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

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



Case Details (Reverse Sorted by Onset Date)

This is page 164 out of 3,524

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VAERS ID: 1321560 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022C21A / 1 LA / IM

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

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

Write-up: Systemic: Dizziness / Lightheadness-Medium, Systemic: Nausea-Mild, Additional Details: 5 minutes after taking the vaccine and while the pt was seated in the waiting area .The pt has complained of headache and dizziness also feeling like throwing up , pharmacist asked the pt the followings :1- to take the jacket off to check for any skin reactions and none were observed . 2- if the pt has any diffuculty breathing or swallowing and pt denied any symtoms The mother asked the pharmacist to call 911 and emergency prcedures were followed. paramedics arrived few minutes later


VAERS ID: 1321562 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: New York  
Vaccinated:2021-05-11
Onset:2021-05-14
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025C21A / 2 RA / IM

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

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

Write-up: Systemic: Allergic: Itch Generalized-Medium, Systemic: Allergic: Rash (specify: facial area, extremeties)-Medium, Systemic: Allergic: Rash Generalized-Medium


VAERS ID: 1321580 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8736 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site erythema, Injection site pruritus, Rash
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Site: Itching at Injection Site-Severe, Site: Redness at Injection Site-Severe, Systemic: Allergic: Rash Generalized-Severe


VAERS ID: 1321583 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: New York  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Confusional state, Dizziness
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Confusion-Mild, Systemic: Dizziness / Lightheadness-Mild


VAERS ID: 1321639 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anxiety, Chest pain, Fall, Feeling abnormal, Pain in extremity, Tremor, Vision blurred, Visual impairment
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Glaucoma (broad), Optic nerve disorders (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Tendinopathies and ligament 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: B12, one a day women?s multi vitamin, omega 3, vitamin d, magnesium. Cannabis extract, vaped 4 hrs before.
Current Illness: None
Preexisting Conditions: Autistic
Allergies: Adhesive, mild reaction.
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Received shot. Saw black dots, pain spread from arm to chest, got up to let the pharmacist know woke up on the floor shaking, head felt like it was bleeding but I didn?t hit me head. Saw black spots and waves of blur in my vision for hours. Meds came decided to observe at home. Did NOT have anxiety. I suffer from anxiety and panic attacks I am well aware of the feelings, coping techniques etc that come with them. Now I have major anxiety that I got a injected with some that may hurt me.


VAERS ID: 1321646 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Fatigue, Headache, Hyperhidrosis, Lethargy, Nausea, Pain in extremity, Pregnancy, Pyrexia, Tinnitus, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hearing impairment (narrow), Normal pregnancy conditions and outcomes (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prenatal vitamins, Flinstones with Vitamin D
Current Illness: None
Preexisting Conditions: 39 Weeks pregnant
Allergies: Cats, dogs
Diagnostic Lab Data:
CDC Split Type:

Write-up: 39 Weeks and 1 day pregnant, estimated due date May 20, 2021. One previous successful pregnancy. Reaction to first shot, sore arm. Reaction to second shot: Vomiting, fever (99.9), lethargy, throbbing joints, headache, tinnitus, 36 hours of nausea, tiredness, sore arm and sweating.


VAERS ID: 1321666 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821286 / UNK - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Decreased appetite, Headache, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Headache, lack of appetite, fever, chills, muscle aches


VAERS ID: 1321679 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Fatigue, Headache, Pain
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: Claritin
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Headache, body ache, fatigue Did not seek medical attention Lasted 24 hours w


VAERS ID: 1321706 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-04-30
Onset:2021-05-14
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 005B21A / 2 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Computerised tomogram, Deep vein thrombosis, Laboratory test, Ultrasound scan
SMQs:, Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: aspirin, atorvastatin, clonidine, escitalopram, losartan/hctz, metformin, metoprolol
Current Illness:
Preexisting Conditions: dm, htn, hyperlipidemia
Allergies: none
Diagnostic Lab Data: ultrasound, CT scan, labs
CDC Split Type:

Write-up: Deep Vein Thrombosis of right lower extremity 15 days after second vaccination


VAERS ID: 1321726 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-05-03
Onset:2021-05-14
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Differential white blood cell count abnormal, Full blood count abnormal, Haemoglobin decreased, Leukopenia, Oropharyngeal pain, Platelet count decreased, Pyrexia, Thrombocytopenia, White blood cell count decreased
SMQs:, Haematopoietic erythropenia (broad), Haematopoietic leukopenia (narrow), Haematopoietic thrombocytopenia (narrow), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (narrow), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Myelodysplastic 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? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: omeprazole and claritin
Current Illness: Sore throat of unknown etiology
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: 5/14/21: CBC WBC 2.1, Platelets 94, Hb 13.9 5/14/21 (repeat): WBC 2.9, Platelet 99, Hb 13.9
CDC Split Type:

Write-up: Thrombocytopenia. Had sore throat and intermittent fevers, as part of evaluation PCP obtained CBC with differential that showed leukopenia and thrombocytopenia. No bleeding or bruising, no petechiae.


VAERS ID: 1321750 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-05-13
Onset:2021-05-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Cough, Headache, Pyrexia, Sinus operation
SMQs:, Anaphylactic reaction (broad), 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: Adderall, Straterra, Guanfacine
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: n/a
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever, Cough, Headache, Sinus drainage


VAERS ID: 1321777 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Rhode Island  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWC185 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Aphasia, Blindness, Deafness, Dizziness, Dyspnoea, Feeling abnormal, Tremor
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Glaucoma (broad), Optic nerve disorders (broad), Cardiomyopathy (broad), Retinal disorders (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hearing impairment (narrow), Vestibular disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Omega-3
Current Illness: None
Preexisting Conditions: Eczema, meibomian gland dysfunction
Allergies: Seasonal allergies, apples
Diagnostic Lab Data: They took her BP at the pharmacy and it was 84/60, w/ a HR of 64
CDC Split Type:

Write-up: Within 10 minutes after the vaccination, there were some body tremors and dizziness, then she lost vision, hearing and ability to speak for a few seconds, followed by difficulty breathing and a feeling of her heart ?jumping out of chest.? Eventually, she recovered, but her right hand (not the injection arm) still has involuntary tremors, which has not gone away.


VAERS ID: 1321816 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-05-13
Onset:2021-05-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

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

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

Write-up: Hives beginning about 18 hours after the vaccine


VAERS ID: 1321867 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: New York  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 1 RA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 1 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Adult female who received her vaccine went to the observation area, became weak and faint. On site EMS that were stationed in the observation transported to local ER. EMS Staff consulted with the patients mother regarding reason to transport, she consented.


VAERS ID: 1321868 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-05-01
Onset:2021-05-14
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0154 / 1 LA / SYR

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

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

Write-up: Fever over 100.4, chills, headache, dizziness Treatment- rest and fluids Time-2 days


VAERS ID: 1321875 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-05-07
Onset:2021-05-14
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 18116022 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Tongue haemorrhage
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (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: Veggie juices
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Mild bleeding in the back of the tongue for the past two nights when brushing teeth.


VAERS ID: 1321901 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Condition aggravated, Exposure during pregnancy, Fatigue, Nausea
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow)

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

Write-up: Nausea, fatigue. While these were present before the vaccine due to my pregnancy and hyper gravidarum, they became significantly worse after receiving the vaccine and persisted for nearly 48 hours.


VAERS ID: 1321922 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dysarthria, Tinnitus
SMQs:, Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hearing impairment (narrow), Hypoglycaemia (broad)

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

Write-up: Systemic: Ringing of the ears, slurred speech-Severe, Systemic: Tinnitus-Severe


VAERS ID: 1321929 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8735 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Incorrect route of product administration, Injected limb mobility decreased, Pain
SMQs:, Drug abuse and dependence (broad), Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Duloxetine 60mg caps Adderall 20mg tabs
Current Illness: None known
Preexisting Conditions: none known
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient called on Saturday 5/15/21 and stated that the vaccine was given 1 inch from the top of her shoulder. She says she was in a tremendous amount of pain overnight. She "has to carry her left arm with her right arm". Patient was advised by Dr. and myself to ice and take Ibuprofen or Naproxen. on Sunday 5/16/21, I do not have an update on patient''s condition.


VAERS ID: 1321936 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-05-13
Onset:2021-05-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0161 / 2 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Chills, Dehydration, Nasopharyngitis, Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Dehydration (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Methadone, blood pressure pill (name unknown)
Current Illness: unknown
Preexisting Conditions: HTN
Allergies: Penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Called patient for a follow up and patient states has been sick for 3 days. Asked patient what sick meant and patient states has been vomiting and had cold chills every since he received the vaccine. Asked the patient if he would like an anti-nausea medication and patient stated that it wouldn''t hurt. Sent in prescription for Zofran 4 mg po q8 hours as needed for nausea and vomiting x 5 days to patient''s pharmacy. Told patient to watch for s/s of dehydration and to go to ER if these occur. Told patient to increase non-caffeinated fluids. Told patient that a report would be made.


VAERS ID: 1321942 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / N/A LA / IM

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

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

Write-up: COUPLE OF MINUTES AFTER RECEIVING THE VACCINE PATIENT GOT UP AND WALK UP TO THE REGISTER. DURING CONVERSATION WITH PHARMACIST PATIENT REMOVED HIS MASK AND SAID SOMETHING WHICH PHARMACIST DIDN''T HEAR OR UNDERSTAND. PATIENT FAINTED AND FELL ON THE FLOOR. AFTER FEW MINUTES PATIENT WAS ABLE TO MOVE AROUND AND COMMUNICATE. PARAMEDIC WAS CALLED AND TAKEN TO THE EMERGENCY ROOM FOR FURTHUR EVALUATION. ACCORDING TO NURSE AT ER PATIENT WAS FINE AND DISCHARGED AFTER COUPLE OF HOURS OBSERVATION. TRY CONTACTING PATIENT MULTIPLE TIMES VIA PHONE AND EMAIL BUT UNABLE TO COMMUNICATE WITH PATIENT AS OF NOW.


VAERS ID: 1322008 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: New York  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 RA / IM

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

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

Write-up: Patient received vaccine, appeared to be fine, I went back into pharmacy and about 1-2 minutes later, patient fainted and fell onto the floor out of his chair. We called 911 immediately and they were here within 5 minutes. Patient continued going in and out of consciousness and they brought him to the hospital via Ambulance where he was later released that day.


VAERS ID: 1322014 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 1 - / IM

Administered by: Public       Purchased by: ?
Symptoms: Dizziness, Headache
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: Same symptoms shortly after receiving her Tetanus shot
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Approximately 10 minutes after receiving her first Pfizer dose IM, Patient was experiencing a headache rated 4/10 on the pain scale as well as light headedness. Patients vehicle was directed to the ambulance on standby, paramedic crew assessed the patient. Vitals were stable and since the patient was a minor, the patient mother made a decision to refuse transport and exited the facility without issue. End of report.


VAERS ID: 1322045 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 - / 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: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Patient was in the passenger seat complaining of lightheadedness and dizziness. Vehicle was directed to the ambulance on standy and an ALS crew assessed the patient and took vitals. Vitals were all within normal limits and after 5 minutes, the patient''s condition improved. Since all symptoms were resolved, patient signed a refusal for Superior ambulance transport and exited the facility without issue. End of report SG.


VAERS ID: 1322069 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Blood pressure increased, Dehydration, Immediate post-injection reaction, 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), Hypertension (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (narrow), Hypoglycaemia (broad), Dehydration (narrow)

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

Write-up: Patient (DOB 05-01-2003) received his 1st COVID vaccine (Pfizer, lot # EW0182 use by 5/15/21 at 0855) at 1539. The patient became pale approximately 30 seconds following the administration of the vaccine, EMT assisted the patient to the chair as he was standing up when he became pale, the patient loss consciousness for approximately 2 seconds. RN arrived at the station and assisted the patient to the ground, where he was placed in a supine position with his lower extremities elevated. The patients face mask was removed, he was alert and oriented to person, place, time, and situation. The patients color slowly returned to his face. Vitals were taken at 1540: BP: 155/70 (R arm, supine position), HR 70, RR 16, oxygen saturation at 97%, and pupils were equal. The patient had a history of fainting x 1 and his last meal was at 0800 and he stated, " I didn''t drink that much today." Denied any chronic medical conditions, was not currently taking any medications, and denied any drug allergies. The patient was moved to the anti-gravity chair and he was given pringles and Gatorade. Vitals were retaken at 1545: BP 162/80 (R arm, sitting upright), HR 50, RR 16, oxygen saturation at 97%. Denied any dizziness, headache, chest pain, or vision changes. Vitals were retaken at 1553: BP 158/72 (R arm, sitting upright), HR 52, RR 16, Oxygen saturation at 97%. The patient was advised to eat a full meal prior to receiving his second COVID vaccine dose and to receive his 2nd dose in the anti-gravity chair. Vitals were retaken at 1558, BP 152/78 (R arm, sitting upright), HR 57, RR 16, and oxygen saturation at 98%. The patient was also given a bottle of water, as he did not consume many liquids during the day. The patient''s color fully returned to his face and he denied any shortness of breath, dizziness, changes in vision, or difficulty swallowing. Vitals retaken at 1603, BP 150/75 ( R arm, sitting upright), HR 60, RR 16, and oxygen saturation at 96%. The patient called his mother to pick him up, as we strongly advised him to not operate machinery/ a vehicle after fainting. The patient''s vital signs were taken at 1608, BP 140/75, HR 60, RR 16, and oxygen saturation at 100%. The patient was advised to drink the entire bottle of water, as his blood pressure was slightly elevated and it was most likely due to being dehydrated, as he did not consume any fluid since 0800 earlier that day. The patient drank a bottle of water and his vital signs were retaken at 1614, BP 122/68 (R arm, sitting upright) and a respiratory rate of 15 breaths per minute. The patient''s mother arrived on site around 1630 and spoke with RN and both EMT. RN instructed the patient about emergency precautions and to follow up with his primary care provider. RN also educated the patient about the importance of informing the healthcare provider about his history of fainting with the first vaccine, when receiving the second COVID Pfizer vaccine. Gave the patient V-safe information and reported the occurrence in VAERS. The patient had a steady and even gait when leaving the site with his mother at 1632.


VAERS ID: 1322128 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP6955 / 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: fainted on vaccination in past
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Patient fainted in waiting room about 5 minutes after shot. He had not eaten (much) prior to immunization. He had history of fainting on vaccination so I encouraged him to eat something but he insisted that it was the site of needle that made him queasy. Patient now feeling fine as he was about 20 minutes later after sitting and eating banana, drinking apple juice.


VAERS ID: 1322169 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 59676-0580-15 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Headache, Pain
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: none
Current Illness: none
Preexisting Conditions: none, active physical trainer
Allergies: none known
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Intense chills, uncontrollable shivering for about an hour, then severe body aches all night followed by a headache all day today.


VAERS ID: 1322202 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-05-13
Onset:2021-05-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 3 RL / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Condition aggravated, Headache, Injection site swelling, Pyrexia, Rash, Trigeminal neuralgia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Demyelination (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: 2017, flu vaccine, swelling at site
Other Medications: Synthroid, Effexor, 81mg ASA, Multi Vitamin, Fish Oil
Current Illness: None
Preexisting Conditions: Thyroid
Allergies: Bactrim, Lexapro, IVP dye, Sulfa
Diagnostic Lab Data:
CDC Split Type:

Write-up: Severe Headache, Triggered Trigeminal Neuralgia, Rash, Fever, Large swelling at vaccine site, Short of Breath


VAERS ID: 1322246 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, Chills, Feeling abnormal, Headache, Heavy menstrual bleeding, Nausea, Pain, Pyrexia, Somnolence
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: First hour, major headache, fuzzy minded, tired First 24-48 , abdominal cramping with menstrual bleeding, body aches, fever, chills, super sleepy, & nausea


VAERS ID: 1322258 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808980 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Feeling abnormal, Paraesthesia oral
SMQs:, Dementia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Lyrica Norco 5-325 mg Prednisone 20mg Tramadol HCI 100mg
Current Illness: Jaw pain Rheumatoid arthritis
Preexisting Conditions: Jaw pain Rheumatoid arthritis
Allergies: Compazine Imitrex Morphine NSAIDs cat blood
Diagnostic Lab Data: unknown
CDC Split Type:

Write-up: She presented to Hospital for Johnson and Johnson Covid vaccine on 5/14/2021. Janssen vaccine was given at 1330. She was instructed by LVN to wait 30 minutes in the waiting area to be monitor for any allergic reactions. At approximately 1550, she presented to LVN reporting tingling sensation in the mouth, lips and tongue, stating "feeling funny". Then she was evaluated by an RN and Benadryl 50 mg was given by mouth at 1553. Her symptoms were increasing. 911 was called at 1606 and she was injected with EpiPen at 1610. Paramedics arrived approximately at 1618 and transported her to the Emergency Department. Patient remined alert during the entire encounter.


VAERS ID: 1322261 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0175 / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Anxiety, Palpitations
SMQs:, Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypoglycaemia (broad)

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

Write-up: Patient left vaccine site without waiting in observation with mother. Came back to site with reported palpitations and anxiety after going to Chik fila nearby. On arrival patient vitals 125/78 HR 85 regular O2 Sate 98% No signs of distress. Patient obviously anxious. Observed for 30 minutes and released with no treatment or transport. Released with Mother.


VAERS ID: 1322474 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: School       Purchased by: ?
Symptoms: Anaphylactic reaction, Chills, Dizziness, Headache, Limb discomfort, Mobility decreased, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (narrow), Anticholinergic syndrome (broad), Anaphylactic/anaphylactoid shock conditions (narrow), Parkinson-like events (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none, normally takes benedryl for pollen allergies. But didn''t take any that day. Did take it on Thursday.
Current Illness: none
Preexisting Conditions:
Allergies: seasonal allergies such as pollen
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Immediately after the shot she had a bad headache and approximately 30 to 35 minutes later dizness, chills, and throat restriction (anaphlaxis), extreme muscle soarness( any sort of touch was extremely painful, and she couldn''t move her neck, it hurt to move from side to side. Her legs began to feel extremely heavy and hard to move. These symptoms seemed to last for approx 30 minutes. Headache didn''t subside until later in the day, it did lighten up.


VAERS ID: 1322488 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-10
Onset:2021-05-14
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: N/A
Preexisting Conditions:
Allergies: NKDA
Diagnostic Lab Data: ROS: General: No fatigue, fevers/chills, malaise Eyes: No eye pain, eye discharge, visual changes Ears: No ear pain, hearing changes Nose/throat: No nasal congestion, sore throat CV ROS: General: No fatigue, fevers/chills, malaise Eyes: No eye pain, eye discharge, visual changes Ears: No ear pain, hearing changes Nose/throat: No nasal congestion, sore throat CV: No chest pain, palpitations, syncope, edema Pulm: No SOB, wheezes, cough, hemoptysis GI: No anorexia, abd pain, nausea, vomiting, diarrhea GU: No dysuria, hematuria, urgency, frequency MSK: No joint pain, edema, warmth, redness, deformity Neuro: No HA, seizures, weakness, numbness/tingling, vertigo, lightheadedness, AMS Skin: + left arm rash, no lesions, itching Heme: No easy bruising/bleeding, petechiae All systems reviewed and negative except as stated above. Physical Exam: Vital signs reviewed, no acute intervention necessary General: NAD, AOX3, cooperative Head: Normocephalic, atraumatic Eyes: PERRL, EOMI, no conjunctival injection, no scleral icterus Ears: No edema/erythema of otic canal, no TM edema/erythema/dullness/bulging Nose: No nasal discharge Throat: No pharyngeal edema, erythema, tonsillar exudates, uvular deviation, asymmetric swelling, trismus, drooling, or voice changes Neck: No meningismus; normal ROM Lymph: No cervical lymphadenopathy Respiratory: Unlabored breathing, normal respiratory effort, LCTAB CV: Normal peripheral circulation, RRR, no m/r/g Abd: Soft, NTND Skin: + left bicep with 6 cm circular erythema without fluctuance, no petechiae, or purpura Neuro: Grossly intact, moves all extremities equally, gait normal MSK: No TTP, deformity, ecchymosis, or focal edema Psych: Normal mood, normal affect, appropriate responses
CDC Split Type:

Write-up: Patient is a 27 year old female who presents to ED with left arm redness and swelling at the injection site of her J&J COVAX from last Tuesday. No fever, no chills, no other symptoms.


VAERS ID: 1322501 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Axillary pain, Mobility decreased, Neck pain, Pain, Peripheral swelling, Skin warm
SMQs:, Cardiac failure (broad), Angioedema (broad), Parkinson-like events (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Birth control, Fluxoetine, Verapamil, Topiramate, Rabaprazole, Metformin, vitamin c, biotin, b12, d3, Allegra
Current Illness: Some type of upper respiratory infection about a week and a half before my vaccination. I was tested for Covid and it was negative. I was better well before it was time for my shot.
Preexisting Conditions: Pre-diabetes
Allergies: Hydrocodone
Diagnostic Lab Data:
CDC Split Type:

Write-up: My whole upper arm has swelled up and I''ve had throbbing pain for 2 days. The pain extends all the way into my neck and arm pit. I''ve been having difficulty using that arm because of the pain. It is also hot to the touch. I have been using Tylenol and ice with little improvement.


VAERS ID: 1322507 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO186 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Arthralgia, Fatigue, Headache
SMQs:, Arthritis (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: Tetanus Toxoid / 20+ yrs ago.
Other Medications: Metoprolol Succ ER; HCTZ; Bupropion XL; Raloxifene; Vit. D; Ca+; MVT; Glucasamine/MSN; Ibuprofen. (None of these taken within 24 hrs of vaccine)
Current Illness: Seasonal allergies
Preexisting Conditions: Osteoarthritis; Osteoporosis; Sinusitis.
Allergies: Tetanus toxoid
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: 9-10 hrs after receiving vaccine I had bad HA, fatigue & severe joint aches. Severe enough I cnx''d my appt''s the next day. These sxm''s were very similar to my sxm''s when I had Covid 19. Sxm''s subsided 24 hrs after they started.


VAERS ID: 1322522 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025C21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Losartan for blood pressure, bupropion, atomoxetine
Current Illness: No
Preexisting Conditions: High blood pressure, sleep apnea
Allergies: No
Diagnostic Lab Data:
CDC Split Type:

Write-up: Tinnitus in the left ear. Bearable, but significant. No changes after 2.5 days.


VAERS ID: 1322607 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:0000-00-00
Onset:2021-05-14
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (UNKNOWN)) / UNKNOWN MANUFACTURER 206A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Eye pain, Headache, Nasal discomfort
SMQs:, Glaucoma (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210527558

Write-up: BURNING SENSATION IN NASAL PASSAGES; HEADACHE; SORE EYES; This spontaneous report received from a consumer concerned a 77 year old female. The patient''s weight was 230 pounds, and height was not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, unknown, batch number: 206A21A, and batch number: 206A21A expiry: UNKNOWN) dose was not reported, administered on 13-MAY-2021 to Right Arm for prophylactic vaccination. No concomitant medications were reported. On 14-MAY-2021, the subject experienced burning sensation in nasal passages. On 14-MAY-2021, the subject experienced headache. On 14-MAY-2021, the subject experienced sore eyes. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from burning sensation in nasal passages, headache, and sore eyes. This report was non-serious.


VAERS ID: 1322622 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040B21 A / UNK LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Chills, Cough, Fatigue, Headache, Impaired work ability, Malaise, Mobility decreased, Pain, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Became very tired and had to go to bed by 6:15 p.m. on date of 2nd injection woke up with chills fever body hurting really bad Friday night went to work Saturday morning had to leave after 3 hours very sick body aching couldn''t hardly move my neck fever chills went to bed was in bed all day Saturday All night Saturday night the fever broke Sunday morning still very tired could only be up for a short time before having the lay back down. Slap half the day Sunday Sunday night primarily just a headache and a mild cough And being very tired as of today Monday.


VAERS ID: 1322840 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Mississippi  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009C21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dysphagia, Flushing, Paraesthesia, Peripheral swelling, Swelling face
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Tingling and swelling to face and hands. Facial flushing to bilateral cheeks. Difficulty swallowing. Patient received Benadryl PO, Pepcid PO, and Decadron Injection for reaction.


VAERS ID: 1322934 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: 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: Vomited Pulse 80 No other sign or symotom of ditress. Adult present. Informed to seek medical attention with any furthter problems.


VAERS ID: 1322953 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Ejection fraction normal, Electrocardiogram ST segment elevation, Electrocardiogram abnormal, Myocarditis, Pericarditis, Pyrexia, Troponin I increased
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? Yes
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: na
Diagnostic Lab Data: ECG with diffuse st elevation, troponin I of 32. Echo with ef of 55%, no effusion. No e/o chf. Presumed myocarditis. Associated with 2nd dose of Moderna covid 19 vax given on 5/14. Sx began that evening. Unclear causality.
CDC Split Type:

Write-up: 27 yo male with 3 days of fevers, chest pain x 3 days, beginning on 5/14/21 and presented to ED on 5/17/21. Found to have pericarditis and myocarditis, troponin I of 32.


VAERS ID: 1322968 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0171 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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 received the vaccine. Patient got very dizzy shortly thereafter. He started vomiting and slumped his head over in the trash can. BP was 98/58 with pulse of 56. Oxygen was 99. We got him to a hospital bed. 5 minutes later his bp was 102/60 with HR of 68. Pulse was now 79 and oxygen 99. 10 minutes out, his bp was 101/65 with a pulse of 72.


VAERS ID: 1322971 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-05-13
Onset:2021-05-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Fatigue, Headache, Injection site pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Started with a slight headache, soreness at the injection site and fatigue the day after the vaccination. Then as the night progressed I had chills and then a 101.2 degree fever. Within 48 hours all symptoms had subsided. Took Motrin during the time to reduce fever and headache.


VAERS ID: 1323012 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0169 / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Dyspnoea, Hypoxia, Lung opacity
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Interstitial lung disease (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: atorvastatin, dexamethasone, lisinopril, valacyclovir, bendamustine, brentuximab
Current Illness: None
Preexisting Conditions: Hodking''s lymphoma (bendamustine and brentuximab since 4/28/21)
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient with Hodking''s lymphoma (bendamustine and brentuximab since 4/28/21), admitted for subacute onset of SOB and hypoxia w/ CT showing bilateral pulmonary opacities concerning for pneumonitis or infection.


VAERS ID: 1323032 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, Gait disturbance
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Client after receiving her vaccine, on the way to the recovery room felt so weak and was supported by her mother before I got there to assist her. She was put on the wheelchair and taken to the rest area where she was made to relax for awhile. vital signs were 98/63, 79, SPO 99% at room air, temp, 96.7,. After resting her are SPO was 99% and respiration even and unlabored before leaving, with the mother. she took the Pfizer vaccine, lot #EW0183, FIRST DOSE.


VAERS ID: 1323053 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Anxiety, Chest pain
SMQs:, Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypoglycaemia (broad)

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

Write-up: Pt c/o stabbing chest pain 15min after receiving the COVID vaccine. Pt was evaluated by MD and determined to be having an episode of anxiety. Vitals signs within normal limits.


VAERS ID: 1323091 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blindness, Dyspnoea, Hypoaesthesia
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Glaucoma (broad), Optic nerve disorders (broad), Cardiomyopathy (broad), Retinal 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: None
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Pt was given COVID vaccine #1. Approximately 10min after vaccine administration pt reported losing his vision, having difficulty breathing and numbness in left arm. Denied chest pain, headache, nausea. Pt pulse 59. SpO2 91-96%. Pt pupils dilated. Pt alert x2. This RN called 911 with mother''s permission. EMS arrived @1800. At that time pt alert x3, no longer pale, numbness decreased, difficulty breathing resolved. Pt walked out of the office on his own. He was not taken to ED via Ambulance.


VAERS ID: 1323126 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER2613 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dizziness, Nausea, Vision blurred, Wheelchair user
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), Hypoglycaemia (broad)

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

Write-up: 12:15pm pt. was seen sitting in wheelchair with EMT and dad at his side. EMT stated pt. c/o dizziness, nausea and blurred vision after taking Pfizer COVID-19 vaccine. At 12:13 vital signs taken by EMT staff. HR 74, BP 104/70, O2Sat 99%. 12:20pm pt. denies any pain or discomfort. 12:30pm pt. left vaccine site to go home via wheel chair. EMT and dat at his dice with no signs of acute distress.


VAERS ID: 1323127 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-05-11
Onset:2021-05-14
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Abdominal pain, Diarrhoea, Dizziness, Dyspnoea, Fatigue, Headache, Nausea, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Noninfectious diarrhoea (narrow)

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

Write-up: Nausea, abdominal cramps, diarrhea, fatigue, vomiting, shortness of breath, dizziness, headaches (severely for 24 hours, mildly for an additional 24 hours). On the 3rd day of symptoms (6 days post-vaccine) - shortness of breath, fatigue, headaches, dizziness.


VAERS ID: 1323170 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016C21A / 1 LA / IM

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

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

Write-up: The patient fainted a few minutes after given the vaccine. The patient was pale and needed to stay in a flat position. The EMT was called and the patient was not taken to the hospital. The patient was feeling better after 30 minutes. The patient stated that she sometimes faints when giving blood.


VAERS ID: 1323206 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: New Hampshire  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

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

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

Write-up: vaccine recipient scheduled to receive second Moderna COVID vaccine received Janssen/J&J vaccine in error.


VAERS ID: 1323286 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: D.C.  
Vaccinated:2021-05-05
Onset:2021-05-14
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / SYR

Administered by: Private       Purchased by: ?
Symptoms: Cerebral venous thrombosis, Magnetic resonance imaging, Road traffic accident, Superior sagittal sinus thrombosis, Transverse sinus thrombosis, Venogram
SMQs:, Ischaemic central nervous system vascular conditions (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Accidents and injuries (narrow), Central nervous system vascular disorders, not specified as haemorrhagic or ischaemic (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, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Hyertension
Allergies: None
Diagnostic Lab Data: 2X MRI and MRV
CDC Split Type:

Write-up: Patient had minor car accident with no evidence of severe trauma. Found to have Cerebral venous thrombosis, sagittal and transverse sinuses .


VAERS ID: 1323287 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 1 UN / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: EMS reports syncopal episode pt turned pale after vaccinated while in observation area. No LOC. Reused transport to ER - Father took pt home.


VAERS ID: 1323297 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 212 91303 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Flushing
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypersensitivity (broad)

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

Write-up: Pt has long hx of allergic (mild - moderate, rash and flushing) with different food preservatives and medication. Was cleared by doctor to get J&J but told to wait 30 minutes before discharge. Several minutes after getting vaccine, pt reported facial flushing and lightheadedness. Pt instructed to sit in reclined position in exam room and given bottled water (which she did not drink due to allergies to preservatives). Physical Exam. BP 167/95, T 96.6, RR 22, O2 95%. Lungs CTAB. Airway clear and non-edematous. After 30 minutes, pt felt well enough to go home on own. Pt given clear ER or PCP clinic return precautions.


VAERS ID: 1323306 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 1 RA / IM

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

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

Write-up: EMS reports pt had syncopal episode after vaccinated while waiting in observation area. No LOC. Refused transport to ER.


VAERS ID: 1323330 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Blindness, Blood glucose normal, Dyskinesia, Hyperhidrosis, Hypotension, Skin warm, Unresponsive to stimuli
SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Dyskinesia (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Glaucoma (broad), Optic nerve disorders (broad), Retinal disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

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

Write-up: 10 minutes after her first dose she had been sitting in a chair & developed diaphoresis, warm skin, loss of vision,& low blood pressure. Pt was initially not responsive, when transferred to a wheel chair to take her to a gurney, left arm & left leg jerk twice. Took her to lay down and check her blood pressure. En route, in the wheel chair within about 5 to 10 seconds, she became responsive and said she could not see. Her vision returned to normal within a minute. Her initial blood pressure was 97/64 with O2 Sat 100% on room air. Her skin temp was 95.5, and her HR was 95. She continued to be responsive with excellent oxygenation and When the EMTs arrived she had a blood sugar of 90 and improving blood pressure with a regular rate and rhythm. Her diaphoresis resolved, and she continued to improve, tolerating water. Had similar reaction last year to flu shot, no hx of seizures


VAERS ID: 1323344 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: New York  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8736 / 1 AR / IM

Administered by: Public       Purchased by: ?
Symptoms: Dizziness, Immediate post-injection reaction
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypersensitivity (narrow)

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

Write-up: Patient felt lightheaded and states everything "went black" immediately after vaccination. Patient brought to lay down on cot. Vital signs stable. Patient states dizziness passed and she sat up and drank water/ ate a snack.


VAERS ID: 1323354 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Blood glucose normal, Hyperhidrosis, Tinnitus, Tunnel vision
SMQs:, Neuroleptic malignant syndrome (broad), Optic nerve disorders (broad), Retinal disorders (narrow), Hearing impairment (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Oral birth control
Current Illness:
Preexisting Conditions:
Allergies: Augmentin
Diagnostic Lab Data: Per CFD EMS: Blood sugar: 90, B/P: 107/57, 98 pulse ox, 68 pulse. Blood pressure after pt reported feeling better: 113/68.
CDC Split Type:

Write-up: Pt states had "tunnel vision and feeling of everything fading", ringing of ears and sweating immediately after receiving vaccine. Pt layed down for a few minutes and felt better. No LOC. Refused transport to ER. Father and family who were present took pt home.


VAERS ID: 1323374 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER2613 / 1 LA / IM

Administered by: Other       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: n/a
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: n/a
Diagnostic Lab Data:
CDC Split Type:

Write-up: After observation time was up, customer''s mother asked for her to sit up to see how she was feeling. After customer sat up she got an instant headache. Code Red was called and EMS and nurse responded to call. BP 123/80, HR 81, O2 99%, 37.2 (Centigrade). Patient still had headache but stated she will be fine.


VAERS ID: 1323375 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Blood glucose normal, Contusion, Dizziness, Electrocardiogram normal, Eye injury, Fall, Joint injury, Loss of consciousness, Nasal injury, Presyncope, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Corneal 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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Headaches
Allergies: NKDA
Diagnostic Lab Data: EKG; BG check; physical exam
CDC Split Type:

Write-up: 59kg 14 yo M with NKDA and PMH of headaches had a syncopal episode after receiving first Covid19 vaccination in left deltoid at 1458 5/14/21 (lot # EW0179) . Patient described feeling light headed and does not recall losing consciousness. Fell face side down and had trauma of right knee and nose and above the left eye. Bruising on his nose. Reportedly hit the metal base of the curtain that separated the vaccination area from the observation area. EMS called for concern of facial fractures. BG 98/48 and HR 75 with O2 sats 99% post event. EKG negative. BG within normal limits. Patient did have sustained loss of consciousness. Followup BP 101/69 with HR 77. Event attributed to vasovagal reaction.


VAERS ID: 1323462 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-05-13
Onset:2021-05-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 AR / IM

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

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

Write-up: Patients sister contacted the pharmacy the day after the vaccine to inform us that this was his third COVID vaccine. She stated he received 2 other shots at facility. We are unaware of any adverse events.


VAERS ID: 1323467 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 1 LA / IM

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

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

Write-up: PATIENT DID NOT MEET AGE REQUIREMENT TO BE ELIGIBLE FOR THE PFIZER VACCINE.


VAERS ID: 1323474 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Lip swelling, Nausea, Paraesthesia oral, Rash, Throat tightness
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Patient received first dose of Pfizer at an unknown location and presented to the ED at with lip swelling and tingling. States the symptoms started 30 mins after the vaccine. Given treatment with steroids and discharged home. Patient returned to the ED on 5/15 complaining of nausea and throat tightening with a rash on her back and arms. Zofran, Benadryl, Pepcid and steroids administered. Pt was discharged home.


VAERS ID: 1323517 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-05-07
Onset:2021-05-14
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 - / SYR

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Feeling abnormal, Headache
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Allegra. Take CalMax every other night that has magnesium, calcium and vitamin D.
Current Illness:
Preexisting Conditions: nothing but have relatively low blood pressure
Allergies: hyperactive if I digest Steroids
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Got up on Friday morning and almost fell over and had to be careful not to fall while walking to bathroom to get a shower. That night I was dizzy and could not lay down and especially could not lay on side so I propped up pillows and slept upright. Same thing Saturday night but less. Some thing on Sunday night but much less. Just a little spaced out on Monday and slight headache. CAlled doctor, no call back yet but I did not want to go to ER. So far it is going in the right direction. Had minor headache initially, night 2, but tylenol worked to relieve.


VAERS ID: 1323569 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Idaho  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025B21A / 1 LA / IM

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

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

Write-up: Dose given to minor


VAERS ID: 1323753 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037C21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: 1st dose Moderna vaccine given at 16 years old
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient under age of 18 years old received Moderna COVID-19 Vaccine. 1st dose given mistakenly at this age. 2nd dose was given in this instance after guidance from CDC to continue with 2nd dose.


VAERS ID: 1323829 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Patient did state that she gets severe swelling at injection site to all vaccines. We informed patient that she needed to wait
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient came in for J&J vaccine 05/14/2021. She selected "no" on her questionnaire to the question "have you received the first dose of a COVID-19 vaccine and want to schedule a second dose". We administered the vaccine and when inputting her information in we noticed she had received a J&J vaccine #3205 on 3/11/2021


VAERS ID: 1323833 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK UN / IM

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, Dizziness, Hyperhidrosis, Hypoaesthesia, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

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

Write-up: AFTER COVID19 VACCINATION, PATIENT EXPERIENCED NUMBNESS, TINGLING, DIZZINESS, WEAKNESS, LIGHTHEADEDNESS AND DIAPHORESIS AT FOREHEAD. NO LOC, NO DIB, NO SYNCOPE, NO CHEST PAIN. AFTER 15 MINUTES PATIENT WAS ASYMPTOMATIC. LEFT WITH FATHER TO HOME AT 11:16 AM. VITAL SIGNS: 1100 BP 72/36, HR 88, RR 20 1105 BP 86/46, HR 84, RR 20 1110 BP 88/62, HR 82, RR 20 1115 BP 96/68, HR 80, RR 20 1116 BP 102/70, HR 82, RR 20


VAERS ID: 1323865 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 2 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Catheterisation cardiac, Chest pain, Electrocardiogram abnormal, Fatigue, Headache, Myocarditis, Pyrexia, Troponin increased
SMQs:, Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Peanuts
Diagnostic Lab Data: Troponin elevated at 14, ekg suggestive of myocarditis. Evaluated by cardiology, underwent cardiac cath on 5/17 no occlusion to support elevation of troponin
CDC Split Type:

Write-up: Fever with fatigue and headache on 5/14 , getting worse. Chest pain on 5/16. Admitted to hospital 5/17 with Myocarditis probably vaccine related


VAERS ID: 1323902 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK UN / IM

Administered by: Public       Purchased by: ?
Symptoms: Asthenia, Decreased eye contact, Dizziness, Somnolence
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

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

Write-up: AFTER COVID19 VACCINATION, PATIENT EXPRIENCED DIZZINESS, WEAKNESS WITH DIFFICULTY MAINTAINING EYE CONTACT. PATIENT STATED SHE FELT SLEEPY WITH DIFFICULTY KEEPING EYES OPEN. AFTER 25 MINUTES, PATIENT WAS AAOX4, VITALS WNL, AMBULATING WITHOUT ASSISTANCE AND LEFT CLINIC WITH FATHER, DENYING ANY DIZZINESS OR WEAKNESS. VITALS: BP HR RR SPO2 12:45 138/80 100 16 99% 12:53 150/90 85 16 99% 12:58 138/90 81 14 99% 13:02 128/80 80 14 99% 13:07 122/86 75 16 99%


VAERS ID: 1323903 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-05-13
Onset:2021-05-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 1 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Heavy menstrual bleeding, Immunoglobulin therapy, Platelet count decreased, Pyrexia, SARS-CoV-2 test positive, Thrombocytopenia, Vaccination complication, Vaginal haemorrhage
SMQs:, Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Cetirizine 10 mg once daily
Current Illness: None
Preexisting Conditions: Obesity, ADHD, seasonal allergies
Allergies: No known allergies
Diagnostic Lab Data: COVID-19 Nasal Swab PCR: Positive on 5/14 Platelets: 8 on 5/14/21, 6 on 5/15/21, 6 on 5/16/21, 16 on 5/17/21.
CDC Split Type:

Write-up: Patient presented to the ED with dizziness, fever and heavy vaginal bleeding around 24 hours after receiving her first dose of the Pfizer-BioNTech COVID-19 vaccine. She was tested for active COVID-29 infection via nasal swab PCR and tested positive. Upon presentation labs were drawn and her platelet count was found to be 8 on 5/15. Repeat labs were drawn that day to confirm low platelet count and confirmed diagnosis and thrombocytopenia secondary to an immune reaction to the vaccine was suspected. She was admitted and was started on tranexamic acid, medroxyprogesterone, dexamethasone and IV immunoglobulin (Ig) to help treat low platelet count and vaginal bleeding. As of writing, she is still admitted and her most recent platelet count on 5/17 was 16.


VAERS ID: 1323911 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-05-13
Onset:2021-05-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dysmenorrhoea, Heavy menstrual bleeding
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: Monteleukast
Current Illness:
Preexisting Conditions: Mild asthmatic
Allergies: Penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Heavy period with 4 days of cramps


VAERS ID: 1323917 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009C21A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest discomfort, Cough, Dysphonia, Dyspnoea, Sensation of foreign body
SMQs:, Anaphylactic reaction (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)

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

Write-up: vaccine given at 0915, pt c/o of chest feeling funny,tight, voice became hoarse and cough started at 0923. 0925 12.5ml Benedryl given , 0930 @ puffs Albuterol given one minute apart 935 c/o hard to get air in and lump in throat, 937 c/o knot in throat feels larger can''t take deep breathe, pt requested we give her Epi pen to her. Epi-Pen 0.3mg given IM right lateral thigh at 0937. 0939 she can take a deep breath, lump in throat feels smaller and she is sitting on the side of the bed. 0940 sitting on side of bed still coughing, 0943 Cough improving talking better no longer hoarse voice. Squad arrived at 0945 and transported to hospital ER. Patient has dealt with anaphylaxis for years due to allergies and per her PCP ok to get Moderna vaccine but she needed to be monitored for two hours after injection.


VAERS ID: 1323973 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8736 / 1 - / IM

Administered by: Other       Purchased by: ?
Symptoms: Oropharyngeal discomfort
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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: 5/14/2021 went to ER at Hospital and received epi pen and IM decadron shot
CDC Split Type:

Write-up: Approximately 20-25 min after vaccination, after leaving 15 min observation time, daughter started complaining of a ball in her throat and "closing sensation"


VAERS ID: 1324017 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0169 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Condition aggravated, Deep vein thrombosis, Erythema, Metastasis, Peripheral swelling, Ultrasound scan abnormal
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Embolic and thrombotic events, venous (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Thrombophlebitis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Non-haematological malignant tumours (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, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: enoxaparin 80mg subq q12h; tramadol 50mg q6h prn moderate pain, temozolomide 200mg daily x 5 days
Current Illness: RLE DVT
Preexisting Conditions: metastatic rhabdomycosarcoma (temozolomide 200mg PO daily x 5, 4/27 -5/1; irinotecan 60mg IV daily x 5, 4/27 - 5/1 ; vincristine 2mg IV x 1, 4/27)
Allergies: NKDA
Diagnostic Lab Data: 5/14 US RLE: IMPRESSION: 1. Progression of deep venous thrombosis with complete occlusion of the right common femoral vein. 2. Stable near complete occlusive deep venous thrombosis in the right superficial femoral vein.
CDC Split Type:

Write-up: Patient recently diagnosed with DVT and was taking enoxaparin 80mg subq q12h. Presented to ED after receiving vaccination with increased swelling and redness in RLE. worsening of DVT on imaging.


VAERS ID: 1324047 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: New York  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Electrocardiogram, Faeces discoloured, Headache, Incorrect dose administered, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious diarrhoea (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Pharmacist gave my daughter all six doses. She used an undiluted bottle and shot her full of it. She has fever chills aches headaches green poop nausea


VAERS ID: 1324097 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 LA / IM

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

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

Write-up: Her arm was red and still is, swollen, and hot to the touch, on Friday and Saturday. Today the symptoms have gotten worse and it is very painful. She is wearing a loose shirt and noticed that it is sore to the touch. Pharmacist, counseled her to take two naproxen tablets 220mg every 12 hours. She went ahead and took two tablets and the pharmacist will follow up later in the day. Also advised to take diphenhydramine 25mg in a few hours if the symptoms have not resolved.


VAERS ID: 1324151 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-13
Onset:2021-05-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 1 LA / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? 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: Fever and chills starting about 24 hours after receiving the vaccine, lasted about 12 hours


VAERS ID: 1324162 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-13
Onset:2021-05-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 1 LA / SYR

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

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

Write-up: Moderate headache, tiredness, fever


VAERS ID: 1324166 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8735 / 1 LA / IM

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

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

Write-up: Pt c/o dizziness. Pt told to rest laying down and was given juice/crackers. Pt return to baseline. A&O x4. BP 99/64, HR 84, RR 18. Pt stable and released from the vaccination site.


VAERS ID: 1324254 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Unknown  
Location: California  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 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: unkown
Current Illness: unkown
Preexisting Conditions: unkown
Allergies: unkown
Diagnostic Lab Data: none
CDC Split Type:

Write-up: syncope


VAERS ID: 1324306 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Flushing/sweating, Dizziness, near syncopal event after witnessing brother have a syncopal event after his first dose. Pt did not have breakfast. BP 100/52, HR 59, RR 18 -- $g 108/67, HR 77 -- $g 110/67, 75. Improved after water, crackers, rest. Recommended patient eat and drink prior to next dose. Patient stable and released from the vaccination site.


VAERS ID: 1324465 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 1 LA / IM

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

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

Write-up: Pt was pale and light headed. Syncopal event- caught by staff (did not fall). Hx of syncopal events with other vaccinations. Pt did not eat breakfast. BP 98/49, HR 65, RR 18 -- $g 94/48, 83, 18 -- $g 93/58 -- $g 106/60. Pt laid down with feet elevated. Pt given crackers and juice. Pt improved, stable, and released from the vaccination site. Recommended patient eat and drink prior to next dose.


VAERS ID: 1325025 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Dyspnoea, Fatigue, Headache, Nausea, Pain, Pain in extremity
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (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: Claritin
Current Illness:
Preexisting Conditions:
Allergies: Penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Nausea, shortness of breath, headache, fatigue, sore arm, body aches


VAERS ID: 1325231 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Idaho  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 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: Unknown
Current Illness: Unknown
Preexisting Conditions: Asthma
Allergies: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: Patient is underage and received the Janssen Covid-19 vaccination.


VAERS ID: 1325397 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021C21A / 2 RA / IM

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

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

Write-up: On 5/14/21 Patient received 2nd dose of COVID Moderna vaccine at 21 days after the 1st dose given on 4/23/21.


VAERS ID: 1325400 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033C21A / 1 RA / IM

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

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

Write-up: 17 year old male patient received 1st dose of COVID Moderna vaccine.


VAERS ID: 1325419 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Erythema of eyelid, Eyelids pruritus, Pain, Pyrexia, Rash, Swelling of eyelid
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), 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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin C 500mg, Zyrtec 10mg, Finasteride 1mg
Current Illness: None
Preexisting Conditions: None
Allergies: None Known
Diagnostic Lab Data:
CDC Split Type:

Write-up: Right eyelid started itching, turning red and swelling along with rash on neck within 30 mins of receiving vaccine. Fever, Body Aches


VAERS ID: 1325430 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-12
Onset:2021-05-14
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 0L2C21A / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Palpitations
SMQs:, Arrhythmia related investigations, signs and symptoms (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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Wellbutrin Valtrex Lunesta Excedrin Multivitamin Probiotic
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: None yet. I don?t know what to do or get and I?m already in massive medical debt so I?m scared to get charged for procedures not covered by my insurance.
CDC Split Type:

Write-up: Racing heart. My heart used to average 60 beats per minute and now is up to around 90 even up to 100 per minute. I?ve been having to take Propranalol to slow it down. It?s horrible. I don?t know what to do.


VAERS ID: 1325438 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: California  
Vaccinated:2021-04-11
Onset:2021-05-14
   Days after vaccination:33
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 UN / UN

Administered by: Private       Purchased by: ?
Symptoms: Computerised tomogram thorax, Embolism venous, Ultrasound Doppler abnormal
SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Cardiomyopathy (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: lisinopril, metoprolol, pravachol
Current Illness: none
Preexisting Conditions: hypertension, high cholesterol
Allergies: prochlorperazine
Diagnostic Lab Data: CT pulmonary angiogram, bilateral lower extremity venous duplex 5/16/21
CDC Split Type:

Write-up: venous thromboembolism


VAERS ID: 1325879 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: Ohio  
Vaccinated:0000-00-00
Onset:2021-05-14
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Body temperature, Fatigue, Headache, Hyperhidrosis, Injection site pain, Nausea, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Alcohol use (Occasional drinking (once or twice a year)); Allergic reaction to antibiotics (Sulfa medications allergy causes hives); Cigarette smoker (1 or 2 cigarettes a day); Drug allergy (Tramadol causes bad migraines)
Preexisting Conditions: Comments: No drug abuse or illicit drug usage
Allergies:
Diagnostic Lab Data: Test Date: 20210514; Test Name: Body temperature; Result Unstructured Data: 100.9 F
CDC Split Type: USJNJFOC20210529745

Write-up: SWEAT; FEVER; NAUSEA; HEADACHE; INJECTION SITE PAIN; TIRED; This spontaneous report received from a patient concerned a 36 year old male. The patient''s height, and weight were not reported. The patient''s concurrent conditions included sulfa medications allergy, tramadol allergy, alcohol user, and cigarette smoker, and other pre-existing medical conditions included no drug abuse or illicit drug usage. The patient received covid-19 vaccine (suspension for injection, route of admin not reported, batch number: 204A21A, expiry: 23/JUN/2021) dose was not reported, administered on 13-MAY-2021 for prophylactic vaccination. No concomitant medications were reported. On 14-MAY-2021, the subject experienced sweat. On 14-MAY-2021, the subject experienced fever. On 14-MAY-2021, the subject experienced nausea. On 14-MAY-2021, the subject experienced headache. On 14-MAY-2021, the subject experienced injection site pain. On 14-MAY-2021, the subject experienced tired. Laboratory data included: Body temperature (NR: not provided) 100.9 F. The action taken with covid-19 vaccine was not applicable. The patient recovered from nausea, and tired on 14-MAY-2021, was recovering from fever, and sweat, and had not recovered from headache, and injection site pain. This report was non-serious.


VAERS ID: 1325880 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Utah  
Vaccinated:0000-00-00
Onset:2021-05-14
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Underdose
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: Non-smoker
Preexisting Conditions: Comments: The patient had no known allergies and did not have drug abuse or illicit drug. The patient was not pregnant at the time of reporting.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210529751

Write-up: UNDERDOSE; This spontaneous report received from a pharmacist concerned a 65 year old female. The patient''s height, and weight were not reported. The patient''s concurrent conditions included non smoker, and other pre-existing medical conditions included the patient had no known allergies and did not have drug abuse or illicit drug. the patient was not pregnant at the time of reporting. The patient received covid-19 vaccine (suspension for injection, route of admin not reported, batch number: Unknown) dose was not reported, administered on 14-MAY-2021 for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On 14-MAY-2021, the subject experienced underdose. The action taken with covid-19 vaccine was not applicable. The outcome of underdose was not reported. This report was non-serious.


VAERS ID: 1325881 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Florida  
Vaccinated:0000-00-00
Onset:2021-05-14
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808982 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Cold sweat, Cough, Diarrhoea, Fatigue, Nausea
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Pseudomembranous colitis (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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210529754

Write-up: COLD SWEATS; COUGHING; DIARRHEA; TIRED AND SLEEP; NAUSEA; This spontaneous report received from a consumer concerned a 44 year old male. The patient''s weight, height, and medical history were not reported. The patient received covid-19 vaccine (suspension for injection, route of admin not reported, batch number: 1808982, expiry: UNKNOWN) dose was not reported, administered on 14-MAY-2021 for prophylactic vaccination. No concomitant medications were reported. On 14-MAY-2021, the subject experienced cold sweats. On 14-MAY-2021, the subject experienced coughing. On 14-MAY-2021, the subject experienced diarrhea. On 14-MAY-2021, the subject experienced tired and sleep. On 14-MAY-2021, the subject experienced nausea. The action taken with covid-19 vaccine was not applicable. The outcome of the cold sweats, tired and sleep, diarrhea, coughing and nausea was not reported. This report was non-serious.


VAERS ID: 1325887 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Utah  
Vaccinated:0000-00-00
Onset:2021-05-14
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Fatigue
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: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210529861

Write-up: FEELING SLIGHTLY TIRED; This spontaneous report received from a patient concerned a 77 year old male. The patient''s weight, height, and medical history were not reported. The patient received covid-19 vaccine (suspension for injection, route of admin not reported, and batch number: 205A21A expiry: 23-JUN-2021) dose was not reported, administered on 14-MAY-2021 16:00:00 for prophylactic vaccination. No concomitant medications were reported. On 14-MAY-2021, the subject experienced feeling slightly tired. The action taken with covid-19 vaccine was not applicable. The outcome of feeling slightly tired was not reported. This report was non-serious.


VAERS ID: 1325890 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: Illinois  
Vaccinated:0000-00-00
Onset:2021-05-14
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / UNK - / -

Administered by: Military       Purchased by: ?
Symptoms: Body temperature, Headache, Palpitations, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data: Test Date: 20210514; Test Name: Body temperature; Result Unstructured Data: 102 F
CDC Split Type: USJNJFOC20210529976

Write-up: PALPITATIONS; HEADACHE; FEVER 102 F; This spontaneous report received from a patient concerned a 26 year old male. The patient''s weight, height, and medical history were not reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 207A21A, expiry: UNKNOWN) dose was not reported, administered on 14-MAY-2021 for prophylactic vaccination. No concomitant medications were reported. On 14-MAY-2021, the subject experienced palpitations. On 14-MAY-2021, the subject experienced headache. On 14-MAY-2021, the subject experienced fever 102 f. Laboratory data included: Body temperature (NR: not provided) 102 F. Treatment medications included: ibuprofen. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from headache, fever 102 f, and palpitations. This report was non-serious.


VAERS ID: 1325892 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:0000-00-00
Onset:2021-05-14
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Abstains from alcohol; Drug allergy (Rash, hives); Iodine allergy (Burns skin); Latex allergy (red marks on skin); Non-smoker
Preexisting Conditions: Comments: The patient was not a drug abuse or illicit drug user.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210530009

Write-up: RED SPOTS ON BOTH THIGHS; This spontaneous report received from a patient concerned a 63 year old female. The patient''s height, and weight were not reported. The patient''s concurrent conditions included morphine allergy, betadine allergy, abstains from alcohol, non-smoker, and latex allergy, and other pre-existing medical conditions included the patient was not a drug abuse or illicit drug user. The patient received covid-19 vaccine (suspension for injection, route of admin not reported, and batch number: 206A21A expiry: 23-JUN-2021) dose was not reported, administered on 04-MAY-2021 13:00 for prophylactic vaccination. No concomitant medications were reported. On 14-MAY-2021, the subject experienced red spots on both thighs. The action taken with covid-19 vaccine was not applicable. The patient recovered from red spots on both thighs on 14-MAY-2021. This report was non-serious.


VAERS ID: 1326059 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Confusional state, Dizziness, Feeling hot, Hypoacusis, Malaise, Nausea
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hearing impairment (narrow), Vestibular disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Multi-vitamin supplement
Current Illness: None. No illnesses in the past year.
Preexisting Conditions: None.
Allergies: One antibiotic (don''t remember name), nitrous oxide
Diagnostic Lab Data: Confusion during this incident leads me to not recall exact medical test numbers. Blood glucose test was fine. However, blood pressure was in the low 70''s and then steadily rose to 140 or so. Please contact staff at Health Center (info provided on this form) for exact information.
CDC Split Type:

Write-up: Remained in waiting room for 15 minutes as per instructions from medical staff. Within approximately 10 minutes of administration, I experienced a wave of warmth that led to a feeling that I would pass out. Called out to nursing staff that I was feeling "dizzy" (didn''t know what else to call it). It was not like normal dizziness. Remained seated with legs stretched out to try to combat the feeling I would pass out. Nurses checked my blood pressure and it was in the low 70''s. Along with low blood pressure, I experienced temporary hearing loss in left ear, nausea (feeling I could throw up), feeling I could diarrhea/defecate immediately (but held it in for obvious reasons), mental confusion. Nurses called the Emergency Department at my local hospital and told me I should (based on symptoms) be admitted to the hospital. Nurse said my blood pressure wasn''t stabilizing at a normal rate of a typical vasovagal reaction. Nurse withheld administering Epipen and monitored the course of my symptoms. EMTs arrived and checked my vitals again in the Ambulance. In the Ambulance, I recall the technician saying my blood pressure was somewhere around 140. This reading is abnormally high for me (my typical blood pressure is around 110). I declined admission to the hospital due to my horrible medical insurance and worry about exorbitant costs. Symptoms did not resolve until approximately 50 minutes after the start of the incident (approx. 9:22 AM).


VAERS ID: 1326597 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / IM

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

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

Write-up: Patient received first dose on 4/30/21 and received second dose too soon.


VAERS ID: 1326625 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-04-01
Onset:2021-05-14
   Days after vaccination:43
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP6955 EXP 6/21 / 2 RA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lisinopril, Ezetimibe, Aspirin, multi vitamin, CoQ10, Fish Oil, Biotin
Current Illness: None
Preexisting Conditions: High blood pressure and high cholesterol
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Dizziness and Vertigo like symptoms


VAERS ID: 1326646 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-05-13
Onset:2021-05-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood creatine phosphokinase increased, Brain natriuretic peptide normal, Chest X-ray normal, Chest pain, Condition aggravated, Echocardiogram, Electrocardiogram, Electrocardiogram ST segment elevation, Fibrin D dimer, Red blood cell sedimentation rate increased, Troponin increased, Urine analysis, White blood cell count normal
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: No known
Allergies: No known
Diagnostic Lab Data: 5/15: EKG with diffuse ST elevation, troponin elevated to 2.39, bedside Echo w/o evidence of effusion, Chest Xray unremarkable. WBC 11.9, ESR 15, CK 366. Electrolytes, d-dimer, BNP were unremarkable; Utox negative. 5/16: CK-MB 99.3, CK 1,328, Trop 20.27-$g 13.42-$g6.56-$g8.38, proBNP 170, echo with normal LV function and no effusion 5/17: Troponin 8.29 -$g 3.63 -$g2.98
CDC Split Type:

Write-up: Received second Pfizer Covid-19 vaccine on Thursday 5/13 without acute adverse events. The following day he developed substernal non radiating pleuritic chest pain that kept him awake all night. The following morning pain progressively worsened so he went to the emergency room.


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