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

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



Case Details (Reverse Sorted by Onset Date)

This is page 165 out of 6,867

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VAERS ID: 1541337 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009C21A / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Chest discomfort
SMQs:, Anaphylactic reaction (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: amlodipine, Claritin
Current Illness: high bp
Preexisting Conditions: high blood pressure
Allergies: lisinopril
Diagnostic Lab Data: 08/10/21 Blood pressure 120/80 is normal Heart rate: 97 is normal
CDC Split Type:

Write-up: Incident occurred at about 6:50pm. The patient complained of pressure in her chest. Patient said she has a history of hypertension. She was asked to lay down for awhile. Checked blood pressure and heart rate. Patient was advised to follow up with provider. Pt felt over 90% better and declined assistance to her vehicle.


VAERS ID: 1541339 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017B21A / 1 AR / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Post vaccination expressed feelings of nausea, dizziness, and syncope. Did not pass out, recovered and left ambulating independently with male companion.


VAERS ID: 1541340 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Dizziness, Fatigue, Flushing, Heart rate increased, Hypoaesthesia, Palpitations, Throat tightness
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypersensitivity (broad), Dehydration (broad), Sexual dysfunction (broad)

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

Write-up: Within 5 minutes of shot, experienced extreme tiredness and flushing of face, tightening of the throat, chest pain, heart pounding, numbness of neck and collarbone, rapid pulse, and dizziness. Staff provided a juice box and said to remain seated. Most symptoms subside but numbness spread and got worse. It spread to rest of head and back. When told about continued numbness after 30 minute, staff said patient could go and if it continues, benadryl should be taken and 911 called. Numbness spread to back and patient took 10 mg of liquid benadryl which took effect within 10 minutes.


VAERS ID: 1541341 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Feeling jittery, Heart rate increased
SMQs:, Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Nikki birth control pill
Current Illness: Urinary
Preexisting Conditions: GERDS
Allergies: Nuts, penicillin of any kind, Bactrim
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Jittery and rapid heartrate 114 beats per minute.


VAERS ID: 1541345 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Kansas  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002F21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Syringe issue
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: AFTER INJECTING PATIENT WITH NEEDLE AND TRYING TO PUSH VACCINE INTO PATIENT''S ARM, THEN VACCINE LEAKED OUT BETWEEN THE SYRINGE AND NEEDLE AND DRIPPED DOWN PATIENT''S ARM.


VAERS ID: 1541348 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0716 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Discomfort, Full blood count, Haematocrit, Haemoglobin, Hypoaesthesia, Metabolic function test, Pain in jaw, Paraesthesia, Red blood cell nucleated morphology, Swelling face
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Osteonecrosis (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Amoxicillin
Diagnostic Lab Data: BMP with Hgb.Hct, POCT Chem 8 with Hematocrit, i-STAT, Point of Care, Blood Complete Blood Count Nucleated RBC
CDC Split Type:

Write-up: Within 35 minutes of the vaccine administration I experienced discomfort in my jaw (left) and numbness and swelling in my cheek (left). I was driven directly to an clinic who directed me to the ER. Clinic performed bloodwork and observation. Bloodwork considered normal. Discharged with information on paresthesia and told to contact primary physician or return to the hospital if symptoms worsened. No symptom change at the time of this report, 4 hours post vaccination.


VAERS ID: 1541350 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040C21A / 3 LA / IM

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

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

Write-up: Patient received third dose of Moderna covid-19 vaccine in August 2021. Patient completed series with last injection on 02-18-21.


VAERS ID: 1541353 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-08-09
Onset:2021-08-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain upper, Cardiac arrest, Chills, Dizziness, Fatigue, Headache, Nausea, Pain, Pyrexia
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Respiratory failure (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 at time of vaccination. Upper respiratory illness from 7/21-7/31.
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: She was seen by a physician as we were concerned that her racy heart could be caused by myocarditis. There was no official diagnosis, but the doctor seemed to think she''s ok, so we held off on the EKG and blood work.
CDC Split Type:

Write-up: My daughter got extremely ill after the second dose. She developed a fever, chills, racing heart, headache, stomach ache, nausea, body aches, dizziness, and fatigue.


VAERS ID: 1541360 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033B21A / 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? 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: nka
Diagnostic Lab Data: none
CDC Split Type:

Write-up: the second vaccine was inadvertently administered on day 21 , I let the patient know that even though it was administered early it does not need to be readministered


VAERS ID: 1541367 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: Rhode Island  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 088D21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Condition aggravated, Fall, Hyperhidrosis, Pallor, Seizure, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

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

Write-up: Patient was walking out the immunization room and fell about a minute after receiving the vaccine. He appeared to be having a seizure but quickly gained consciousness. Mom was with him and refused for me to call 911. He then began to vomit on his side laying down. I eventually got him to sitting up he was pale and sweaty, put cold packs on him and wet wash clothes. He drank a cold water slowly and I gave him 2 Benadryl tablets. after about 15 minutes he was able to stand and I helped him out to the car with his mother.


VAERS ID: 1541368 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 1 LA / IM

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

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

Write-up: Patient was given first dose of Pfizer-BioNTech today 8/10/21 but had received another COVID19 vaccine product in previously. Patient tolerated vaccination well without side effects/symptoms in office


VAERS ID: 1541371 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-08-09
Onset:2021-08-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808982 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Chills, Dysphagia, Fatigue, Injection site pain, Musculoskeletal stiffness, Pyrexia, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (broad), Parkinson-like events (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), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: synthroid cytomel lisinopril
Current Illness: asthma attack had to use Proventil inhaler a week before
Preexisting Conditions: obese HBP
Allergies: sulfa lidocaine
Diagnostic Lab Data:
CDC Split Type:

Write-up: Started feeling tired and wiped out and went to bed around 8 pm around midnight woke up to extremely high fever with significant chills, shaking and muscles in head and neck locked in middle of the night extreme difficulty swallowing pills. Aching pain in all joints. Fever did respond to tylenol and gatorade after several hours. Still significant pain in injection site post 24 hours even with massage therapy and hot shower.


VAERS ID: 1541372 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Pallor
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad)

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

Write-up: Patient became pale and felt faint within 10 minutes of receiving vaccine


VAERS ID: 1541374 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cold sweat, Fear of injection, Muscle twitching, Pallor, Shock, Speech disorder, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Dementia (broad), Dyskinesia (broad), Dystonia (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Routine vaccinations
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Hx of faint, pale after other vaccinations, but came back within first 10 minutes
Diagnostic Lab Data: None
CDC Split Type:

Write-up: 15 y/o male with hx of faint/pale from previous other vaccines (came back to normal within first 10 minutes) came to our pharmacy to get his 1st Pfizer COVID-19 vaccine. His mother and the patient both aware of the vaccine may cause the similar reaction and agreed to get the vaccine. Around 4:10pm I gave him a candy, then I have administered the vaccine. I monitored him about 2 minutes, I asked if he wanted some water, he said yes. While I went to go grab a bottle of water, he fainted and fell on ground. He started turning pale, showing of cold sweat, and twitching. I continuously monitored, checked his vital which was within normal range. He was responsive to my questions. 5 minutes later, he wanted to throw up and his mother told us he ate around 2pm. Around 4:40pm I had someone to call 911 for medical checkup after patient''s mom agreed to. EMS arrived within 10 minutes, they checked vital and his condition. After the examination, they concluded that he had a shock from the fear of the needle. My concern is that he was able to answer with shaking & nodding his head, and thumbs up and down, however not able to speak. Medics tried to make him to say his name, but he was not able to. Patient''s mother decided to carry him to the ambulance. I will make a follow up call to the patient to see if any progress is made.


VAERS ID: 1541375 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-08-01
Onset:2021-08-10
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Pain in extremity, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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: Marlissa birth control
Current Illness: None
Preexisting Conditions: Asthma
Allergies: Morphine
Diagnostic Lab Data:
CDC Split Type:

Write-up: Arm pain, fatigue, headache, vomiting


VAERS ID: 1541376 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ezetimibe , metoprolol, famotidine , hydrochlorothiazide
Current Illness: na
Preexisting Conditions: na
Allergies: lisinopril, codeine, penicillins , statins , propoxyphene, amlodipine
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: pt felt like she was breaking out in rash, she was pointing to the interparts of her fingers and her legs.


VAERS ID: 1541384 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024C21A / 1 LA / IM

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

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

Write-up: Medication error by administering Moderna vaccine to a 14 year old female patient. Immediately notified Mom and patient who were in the car waiting the mandatory 15 minutes after any given vaccine, called Moderna @ 1420, spoke to representative for Moderna.


VAERS ID: 1541388 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Muscular weakness, Swollen tongue, Throat tightness
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (broad), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (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: pt stated started feeling weak in legs and her throat got tight after vaccination. no problems breathing but tongue did swell slightly.


VAERS ID: 1541391 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 035C21A / 2 LA / IM

Administered by: Unknown       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: Pt received second of Moderna Vaccine 1 week early.


VAERS ID: 1541396 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: Hawaii  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 LA / IM

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

Write-up: Patient felt dizzy then fainted about 5 minutes after getting the vaccine


VAERS ID: 1541401 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Rhode Island  
Vaccinated:2021-08-08
Onset:2021-08-10
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Tonsillar hypertrophy
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow)

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

Write-up: At the dentist today it was brought to my attention that my daughter tonsils are very swollen. She has no fever, no soar throat, and no difficulty breathing or swallowing. I dont know if her swollen tonsils were present before her vaccine or if they developed as a side effect of the vaccine or are an unrelated development within the last 2 days.


VAERS ID: 1541407 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: New Mexico  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anxiety, Dizziness, Mouth swelling, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Anticholinergic syndrome (broad), Oropharyngeal allergic conditions (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Vestibular disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: About 15 minutes after receiving the vaccine the patient returned to the pharmacy with his wife saying he was feeling dizzy. We had him sit in the consultation room for observation. After a few more minutes upon asking if he felt any swelling of his lips, tongue or throat pt reported that his mouth felt like it may be swelling but he wasn''t sure if he was just having anxiety. Upon further questioning he felt like it definitly could be swelling. I administered 0.3mg of epinephrine via epipen in the right outter thigh. I called 911 and had paramedics come to the pharmacy. They took him to the hospital. Pt''s wife came in a couple hours later and said that he did break out in hives and they were treating him but she didn''t know with what and that they were already going away.


VAERS ID: 1541618 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002F21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cold sweat, Dizziness, Heart rate decreased, Hyperhidrosis, Pallor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: About 1 min after injection the pt became pale and clammy. He started sweating. His heart rate dropped and he said he felt like he was going to pass out. 911 was called.


VAERS ID: 1541620 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: Oklahoma  
Vaccinated:2021-08-04
Onset:2021-08-10
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052E21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Bone pain, Burning sensation, Rash, Rash erythematous
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Osteonecrosis (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: Spironolactone, Coreg, Albuterol 0.083%, Lasix, Amiodarone, Eliquis, Losartan
Current Illness: RSV 1 month ago
Preexisting Conditions: CHF
Allergies: NKDA
Diagnostic Lab Data: advised patient went to dr and patient refused treatment, over the phone.
CDC Split Type:

Write-up: Patient states that within 24 hours he started feeling like his bones were on fire and has a red rash all over his body - refused medical treatment


VAERS ID: 1541622 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Hyperhidrosis, Somnolence, Syncope, Tinnitus, Tremor, Vision blurred
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Glaucoma (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Hearing impairment (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Patient did not report any prescription medication, dietary supplement or herbal remedy use.
Current Illness: Patient did not report any illnesses
Preexisting Conditions: Patient did not report any health conditions
Allergies: NKDA
Diagnostic Lab Data: no medical tests were conducted at the time of the event.
CDC Split Type:

Write-up: Approximately 3 minutes after receiving the first dose of the Pfizer Covid 19 vaccine, the patient fainted. Symptoms included sweating, shaking, ringing ears and blurred vision. Patient also stated he felt as if he was tired all of a sudden and "fell asleep."


VAERS ID: 1541627 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-08-09
Onset:2021-08-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / N/A LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Fever and urticaria following Anthrax vaccine in 1998, ROK, US ARMY
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Nausea, fever, aches, chills, headache.


VAERS ID: 1541631 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 1 LA / IM

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

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

Write-up: The reason for this submission is due to patient stated verbally that she was here for 1st covid shot and also indicating on questionaire that she has not received any covid vaccines. I was documenting vaccination in chart when red flag popped up indicating that she was complete for covid vaccine. She had previously received the Johnson and Johnson vaccine on 04/28/21. She failed to mention this 3 times when asked. She then said that she wanted to get vaccinated with the Pfizor or Moderna due to the Delta variant and wanted better protection. We informed her that this shot should not have occurred and she will need no further vaccination. She then requested to receive the 2nd pfizer shot and we informed that it was not necessary.


VAERS ID: 1541633 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-08-09
Onset:2021-08-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / N/A LA / IM

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

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

Write-up: Fever, body aches, headache, chills, nausea.


VAERS ID: 1541641 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052E21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Hyperhidrosis, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (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? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Info not available
Current Illness: None
Preexisting Conditions: None
Allergies: none
Diagnostic Lab Data: not known
CDC Split Type:

Write-up: Pt felt lightheaded and sweaty about 10 minutes after 1st Moderna dose. She fainted and then about 30 sec later became responsive. She continues to feel lightheaded and sweating. EMT is called and attended to pt.


VAERS ID: 1541642 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Louisiana  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002F21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Eye movement disorder, Fall, Hyperhidrosis, Seizure, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

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

Write-up: Immediately upon injecting patient, patient fell over and started having convulsions. Patient was not responding to our questions but was breathing. Patient could not open eyes and was sweating. After about 10 minutes patient came thru with no intervention needed. EMS was called, but patient refused to go with them.


VAERS ID: 1541644 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Confusional state, Dizziness, Dyspnoea, Incoherent, Seizure
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Dementia (broad), Convulsions (narrow), Acute central respiratory depression (broad), Psychosis and psychotic disorders (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None reported
Current Illness: None reported
Preexisting Conditions: None reported
Allergies: None reported
Diagnostic Lab Data: BP 90/45 approx 5 minutes post injection.
CDC Split Type:

Write-up: 30 YO Male patient received injection of Janssen (lot#202A21A) at 4:31 PM PST, at 4:35 he complained of being dizzy and within a few seconds became incoherent and had a seizure that lasted about 10 seconds. He awoke lucent yet confused about what occurred. I told him he had a seizure and took his blood pressure at 90/45. He started to complain about having difficulty breathing. Staff called 911. EMR arrived within minutes and took his blood pressure again. I observed his BP on the EMR monitor to be at 98/68. The patient reported he was feeling somewhat better and able to breath better. He was transported to Providence ER at 5:02 PM lucid and alert.


VAERS ID: 1541646 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: West Virginia  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

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

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

Write-up: Dizziness with 15 minutes and lasted 2 hours, brain fog within 1 hour( still ongoing 4 hours after) headache within 1 hour( ongoing 4 hours later), slight nausea within 1 hour and lasted about 1 hour.


VAERS ID: 1541647 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: New York  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 2 LA / IM

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

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

Write-up: 12yo child complained of very itchy arm and redness after second dose of pfizer covid 19 vaccine. Offered dose of childrens benadryl 10ml to grandmother whom gave permission to administer. Grandmother stated child was 105/110 pounds. Family and patient left 15 min later with no further complaints


VAERS ID: 1541649 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Heart rate increased and experiencing little palpitations. paramedics came over checking out rates and back to normal about 5 minutes


VAERS ID: 1541651 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003F21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Amnesia, Cold sweat, Dizziness, Fall, Loss of consciousness, Musculoskeletal stiffness
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Arthritis (broad), Hypoglycaemia (broad)

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

Write-up: Patient received vaccine and said he felt fine, was surprised by this because he usually faints when getting blood drawn and around needles. Was talking to pharmacist and wife for 2 minutes post shot and then leaned over slowly and fell sideways. The pharmacist caught his head but he had passed out and his body was stiff. Patient was breathing fine and "Woke" up 10 seconds later. He did not know what happened and where he was temporarily. Patient said he felt fine but became clammy and light headed 2 minutes after that incident. He drank water and sat on the floor for 20 more minutes per the pharmacist''s request and then felt fine.


VAERS ID: 1541656 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 RA / -

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

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

Write-up: hives on arm and back


VAERS ID: 1541658 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Rhode Island  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821281 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cold sweat, Dizziness, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Anticholinergic syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Vestibular disorders (broad), Hypoglycaemia (broad)

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

Write-up: patients arm started to swell right away after given injection, applied ice, swelling started to decrease, after about a minute patient complained of feeling lightheaded and felt he was going to pass out/never did stayed seated entire time, then a few minutes after that patient had cold sweats, called 911, stayed with patient entire time until rescue arrived. no tightness in chest or breathing issues, patient started to feel a little better when they arrived, took them about 10 minutes to arrive. patient did go with rescue to hospital to be checked.


VAERS ID: 1541659 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-08-08
Onset:2021-08-10
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 00F21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Orthostatic hypotension, Skin discolouration
SMQs:, Anticholinergic syndrome (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (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: Wellbutrin 300mg PO daily Melatonin 5mg PO qhs Omega 3 1000mg po daily
Current Illness: None
Preexisting Conditions: Asthma in remission for over 4 years
Allergies: No know drug allergies or food allergies
Diagnostic Lab Data: None available.
CDC Split Type:

Write-up: After exercise (typical for my lifestyle) I experienced my first instance of what seemed to be orthostatic hypotension. After standing up from bending over in the shower, roughly 10 minutes after exercise, my wife had to catch me from falling over as I became lightheaded, dizzy and lost color to my face. After 10-15 seconds I regained full neurological function.


VAERS ID: 1541661 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 2 LA / IM

Administered by: Public       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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: Unkown
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient reported that upon arrival to the observation period he felt "palpitations." The patient stated the palpitations lasted about 30 seconds. The patient denied any shortness of breath, itching, dizziness, or chest pain. Educated the patient and his mother regarding s/s of anaphylaxis and when to seek EMS. The patient stated he was feeling well and denied any persistent palpitations. The patient was drinking water. The patient stated that he was feeling anxious prior to receiving the vaccine. The patient did eat today prior to receiving the vaccine. The patient denies any chronic conditions. The patient does not take any medications regularly. The patient has no known allergies. Vitals obtained at 3:43PM were as follows: BP 119/72, HR 73, O2 98%.


VAERS ID: 1541672 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: New York  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Hyperhidrosis, Paraesthesia, Photopsia, Visual impairment
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (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: None
Current Illness: None
Preexisting Conditions: None
Allergies: Sou, neomycin, propylinegycol, fish mix, milk wheat , sunscreen
Diagnostic Lab Data: Allergy test 8/6/21
CDC Split Type:

Write-up: Upon injection (it?s like I?m seeing stars) to Few minutes after shot- lightheadedness, until now. Vision change, tingling on hands, sweating feet (slight)


VAERS ID: 1541819 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood pressure immeasurable, Hyperhidrosis, Hypotension, Loss of consciousness, Nausea, Pallor, Pulse abnormal, Slow response to stimuli, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

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

Write-up: Patient fainted after a few minutes of receiving vaccine. After regaining consciousness the patient was very pale, sweating, and nauseous. We tried to take the patients blood pressure but it was low enough to cause an error reading on the monitor and her pulse was weak. The patient remained very slow to respond and emergency was call and patient was taken to the ER.


VAERS ID: 1541822 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 078C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Balance disorder, Cold sweat, Dizziness, Fall, Lip injury, Loss of consciousness, Pain, 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), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

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

Write-up: After receiving the shot, Patient went to the restroom. He felt dizzy, wobbled a little, got back his balance, and as he walked out of the restroom, lost his balance and passed out. He fell to the ground and possibly fell onto a nearby cart. He quickly regained consciousness, but was clammy and pale. He split his lip and is very sore throughout his body. After sitting for several minutes, drinking water and drinking a berry smoothie, color came back to his face and he was coherent, able to carry on a conversation. He mentioned that he hadn''t eaten after breakfast. The pharmacist administering the vaccine reported that he was nervous prior to getting the shot.


VAERS ID: 1541824 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3186 / 1 - / IM

Administered by: Other       Purchased by: ?
Symptoms: Chest pain, Pharyngeal enanthema, Rash
SMQs:, Anaphylactic reaction (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (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? Yes
Hospitalized? No
Previous Vaccinations: Flu shot
Other Medications: Patient said she was not sick but when i called the patient later to check on her, mom said that she was taking Vancomycin for infection.
Current Illness: Patient said no but later mom said she was taking Vancomycin for an infection
Preexisting Conditions: Asthma
Allergies: Patient is allergic to penicillin
Diagnostic Lab Data: not known
CDC Split Type:

Write-up: About 20 minutes after administering the vaccine, I checked on the patient and she said she has chest pain. I asked our intern to stay with the patient while i called 911. The emergency crew arrived, completed the tests and advised to take her to the hospital. I called the mom later to check on her, mom told me that patient developed rash on her skin and throat. She was given oral Benadryl


VAERS ID: 1541826 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 RA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Anxiety, Discomfort, Pruritus, Tachycardia, Tachypnoea
SMQs:, Anaphylactic reaction (narrow), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Spironolactone (new, 1st dose taken 45 minutes prior to vaccination), albuterol MDI, gabapentin, others for heart failure (patient unsure)
Current Illness: Recent hosp Medical Center for heart failure exacerbation.
Preexisting Conditions: Heart failure, pre-diabetes, morbid obesity, ?neuropathic pain?
Allergies: No known drug allergies. Son explained patient is also allergic to peanut butter (itching), patient did not report this during consent process.
Diagnostic Lab Data: None
CDC Split Type:

Write-up: ~10 minutes after in-home vaccine administration, patient complained of significant localized itching of lower aspects of feet bilaterally, causing anxiety, some mild tachypnea (RR ~20), and mild tachycardia (HR ~110, regular). No other symptoms, including absence of upper airway problems, dermal reactions, or evidence of hypo perfusion but in significant discomfort (patient rated 10/10). Due to obesity & long fingernails, pulse ox & BP were not detectable. Following some deep breathing exercises, anxiety and tachycardia improved and patient given diphenhydramine 25mg po x 1 ~2:35pm. Symptoms improved (rated 5/10) at 2:50pm, HR ~100 (regular), RR normal. 3:15pm: itching much improved (2/10), patient ambulated to couch without incident. 3:30pm: symptoms mostly gone, patient much more comfortable. 4:15pm: symptoms resolved.


VAERS ID: 1541828 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Mississippi  
Vaccinated:2021-08-09
Onset:2021-08-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0175 / 3 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lisinopril, Zyrtec, singulair, metformin, vyvanse, trentellix, MVI, fiber, ambien, baclofen
Current Illness: None
Preexisting Conditions: DmII, ADHD, HTN, seasonal allergies, anxiety
Allergies: NSAIDs, adhesive
Diagnostic Lab Data:
CDC Split Type:

Write-up: Nausea 8/9/2021 1900 Dizziness 8/10/2021 0515 all day Fainting 8/10/2021 0515 one occurrence


VAERS ID: 1541833 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Hawaii  
Vaccinated:2021-06-21
Onset:2021-08-10
   Days after vaccination:50
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: meloxicam
Current Illness: none
Preexisting Conditions: fatty liver, emphysema, hyperlipidemia, BPH
Allergies: NKDA
Diagnostic Lab Data: SARS-COV2-NAA
CDC Split Type:

Write-up: tested positive for Covid 19


VAERS ID: 1541841 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 LA / IM

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

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

Write-up: Patient moved from vaccine area to observation in pharmacy lobby, told his dad he didn''t feel good and passed out before dad could get him to sit down. Patient came to immediately, asked for a sip of water. Checked pulse and monitored patient for worsening symptoms. questioned patient on meals, activity before vaccine=he had not eaten since dinner night before. Patient moved to chair, where he and his dad waited for 30 mins. Symptoms improved after water and a couple pieces of candy. Color and pulse were normal when patient left lobby


VAERS ID: 1541842 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Blood pressure increased, Dizziness, Heart rate increased, Nervousness
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Hypertension (narrow), Vestibular disorders (broad), Hypoglycaemia (broad), Dehydration (broad)

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

Write-up: Client reported dizziness at 6:46 PM. The client ambulated and sat in the anti-gravity chair. The client denied any other s/s of anaphylaxis. The client''s father stated that red markings on the client''s face have been present for several years. The client last ate around 2:00PM and drank water about one hour ago. Vitals obtained at 6:47PM were as follows: BP 154/99, HR 99, O2 99%. Repeat vitals obtained without the client''s sweatshirt on at 6:51 PM were as follows: BP 138/85, HR 91%, O2 99%. The client stated the dizziness had resolved. He states that he was feeling nervous about getting the vaccine and is still currently feeling nervous. The client denies any chronic conditions or cardiac conditions. The client has no known allergies. The client does not take any medications regularly. Educated the client and his father regarding elevated BP, importance of hydration, when to seek EMS, and s/s of anaphylaxis. The client''s father states he has a blood pressure cuff at home. Educated the client''s father on normal BP range and suggested the client follow up with PCP regarding elevated BP. The client''s father voiced understanding of this. The client stood up at 6:54 PM and denied any s/s of anaphylaxis or dizziness. The client sat down again. Repeat vitals obtained at 7:00PM were as follows: BP 128/82, HR 101, and O2 99%.


VAERS ID: 1541843 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-09
Onset:2021-08-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052E21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Adverse reaction, Erythema, Pain, Peripheral swelling, Pyrexia
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (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)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: type 1 diabetes
Allergies: amoxicillin allergy
Diagnostic Lab Data:
CDC Split Type:

Write-up: On 8/10/21 at 5:33pm, patient called the pharmacy that she had a reaction to moderna shot. Had red swollen arm and getting fever. She called her dr and her dr recommended tylenol for the pain and fever. I said if not doing better to check back with the doctor.


VAERS ID: 1541849 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-08-09
Onset:2021-08-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Disturbance in attention, Fatigue, Headache, Injected limb mobility decreased, Rash, Somnolence, Swelling face
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Depression (excl suicide and self injury) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Pain and swelling of arm
Other Medications: Furosemide
Current Illness:
Preexisting Conditions: Left Ventricular Hydropathy
Allergies: Penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Extreme fatigue and sleepiness. Slept for 20+ hrs beginning 8/10/2021 Mild to moderate heaches Difficulty in concentration Rash and swelling of face Inability to fully raise arm where the injection was. Symptoms still ongoing


VAERS ID: 1541909 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006D21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Dizziness, Gait disturbance, Hyperhidrosis, Hypoaesthesia, Nausea, Sluggishness
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypoglycaemia (broad), Sexual dysfunction (broad)

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

Write-up: patient received his second moderna vaccine. He came in with a female companion. After the vaccine he was asked to go the waiting area for 15 minutes. I left the immunization booth to give them a minute to there belongings as I prepare for the next vaccine patient. After two or so minutes when I returned the patient was still seated with the head leaning forward and had out trash can in front of him, He was not throwing up but he said he was feeling nauseated and also looked as if he was sweating, He was able to answer all my questions during the entire event.. He later said he was feeling dizzy and light headed. He did not want to lay down but he accepted a bottle of water. After about 10 minutes he he said his right arm was numb. (vaccine was given on the left arm). at that point he was more sluggish. at that time I told the female companion that we have to call ems because she was starting to contemplate taking him to the urgent care herself. The ems were called. The patient state did not change all up to the time the ems got here. At one point while waiting for the ems the wanted to leave because he did not want to go the hospital but he could not gather enough strength to walk by himself.


VAERS ID: 1542058 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 088D21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Ear discomfort, Hypoaesthesia, Injection site swelling
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Sexual dysfunction (broad)

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

Write-up: PATIENT felt numbness in her face and swelling of the side where she got her shot.patient stated even her ears feels numb


VAERS ID: 1542064 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD 8448 / UNK - / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Computerised tomogram, Dizziness, Exposure during pregnancy, Full blood count, Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Aspirin and prenatal vitamins
Current Illness: No
Preexisting Conditions: No
Allergies: No
Diagnostic Lab Data: CBC blood test: 8/10/2021 CT scan: 8/10/2021
CDC Split Type:

Write-up: Patient is 20 weeks pregnant with a due date of 12/27/2021. Has factor V leiden mutation for which takes aspirin. 7-8 minutes after first dose, patient started getting dizzy and passed out. Did not suffer injury as was sitting in chair. Went to emergency room and was given CT to rule out blood clots and pulmonary embolism. Patient discharged feeling better.


VAERS ID: 1542067 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Delaware  
Vaccinated:2021-08-02
Onset:2021-08-10
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939902 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site erythema, Injection site pain, Injection site pruritus, 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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Asthma, eczema
Allergies: Penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Injection site red, swollen, itchy, tender


VAERS ID: 1542069 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: No medications recorded on patient''s pharmacy profile
Current Illness: None
Preexisting Conditions: None
Allergies: None per patient. However, patient states he does experience outbreaks towards a specific detergent, but it has not be diagnosed by a healthcare provider yet
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient returned to pharmacy ~30 minutes after the immunization. Patient states he had an outbreak on his forehead (could see bumps on head) starting ~25 minutes after immunization; patient noticed the outbreak while waiting in car and while talking to his mother on the phone (patient left pharmacy waiting area after sitting there for 10 - 15 minutes. Patient stated the outbreak was slightly itchy. When asked if patient had difficulty breathing or experienced swelling, he denied it. Advised patient to take Benadryl for the rash and go to the ER if necessary. Called patient ~30 minutes after he left pharmacy to see how he was doing, patient stated he was doing okay and did take a Benadryl, still had the outbreak (still slightly itchy and bumpy, but also occurred partially around the chin/mouth area). However, patient also denied having difficulty breathing or experiencing swelling. Then advised patient to go to ER for further evaluation to be extra safe.


VAERS ID: 1542071 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-08-09
Onset:2021-08-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 2 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Chills, Dizziness, 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: This morning after his second shot yesterday he had a fever of 99. This afternoon about 24 hours after his vaccination it was 100.8. Normal for him is 97.5. He''s complained of chills also and dizziness.


VAERS ID: 1542072 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dyspnoea, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: None reported
Preexisting Conditions: Lupus, mast cell activation syndrome, idiopathic angioedema
Allergies: Yes reported Iodine and Toradol
Diagnostic Lab Data:
CDC Split Type:

Write-up: Injected COVID Pfizer vaccine LOT FC3181 IM left deltoid. Patient 5 minutes later reported trouble breathing and closing of airways. EMS was notified immediately and patient was given 50 mg of diphenhydramine and monitored. Patient was transported to hospital for further evaluation and monitoring.


VAERS ID: 1542082 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-02
Onset:2021-08-10
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / -

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

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

Write-up: Delayed reaction. Injection site turned red and warm, painful. 8 days after injection


VAERS ID: 1542083 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blindness, Disorientation, Disturbance in attention
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Glaucoma (broad), Optic nerve disorders (broad), Retinal disorders (broad), Depression (excl suicide and self injury) (broad), Hypoglycaemia (broad), Dehydration (broad)

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

Write-up: About 2-3 minutes after receiving the shot in my left arm, I began to get extremely disoriented. I lost my vision in in both eyes and completely lost my sense of direction. So much so that I walked into several walls in the isles. After regaining vision about a minute after, I began to search for my father who had came with me. As I walked, I felt very heavy like a huge weight was pulling me down. I began to feel flush like a change in temperature but not almost like a tingling but over my whole body. During that time I began to sweat and my walking was heavy like I was carrying extra weight. A few times I had to stop walking and catch my breath but I was not overwhelmed by movement but more so something had come over me as if my body didn?t like what was going on. Once I located my father, I let him know I wasn?t feeling well after receiving the shot. I became thirsty and needed some hydration so I purchased a soda while feeling very fatigued and sweating profusely. I also purchased a candy bar as I had not eaten and hoped it would help. After my purchase I went back to the pharmacy and explained what I had went through. I ate the candy bar and drank the soda and after about 5 minutes I realized what I needed from the store. I advised the doctor that it seemed to go away and that I was no longer feeling the same symptoms. No explanation was given but was told I could go. Snce then I have had this weird feeling in my head like I am about to get a headach but it never comes just there like it wants to start or something but I just wanted to share my experience because I have not heard anything about what I went theough.


VAERS ID: 1542835 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anxiety, Faeces discoloured, Fatigue, Frequent bowel movements, Haematochezia, Limb discomfort, Pain in extremity
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Gastrointestinal haemorrhage (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

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

Write-up: Hi. I am registered nurse. I got my vaccine 08/10/21 at pharmacy at 09:15 am. I felt fatigue and and pain/soreness on my left arm. It feel heavy too. I had my bowel movement today four times already. First three times of my BM, the stool?s consistency was semi-formed. My latest bowel movement which was around 11:45 pm - 08/10/21. It was a bright red bloody stool. I am worried and still watching out for my symptoms. I don?t have a primacy care physician right now because I don?t have insurance. Can you help me with this?


VAERS ID: 1542841 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Anxiety, Heart rate increased, Hypoaesthesia, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Hypoglycaemia (broad), Dehydration (broad), Sexual dysfunction (broad)

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

Write-up: At 11:12am pt c/o increase heart rate due to anxiety and tingling numbness in last 2 fingers of left arm. Vital taken at 11:12am - BP: 159/116. HR: 75. SpO2: 100% Vital taken at 11:30am - BP: 160/112. HR 75. SpO2: 100% Nurse practitioner on site did the assessment on pt and did not call EMS. Advise pt to see PCP for high blood pressure. Pt left site in stable condition.


VAERS ID: 1544625 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Chest pain, Chills, Dizziness, Dysphagia, Dyspnoea, Eye swelling, Flushing, Headache, Hyperhidrosis, Mouth swelling, Nausea, Pain, Paraesthesia, Pruritus, Swelling face, Swollen tongue, Tachycardia, Throat tightness
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (narrow), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad)

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

Write-up: Systemic: Allergic: Difficulty Breathing-Medium, Systemic: Allergic: Difficulty Swallowing, Throat Tightness-Medium, Systemic: Allergic: Itch Generalized-Medium, Systemic: Allergic: Swelling of Face / Eyes / Mouth / Tongue-Mild, Systemic: Body Aches Generalized-Severe, Systemic: Chest Tightness / Heaviness / Pain-Medium, Systemic: Chills-Severe, Systemic: Dizziness / Lightheadness-Severe, Systemic: Flushed / Sweating-Severe, Systemic: Headache-Medium, Systemic: Nausea-Medium, Systemic: Tachycardia-Medium, Systemic: Tingling (specify: facial area, extemities)-Severe


VAERS ID: 1544628 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003C21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Pruritus, Tremor
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Vestibular disorders (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Allergic: Itch (specify: facial area, extremeties)-Medium, Systemic: Dizziness / Lightheadness-Medium, Systemic: pt started having severe tremors all over within 15 minutes of injection-Severe


VAERS ID: 1544651 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 2 LA / IM

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

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

Write-up: Error: Incorrect Reconstitution-


VAERS ID: 1544652 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 066D21A / 1 LA / IM

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

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

Write-up: Systemic: Dizziness / Lightheadness-Medium, Systemic: Fainting / Unresponsive-Medium, Additional Details: Patient passed out after getting vaccination and hit head on chair. She was checked out by EMS


VAERS ID: 1544653 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-08-01
Onset:2021-08-10
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Wellbutrin, Losartan
Current Illness: None
Preexisting Conditions: High blood pressure, depression and anxiety
Allergies: Morphine
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Fever; chills; body aches; headache; fatigue for 2 days.


VAERS ID: 1544656 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-08
Onset:2021-08-10
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 088D21A / 2 LA / IM

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

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

Write-up: Site: Redness at Injection Site-Mild, Site: Swelling at Injection Site-Mild, Additional Details: Patient called pharmacy 2 days post 2nd dose of COVID 19 vaccine. Patient received on 8/8/21 and states on 8/10/21 (this morning) he noticed 2 red dots at the site he received vaccine and some "puffiness/swelling." Patient states it is not itchy. Pharmacist advised redness/swelling is a known side effect, however, if patient notices worsening symptoms to seek medical attention if needed.


VAERS ID: 1544657 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 088D21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anxiety, Dysphagia, Injection site erythema, Nervousness, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Hypersensitivity (broad), Hypoglycaemia (broad)

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

Write-up: Site: Redness at Injection Site-Mild, Systemic: Allergic: Difficulty Swallowing, Throat Tightness-Mild, Additional Details: PATIENT FELT TIGHTNESS ON HIS THROAT AND WE CALLED EMERGENCY THEN HE SAID HE IS FINE & TO CANCEL IT. AFTER ABOUT 15MINS HE FELT TIGHTNESS ON HIS THROAT AGAIN WE WE CALLED EMERGENCY. PARAMEDICS CAME CHECKED HIS VITALS EVERYTHING WAS NORMAL. HE WAS VERY ANXIOUS/NERVOUS ABOUT VACCINE. HE FELT MUCH BETTER AFTER A WHILE. HE WALKED OUT WITH THE PARAMEDICS BUT NOT SURE HE IS WENT TO ER OR NOT...


VAERS ID: 1544659 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Rhode Island  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain, Flushing, Hyperhidrosis, Nausea
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Abdominal Pain-Medium, Systemic: Flushed / Sweating-Medium, Systemic: Nausea-Medium


VAERS ID: 1544661 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Kansas  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? 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: Fainting / Unresponsive-Medium, Systemic: Flushed / Sweating-Medium, Systemic: Headache-Mild, Systemic: Hypotension-Mild, Systemic: Vomiting-Mild


VAERS ID: 1544663 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821286 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Electrocardiogram abnormal, Flushing, Hyperhidrosis, Hypotension, Injection site pain, Loss of consciousness, Pallor, Syncope, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

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

Write-up: Site: Pain at Injection Site-Mild, Systemic: Dizziness / Lightheadness-Medium, Systemic: Fainting / Unresponsive-Medium, Systemic: Flushed / Sweating-Medium, Systemic: Hypotension-Medium, Additional Details: Patient was found in waiting room during 15-min observation period. Pt was diaphoretic, pale, had loss of consciousness, hypotensive. Placed patient lying down with legs in air, vitals & appearance improved. EMS was activated and per paramedic & provider''s discretion d/t some abnormality on EKG, recommended that patient be further evaluated at local hospital.


VAERS ID: 1544664 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-07-30
Onset:2021-08-10
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027D21A / 1 LA / IM

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

Write-up: Site: Redness at Injection Site-Medium, Site: Swelling at Injection Site-Medium


VAERS ID: 1544681 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0171 / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Chest pain, Cough, Dermatitis allergic, Diarrhoea, Hypoaesthesia, Increased viscosity of upper respiratory secretion, Nausea, Pain, Pain in extremity, Rash
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Peripheral neuropathy (broad), Pseudomembranous colitis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow), Arthritis (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Scoliosis, arthritis in knees
Allergies: Morphine
Diagnostic Lab Data: None, I am calling my doctors office when they open to schedule testing.
CDC Split Type:

Write-up: Non severe allergic reaction rash on left ankle, dull chest pain, numbness of hands feet and top of head, joint pain in left knee (2011 arthroscopic release on left knee, healed and recovered), nausea, diarrhea, arm pain, very thick nasal mucus and coughing, all symptoms have happened within 24 hours of administered vaccine.


VAERS ID: 1544685 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 3 LA / IM

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

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

Write-up: Error: Booster Given Too Late-


VAERS ID: 1544686 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-08-09
Onset:2021-08-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052E21A / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chills, Injection site erythema, Injection site reaction, 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? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: fluticasone nasal spray
Current Illness:
Preexisting Conditions:
Allergies: penicillin allergy - causes hives in genital area
Diagnostic Lab Data:
CDC Split Type:

Write-up: Subjective and objective fever with temp up to 102. Chills. Localized skin reaction over injection site - 4 cm circle of erythema.


VAERS ID: 1544689 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-08-01
Onset:2021-08-10
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047C21A / 2 RA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Delusion, Dizziness, Fatigue, Feeling abnormal, Feeling hot, Headache, Malaise, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Psychosis and psychotic disorders (narrow), Noninfectious encephalopathy/delirium (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: Suboxone
Current Illness: None
Preexisting Conditions: None
Allergies: Augmenton
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Woke up day after shot feeling sick and woosey. Headache that continued to get worse all day. Felt kind of out of it. Light headed. Tired. I was hot so hot. Husband said I had fever and was a bit delusional but I don''t remember for sure. I just know I felt awful. He wanted to take me to doctor or hospital but I declined and wanted to sleep it off. The next day I feel fine.


VAERS ID: 1544695 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821286 / 1 LA / IM

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

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

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


VAERS ID: 1544848 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-05
Onset:2021-08-10
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011D / 1 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Bell's palsy, Borrelia test, Full blood count, Liver function test, Metabolic function test
SMQs:, Hearing impairment (broad)

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

Write-up: mild right sided Bells Palsy


VAERS ID: 1544856 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Mouth haemorrhage, Secretion discharge, Seizure, Tremor
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: Seizure-Severe, Systemic: Shakiness-Severe, Additional Details: patient had severe seizure few minutes after vaccine which lasted for about a minute and was bleeeding from the mouth. mucus also were coming out from the mouth . no breathing problems, called and EMS came and took him to the hospital


VAERS ID: 1544860 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Alabama  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 066D21A / 1 LA / IM

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

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

Write-up: Systemic: Dizziness / Lightheadness-Medium, Systemic: Fainting / Unresponsive-Medium, Additional Details: Patient fainted approximately 5 minutes after vaccination and was unresponsive for approximately 10-15 seconds. EMTs were called and continued care. Patient was alert and oriented when taken by EMTs.


VAERS ID: 1544862 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-05-25
Onset:2021-08-10
   Days after vaccination:77
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 8/9/21 COVID + result
CDC Split Type:

Write-up: suspect COVID vaccine breakthrough


VAERS ID: 1544866 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Oklahoma  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002F21A / 1 LA / IM

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

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

Write-up: Systemic: Fainting / Unresponsive-Medium, Additional Details: patient passed out from getting shot. he stated he always does due to anxiety with needles. he was up and feeling fine after a couple of minutes


VAERS ID: 1544875 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-01-18
Onset:2021-08-10
   Days after vaccination:204
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 8/3/21 COVID + test
CDC Split Type:

Write-up: Suspect COVID vaccine breakthrough case Pfizer dose 1 on 1/18/21 and dose 2 on 2/8/21


VAERS ID: 1544886 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: South Dakota  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821286 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Bone pain, Fatigue, Headache, Myalgia, Pain
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad), Osteonecrosis (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Shooting muscle/bone pain throughout body, extreme fatigue, headaches


VAERS ID: 1544893 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-08-01
Onset:2021-08-10
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Dexilant, 60 mg daily
Current Illness: None
Preexisting Conditions: GERD (see Item 9 above)
Allergies: None
Diagnostic Lab Data: None yet.
CDC Split Type:

Write-up: Significant tinnitus in my right ear (started yesterday, 10 days after my first vaccination).


VAERS ID: 1544919 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Alanine aminotransferase normal, Anion gap decreased, Anxiety, Aspartate aminotransferase normal, Blood albumin normal, Blood alkaline phosphatase normal, Blood bilirubin normal, Blood calcium normal, Blood chloride normal, Blood creatine normal, Blood glucose increased, Blood magnesium increased, Blood phosphorus decreased, Blood potassium decreased, Blood sodium normal, Blood urea normal, Breath sounds abnormal, Carbon dioxide decreased, Cough, Dry throat, Dyspnoea, Globulin, Glomerular filtration rate decreased, Hypokalaemia, Metabolic acidosis, Oropharyngeal pain, Palpitations, Protein total normal, Respiratory distress, Swelling face, Tachycardia, Wheezing
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Anaphylactic reaction (narrow), Angioedema (narrow), Asthma/bronchospasm (broad), Lactic acidosis (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Hypersensitivity (narrow), Tumour lysis syndrome (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Asthma, Diabetes Mellitus, Eczema, Essential hypertension, and Hyperlipidemia
Allergies:
Diagnostic Lab Data: Results as of 8/11/2021 09:31 8/10/2021 12:47 Sodium: 139 Potassium: 3.1 (L) Chloride: 103 CO2: 19 (L) Anion Gap: 18 BUN: 12 Creatinine: 0.9 Glucose, Bld: 172 (H) Calcium: 9.0 8/11/2021 08:56 Sodium: 136 Potassium: 4.2 Chloride: 103 CO2: 22 Anion Gap: 11 BUN: 14 Creatinine: 0.8 Glucose, Bld: 275 (H) Calcium: 9.0 Magnesium: 2.3 Phosphorus: 2.8 Total Protein: 7.0 Albumin: 4.2 Globulin: 3 AST: 18 ALT: 15 Bilirubin Total: <0.5 Alk Phos: 68
CDC Split Type:

Write-up: H/o multiple known allergies, Bronchial Asthma, DM, HTN, HLD who was BIBEMS from after developing progressively worsening dyspnea, wheezing and facial puffiness following administration of his first dose of Pfizer COVID vaccine, with signs of severe generalized allergic reaction. Pt given IV solumedrol, Benadryl, IVF, Pepcid, and one dose of IM epinephrine on site and then EMS activated. According to EMS records, on arrival at hospital pt''s sats were in the 80s, and his lung sounds were very tight, almost no air movement detected, with pt in severe resp distress and anxious. On arrival in our ED, pt tachycardic, with good air entry with good b/l breath sounds, remains mildly anxious but answering questions well. Initial BP here was 143/91. Except mild hypokalemia and metabolic acidosis, patient''s initial labs were within normal limits. He reports occasional wheezing, sore throat/dryness, dry cough intermittent SOB and palpitations but denies any current chest pain, fever, headache, nausea/vomiting. Patient still in hospital as of 8/11/21.


VAERS ID: 1544925 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 078C21A / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Dyspnoea, Paraesthesia oral, Pharyngeal paraesthesia, Throat irritation
SMQs:, Anaphylactic reaction (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad)

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

Write-up: About 10 minutes after vaccination patient said that she started to feel a tingle/scratch in her throat and had a little shortness of breath. She was not wheezing or gasping for air but had to stop a little as she was talking to breathe in. After 3-4 minutes she stated that she felt the same but it was not going away. EMTs were called Epi-Pen was ready for use if the patient started to suddenly feel worse. EMTs arrived in about 6-7 minutes the patient added that she was beginning to feel a tingling around her lips. EMTs told her to stick her tongue out and checked airway and took her into the ambulance to get checked out. Patient has no drug allergies, has not had reactions to vaccines in the past, the only allergy she reported was pollen and topical cocoa butter.


VAERS ID: 1544929 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Current medication list includes Flexeril, Lasix, Amaryl, Norvasc, Lipitor, Proscar, Lisinopril, Glucophage, Flomax, Detrol LA, Diclofenac, Albuterol, Aspirin 81 mg
Current Illness:
Preexisting Conditions: Diabetes type 2, HTN, OSA on CPAP, Hyperlipidemia, BPA, Obesity hypoventilation syndrome, Chronic CHF, Morbis Obesity, RLS, Fibromyalgia, Raynaud''s disease.
Allergies: Penicillin
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient was given 0.9mL of Pfizer Covid 19 vaccine- staff then discarded rest of the vial. Wrong dose was not discovered until hours later. Patient did fine during 15 minute wait time and was doing fine when called after event was discovered. Reported no signs or symptoms relating to the covid vaccine.


VAERS ID: 1544930 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-02-07
Onset:2021-08-10
   Days after vaccination:184
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9266 / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin D3 zinc humalog melatonin
Current Illness:
Preexisting Conditions: diabetes
Allergies: Iodinated contrast media, sulfa, midazolam
Diagnostic Lab Data: covid 19 test 8/10
CDC Split Type:

Write-up: patient tested positive for covid 19


VAERS ID: 1544960 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

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

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

Write-up: Within 10 minutes of receiving the vaccine, I began feeling light headed and slightly nauseas. I was sitting down in a chair and began to black out. The next thing I remember is waking up on the floor next to the chair. After drinking some water and eating some candy, I began to feel better. After 40 minutes from receiving the shot, I was able to leave the facility on my own.


VAERS ID: 1544966 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / IM

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

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

Write-up: She had previously received the Moderna covid vaccine on 3/29/21 unbeknownst to the vaccine provider.


VAERS ID: 1544979 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dysgeusia, Immediate post-injection reaction
SMQs:, Taste and smell disorders (narrow), Hypersensitivity (narrow)

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

Write-up: Metallic taste in mouth immediately after injection.


VAERS ID: 1545009 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031B21A / UNK LA / SYR

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

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

Write-up: Discovered after the fact that the person was under the age of 18 yrs. Observed as per protocol and no issues. Hot wash held after clinic to determine what went wrong and protocols already in place tightened.


VAERS ID: 1545024 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Facial pain, Fatigue, Feeling abnormal, Hypoaesthesia, Immediate post-injection reaction, Impaired driving ability, Injection site abscess, Injection site haemorrhage, Memory impairment, Mobility decreased, Pain, Paraesthesia, Upper-airway cough syndrome
SMQs:, Peripheral neuropathy (broad), Haemorrhage terms (excl laboratory terms) (narrow), Dementia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Glaucoma (broad), Depression (excl suicide and self injury) (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Adderal XR 20 mg
Current Illness: None
Preexisting Conditions: None
Allergies: Augmenton
Diagnostic Lab Data: Pending visit to medical doctor for additional tests
CDC Split Type:

Write-up: Immediate symptoms displayed such as immediate site injection pain and heavy bleeding at vaccine site. Pain and heaviness in left arm also reported. Additional symptoms began approximately 45 minutes after vaccine injection, including sharp shooting pains in face, from right side of the nose to the top of the head, brain fog, fatigue, salty post nasal drip, and memory challenges displayed, i.e. losing items, difficulty driving, and finding items. Note that these symptoms were displayed nearly immediately after injection. These symptoms were not present prior to receiving the vaccine. Symptoms continued into the following day (Aug 11th), brain fog, neurological shooting/sharp pain in face from bridge of nose to top of head, brain fog, and fatigue. Additional neurological symptoms noted, such as tingling and numbness in extremities. Pain in arm also reported, cannot lift arm past shoulder.


VAERS ID: 1545048 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site pain, Menstrual disorder, Menstruation irregular
SMQs:, Extravasation events (injections, infusions and implants) (broad), Fertility disorders (broad)

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

Write-up: Pain in injection site. Changes in menstration. My period started and it wasn?t supposed to.


VAERS ID: 1545066 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031B21A / 2 LA / IM

Administered by: Public       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: None noted
Current Illness: None noted
Preexisting Conditions: None noted
Allergies: No known allergies noted
Diagnostic Lab Data: None
CDC Split Type:

Write-up: This gentleman came in to get his second COVID-19 vaccine. The appointment was scheduled as a second dose for Moderna. I had asked him if he was here for second dose of Moderna. No conflict was noted at the time. I did not get his card from him until afterwards, so I did not see what his first dose was- I just went off of the scheduled appointment. After he left he had called the facility and stated his first dose was Pfizer. I looked in our system, noticing he has three different accounts. I told him I would check with agency to see if there was anything I needed to do about it. I called him back after agency had contacted me back to let him know the information I received. I let him know that we would not repeat another dose at this time and that he would still be considered fully vaccinated against COVID-19 ?2 weeks after receipt of the second dose of an mRNA vaccine.


VAERS ID: 1545074 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-08-09
Onset:2021-08-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dyspnoea, Heart rate irregular, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Cardiac arrhythmia terms, nonspecific (narrow), Tendinopathies and ligament disorders (broad)

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

Write-up: irregular heart beat, short of breath. occasional muscle pain


VAERS ID: 1545077 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: North Dakota  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 023C21A / UNK RA / SYR

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

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

Write-up: Staff administered the Moderna vaccine to my 16 child when it should have been the pfizer


VAERS ID: 1545078 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-09
Onset:2021-08-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Conjunctivitis, Rash
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Conjunctival disorders (narrow), Ocular infections (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: none
Current Illness: no
Preexisting Conditions: no
Allergies: none that I know of.
Diagnostic Lab Data:
CDC Split Type:

Write-up: took the shot on Monday woke up Tuesday morning with pink eye on my left eye and body broke out in a rash by Tuesday at 4 pm today is Wednesday and I have the rash all over my body


VAERS ID: 1545089 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048C21A / 2 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EH9899 / 1 RA / IM

Administered by: Senior Living       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: CALTRATE 600 + D, LIPITOR 10MG, ANASTROZOLE 1MG, VIT D3 2000U, LASIX 20MG, CELEXA 5MG, ZOFRAN 4MG, LORAZEPAM 0.5MG, HYDROCORTIZONE CR 0.5%, MILK OF MAG, FLEETS ENEMA, BISACODYL SUPP
Current Illness:
Preexisting Conditions: CANCER, MAJ DEPRESSION, HYPERLIDEMAI,OSTEOARTHRRITIS, HTN, ANXIETY, CHF, ARTIFICIAL KNEE JOINT, MILD COGNATIVE IMPAIRMENT
Allergies: NKA
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: MIXED COVID MRNA VACCINATION PFIZER AND MODERNA


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