was able to speak and drink water. Susbsided after a minute. Could?ve been vagal response.


VAERS ID: 1540887 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-08-09
Onset:2021-08-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Circumoral swelling, Facial paralysis, Hemiplegia
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow), Hearing impairment (broad), Hypersensitivity (narrow)

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

Write-up: PATIENT REPORTS SWELLING ROUND THE RIGHT SIDE OF HER MOUTH, PARTIAL FACIAL PARALYSIS, AND RIGHT-SIDE PARTIAL PARALYSIS AND/OR WEAKNESS.


VAERS ID: 1540897 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 059E21A / 1 - / IM

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

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

Write-up: Patient was asked twice regarding if patient had received previous COVID vaccines before the vaccine (Moderna) was administered. The vaccine was given and patient was given multiple opportunities to inform us of previous vaccine history.


VAERS ID: 1540903 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood pressure increased, Heart rate increased
SMQs:, Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Hypertension (narrow), Dehydration (broad)

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

Write-up: Pt reported rapid heart rate. 2:25 PM: Measured Blood pressure of 160/120 and pulse of 124. Rechecked Blood pressure at 2:40PM Blood pressure was 162/128 and pulse of 112. No dizziness or other signs or symptoms. Patient stated she felt fine other than rapid heart rate. Discussed with patient recommendation for monitoring due to continued increased blood pressure. Patient left with parent and is being driven to urgent care in town.


VAERS ID: 1540905 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939902 / 1 LA / IM

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

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

Write-up: Patient passed out about 10 min after shot


VAERS ID: 1540911 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-08-04
Onset:2021-08-10
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 2 LA / -

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

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

Write-up: No adverse reactions Vaccine was adminstered at 14 day interval


VAERS ID: 1540937 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Puerto Rico  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 091D2A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain, Confusional state, Diarrhoea, Feeling cold, Tremor
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Pseudomembranous colitis (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Hypoglycaemia (broad)

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

Write-up: Patient claims he started tremors and chills and abdominal pain with diarrhea . He went to ER but got confused and did not know where he was. Someone help him out and call ambulance and he was treated in nearby ER. He said vital signs were normal but oxigen was given to him and he was discharge from the hospital by 9:00pm.


VAERS ID: 1540939 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Mississippi  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030B21A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Monoplegia
SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (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: AMLODIPINE VALSARTAN JUNEL IRON
Current Illness: HTN
Preexisting Conditions: HTN ANEMIA
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: RIGHT ARM PARALYSIS THAT LASTED FOR 20 MINUTES


VAERS ID: 1540940 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Confusional state, Hyperhidrosis, Pallor, Presyncope, Unresponsive to stimuli, Vomiting
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: After receiving her first Pfizer covid vaccine (less than 10 minutes) the patient appeared to have a vasovagal event. She was seated and her husband called her name to which she was unresponsive--I was nearby and saw the patient tilt her head back/close her eyes/not respond to myself or her husband talking to her. A minute later the patient "came to" and shouted and told me her name when I asked. She appeared sweaty, pale, and confused. We applied a cold pack to her neck and gave her water. We asked if patient would feel more comfortable lying down on her side and she said yes so helped her get into a rescue position. She proceeded to throw up and EMS was notified in the mean time. EMS arrived on scene to assess patient and her vitals. The patient continued to vomit a few more times, but was alert and able to answer questions the entire time EMS assessed her. We provided them a copy of her vaccine consent form and any medical history we were given. She did choose to go with EMS to be further evaluated. The patient had no history of vaccine reactions and the only "yes" on her consent sheet was to medication allergies (but none were anaphylactic).


VAERS ID: 1540944 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Unknown  
Location: Minnesota  
Vaccinated:2021-04-15
Onset:2021-08-10
   Days after vaccination:117
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8735 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, Blood culture, Blood lactic acid, Blood potassium, Blood thyroid stimulating hormone, Bowel movement irregularity, C-reactive protein increased, Diarrhoea, Differential white blood cell count, Diverticulitis, Dyspnoea, Electrocardiogram, Fibrin D dimer, Full blood count, Hypokalaemia, Leukocytosis, Metabolic function test, Sinus tachycardia, Troponin increased, Urine analysis
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Supraventricular tachyarrhythmias (narrow), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific inflammation (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad), Hypokalaemia (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Labs drawn: Troponin, blood cultures, k , lactic acid, urinalysis, CBC with diff, BMP, TSH, EKG
CDC Split Type:

Write-up: Abdominal pain for 5-7 days prior to ED, diarrhea, irregular bowel movements for 1+ month, shortness of breath, elevated troponin, sinus tachycardia Sigmoid diverticulitis, elevated CRP, leukocytosis, hypokalemia, + D-Dimer,


VAERS ID: 1540956 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: New Hampshire  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821287 / 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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient experienced syncope 5 minuteas after administration. He was only briefly (seconds) affected and was subsequently examined by EMT with normal BP and pulse. No treatment was administered.


VAERS ID: 1540960 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-03
Onset:2021-08-10
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site erythema, Injection site indentation, 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: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Swollen, warm, red and itchy at injection site suddenly appearing one week after injection.


VAERS ID: 1540978 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 LA / IM

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

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

Write-up: Patient received first dose of Pfizer COVID vaccine and was standing waiting for her mom to receive her dose when she fainted. She fell backwards and hit the ground harshly. I responded by lifting her feet and she seemed to regain consciousness quickly. We let her sit on the floor to regain some stability and then moved her into a chair. She was given an icepack for the back of her neck/head, as we assumed that she probably hit her head. We could not feel any lump, and she did not complain of her head hurting but did feel a little dizzy. We also gave her a water and then a sports drink as she could not remember eating breakfast, only coffee, and was on her way to eat lunch. She asked what happened, was laughing, and said it felt like an out of body experience. At that point, her coloring began to look off (pale) according to her mom so we returned her to the floor and elevated her feet. Her coloring seemed to return quickly, she was laughing again, and she said she was feeling better. We took time to let her sit up on the floor and then moved to standing position but then she said she felt "a little weak," so I had her sit in a chair. At this point I asked her birthday (correct response), the president (correct response), and what day it was (she did not know but said she wouldn''t normally.) Her mom followed up with asking what time soccer practice was and she thought for a long time but then said "is it 8 am?" which was incorrect and already past for the day. At this point, I became more concerned about time orientation and concussion concerns. I checked her pupils which seemed equal and reactive. We asked if she remembered what happened and she could not but she did know that she had came in to get her shot. A few minutes later it became apparent that she still didn''t remember what happened after she asked what happened again. She asked or didn''t know what happened 4 times what happened in about a 20 minute time period. Mom asked if she thought I should take her to the hospital and I said that I probably would since she doesn''t seem to be getting better as far as remembering what happened. Her mom, and I walked her outside and her mom went to get her vehicle. At this point, we believed she was going to the ER to be assessed and would follow up in a couple hours. However, her physician''s office called about 20-30 minutes after they left to get details about the incident and ask why we didn''t refer to the ER. Mother had told office that she was instructed to call the office. I told her that we thought she was going to the ER and relayed the details of this report. Office reported that they are going to see her and told mother to take to the ER if her condition worsens. I will call the mother in a couple hours to check on her.


VAERS ID: 1540979 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-07-13
Onset:2021-08-10
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -

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

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

Write-up: pt recived janssen covid vaccine on 3/12/21. Then came got Moderna covid vaccine on 7/13/21 (1st dose). Insurance was not billed at that time so were not able to see if he got Janssen vaccine. Today (8/10/21)he came to get the 2nd dose of Moderna and we found out that he got Janssen back in 3/12/21 per insurance decline. He did not report any side-effect from Moderna


VAERS ID: 1540992 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 RA / IM

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

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

Write-up: PATIENT SUFFERED A CONVULSIVE SYNCOPE EPISODE. PATIENT PASSED OUT IN CHAIR AND ARMS AND LEGS STARTED FLAILING. PHARMACIST WAS ABOUT ADMINSTER EPINEPHRINE THEN PATIENT WOKE UP. HE WAS HELPED TO THE FLOOR TO LAY AND LEGS WERE ELEVATED UNTIL PARAMEDICS ARRIVED.


VAERS ID: 1541005 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 LA / SC
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 2 RA / IM

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

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

Write-up: The patient received his 2nd dose outside of the 42 days parameter


VAERS ID: 1541014 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: After receiving the COVID-19 vaccine, patient fainted, his head hit the wall, felt very hot, nauseous and dizziness. @1050 patient was evaluated by Dr. BP was taken every 10 minutes.


VAERS ID: 1541016 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808980 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Extra dose administered, Interchange of vaccine products, SARS-CoV-2 antibody test negative
SMQs:, Medication errors (narrow), COVID-19 (broad)

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

Write-up: Patient presents to Covid Vaccine Clinic for vaccine. Patient received J & J vaccine. Patient later informed staff she was receiving this vaccine because her covid antibody test was negative after received the Moderna Jan/Feb.


VAERS ID: 1541021 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-07-22
Onset:2021-08-10
   Days after vaccination:19
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Intermenstrual bleeding, Vaginal haemorrhage
SMQs:, Haemorrhage terms (excl laboratory terms) (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: Ibuprofen
Current Illness: None
Preexisting Conditions: Arthritis IBS
Allergies: Diflucan- hives
Diagnostic Lab Data:
CDC Split Type:

Write-up: 19 days post vaccine, I developed breakthrough vaginal bleeding. I had not had a period post ablation for greater than 10 years. Bleeding was mild to moderate and has lasted one day so far.


VAERS ID: 1541028 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-08-09
Onset:2021-08-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Fatigue, Injection site pain, 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: Vitamin C Fish oil Zinc Vitamin D Apple cider vinegar pill
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: Sulfa
Diagnostic Lab Data:
CDC Split Type:

Write-up: Sore at the injection site Chills while sleeping Aches Tired


VAERS ID: 1541034 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-02-24
Onset:2021-08-10
   Days after vaccination:167
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6202 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood culture, COVID-19, Chest X-ray, Full blood count, Metabolic function test, Urine analysis
SMQs:, Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Aspirin 81mg Daily Diclofenac Topical 1% gel QID PRN for pain Diltiazem 240mg Daily Fluticasone 0.05mg/inh nasal spray HS NovoLog 100units/mL Levothyroxine 125mcg daily Citrucel 2g/19g oral powder for reconstitution 1 TBSP daily Multivitam
Current Illness:
Preexisting Conditions: Benign prostatic hypertrophy with outflow obstruction Hypothyroidism Diverticulosis of colon hypercholesterolemia Hypertension Diabetic renal disease Type 1 Diabetes
Allergies: Lisinopril - Cough
Diagnostic Lab Data: Chest X-ray, CBC, CMP, Urinalysis, Blood Culture
CDC Split Type:

Write-up: Patient contracted COVID-19 after being fully vaccinated


VAERS ID: 1541035 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 1 LA / IM

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

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

Write-up: Patient developed a rash on her neck and upper back and rash while being observed in the clinic COVID-19 post-vaccination area. RN immediately notified provider of the observed reaction. Patient stated the area was mildly itchy. Zyrtec 5mg given and Benadryl given; vital signs taken, and patient observed until 4:00pm. Patient prescribed Benadryl 25-50 mg tablets at bedtime for 5 nights, Zantac or over the counter histamine 2 blocker one table every morning for 5 days, an epipen, and for patient to take Zyrtec 5mg tablet one hour prior to receiving the 2nd dose vaccine and to be observed for 30 minutes after receiving the 2nd vaccine. Patient informed to make a follow-up visit with provider, for 8/11/2021.


VAERS ID: 1541037 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Unknown  
Location: North Carolina  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Petit mal epilepsy
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow)

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

Write-up: Shortly after injection patient experienced absence seizure


VAERS ID: 1541050 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017E21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: not known
Preexisting Conditions: not known
Allergies: no known allergies
Diagnostic Lab Data: na
CDC Split Type:

Write-up: Patient filled out paperwork and did not show previous vaccine dose (assuming Johnson and Johnson) and when we processed claim it showed pt did have previous covid vaccine reported as a single dose vaccine.


VAERS ID: 1541053 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-02-24
Onset:2021-08-10
   Days after vaccination:167
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6202 / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Tylenol PM HS PRN for sleep Levothyroxine 112 mcg Daily
Current Illness:
Preexisting Conditions: Hypothyroidism Hypercholesterolemia Blood glucose abnormal GERD Psoriasis Vitamin D deficiency
Allergies: No Known Allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient contracted COVID-19 after being fully vaccinated


VAERS ID: 1541055 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Male  
Location: South Dakota  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 1 LA / IM

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

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

Write-up: The patient''s mother identified her child was twelve years of age and did complete that he was age 12 on the front page of the Prevaccination Checklist form. The nurse administered the Pfizer vaccine in a Public Health setting, as requested by the patient''s mother. Upon return back to the facility to begin documentation on the patient receiving the vaccine, the nurse identified the patient is eleven years of age.


VAERS ID: 1541081 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-08-07
Onset:2021-08-10
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 LA / IM

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

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

Write-up: patient had already had Jansen vaccine early in the year at packing plant but failed to let us know, also answered "no" to previous dose of vaccine on consent form, was contacted by department of public health


VAERS ID: 1541084 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: New York  
Vaccinated:2021-08-09
Onset:2021-08-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Abdominal pain upper, Blindness transient, Dizziness, Nausea, Presyncope
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Embolic and thrombotic events, arterial (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Optic nerve disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: 26 hours after his first Pfizer COVID19 shot, my son had a sudden sharp stomach pain and nausea. He became very dizzy and nearly fainted. He couldn''t see for a few seconds but was conscious. The dizziness and lightheadedness lasted a fewminutes. The nausea lasted about 15 minutes. This has never happened before to my son.


VAERS ID: 1541085 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 RA / IM

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

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

Write-up: Patient completed vaccine consent form as never having had a COVID vaccine before, and not having any vaccine in the last 14 days. When reporting the administered Janssen vaccine, it was discovered that she had received a Pfizer COVID vaccine on 8/2/21. Upon questioning patient, she admitted to lying on the consent form and in conversation. She needed to be fully vaccinated to attend her daughter''s graduation in 16 days, and could not wait for 2nd dose of Pfizer. Patient reported no side effects when leaving pharmacy 15 min after administration of Janssen vaccine. She was advised to report any adverse reaction if any should occur.


VAERS ID: 1541098 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO169 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: At approximately 2:04pm patient stated she was dizzy and would like to lie on gurney. Assisted to gurney, VS 90/58 ,p 111- 97%, resp 16 Denies medical issues, DM, takes no medications and mom who is with Pt confirms this. Rested for 5 min and states feels better and no longer dizzy. VS 96/60 p 99-97%, Resp 14. Apple juice provided. Pt states has hx of "fainting" with blood draws. Advised to request to lie down when returns for 2nd vaccine. Pt states feeling better and ambulated with steady gate to car with mom at side.


VAERS ID: 1541099 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016C21A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: TALKING TO THE MOTHER AFTER VACCINE, PATIENT PASSED OUT STANDING UP BEFORE HE COULD SIT DOWN TO WAIT THE 15 MIN PERIOD POST VACCINE. PATIENT WOKE UP AFTER LYING FLAT ON HIS BACK. HE ANSWERED QUESTIONS CORRECTLY BREATHING OK WITH NO RASH PRESENT. PATIENT DID BUMP HIS HEAD ON TABLE. CALLED EMT SERVICE AND PATIENT WAS CHECKED OUT AND AFTER EXAMINATION BY EMT WERE RELEASED HOME. PATIENT DID STATE THEY WERE NERVOUS ABOUT GETTING THE VACCINE


VAERS ID: 1541118 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Hypoaesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Sexual dysfunction (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: Jardiance, Humulin 70/30
Current Illness: None
Preexisting Conditions: DM, hyperlipidemia, DM2 with neuropathy, obstructive sleep anea, exposure to hep B, fatty liver, R knee sprain
Allergies: NKA
Diagnostic Lab Data: None
CDC Split Type:

Write-up: @1215 Pt complained of R arm numbness post vaccination. +CMS to R arm. Instructed pt to keep moving R arm and to ice vaccination area. Instructed to message PMD today about her symptoms, follow up with PMD if pain lasts for more than 3 days, and ED precautions. Pt verbalized understanding. Dr aware.


VAERS ID: 1541120 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-08-09
Onset:2021-08-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / -

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

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

Write-up: Bad raised rash all up and down both arms. Extremely itchy. Itchy scalp as well. This reaction is happening right now so I''m not sure if I will need medical attention.


VAERS ID: 1541130 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 LA / IM

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

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

Write-up: C/O headache after vaccine. Pt had taken Tylenol earlier before vaccine. BP 100/60, O2 Sat 98%, P - 75. Pt offered Ice Pack and water. No SOB, blurred vision or dizziness. Pt felt better and left site.


VAERS ID: 1541137 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Vermont  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Fall, Loss of consciousness, Malaise, Nausea, Pallor, Yellow skin
SMQs:, Torsade de pointes/QT prolongation (broad), Cholestasis and jaundice of hepatic origin (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), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: After patient finished 15 minute observation time he did his grocery shopping. He said he was out in parking lot (90+ degrees) feeling nauseous. He sat in car and felt better then again did not feel well. His girlfriend helped him back into the store. He came to the pharmacy yellowish in palor. I asked if he was ok then while I came around the counter he began to pass out. He fell back a customer prevented him from hitting his head. I approached him and checked his status. He opened his eyes and was breathing ok. He said he needed an Epi-Pen. I asked a customer to call 911, my tech stayed with him while a retrieved the Epi-Pens. When I returned he was still resting comfortably, realizing he breathing was regular and there were no signs of anaphylactic reactions, i did not give the EPI-Pen. He stayed laying flat describing how he felt, breathing well but feeling light headed. The First responder arrived and took over. After reviewing his vitals they opted to take him to the hospital.


VAERS ID: 1541143 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821288 / 1 LA / IM

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

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

Write-up: Within minutes of receiving vaccine patient reported nausea and hot flashes. Patient was given a bottle of water and an ice pack, which he placed on his neck. After about 5 minutes he reported that he was feeling better. Patient was observed for a total of 30 minutes, at which point he said he was feeling totally normal again.


VAERS ID: 1541152 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Throat tightness, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Eosinophilic pneumonia (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: NA
Current Illness: heart disease obesity sleep apnea
Preexisting Conditions: heart disease obesity sleep apnea
Allergies: none
Diagnostic Lab Data: 911 was called
CDC Split Type:

Write-up: patient start wheezing after 10 minutes of the injections, and stated that he feels his throat is closing up


VAERS ID: 1541158 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939902 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Injection site swelling, Nausea, Tremor, Vision blurred
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

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

Write-up: Patient felt light headed, developed nausea, blurry vision and shakiness. Had some injection site swelling.


VAERS ID: 1541160 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002F21A / 1 LA / IM

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

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

Write-up: Patient is under the age of 18 and received the Moderna vaccine instead of the Pfizer vaccine.


VAERS ID: 1541164 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: New York  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Contusion, Head injury, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Haemorrhage terms (excl laboratory terms) (narrow), Arrhythmia related investigations, signs and symptoms (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Patient fainted and hit head resulting in a contusion. Patient came to within a few seconds and recovered quickly.


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