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From the 9/3/2021 release of VAERS data:

Found 661,087 cases where Vaccine is COVID19 and Patient Did Not Die



Case Details (Reverse Sorted by Onset Date)

This is page 169 out of 6,611

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VAERS ID: 1515729 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006D21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood pressure increased, Feeling hot, Flushing, Pruritus, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Hypertension (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Rosuvastatin Calcium 5mg Prozac HCL 20mg Norvasc 10mg Metformin HCL 1000mg
Current Illness: Denied
Preexisting Conditions: Diabetes, HTN
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was showing symptoms of a systemic reaction to the vaccine. She reported feeling warm, was flush, and broke out in hives. She also c/o itching all over. Doctor was notified and gave orders for Methylprednisolone 80mg IM x 1 dose and 25mg tab of Benadryl. Patient''s VS were taken. BP 159/89 HR 93 RR 20, SP02 on RA 96%. Patient did not exhibit any difficulty breathing, swallowing or SOB. Medications were given as ordered, without difficulty. Patient''s was monitored 1:1 for worsening symptoms. Symptoms resolved after 45 minutes VS returned to normal limits, BP was checked again and was at 150/83, HR 82, SP02 on RA 97% RR 18. Patient had no other complaints, and no other symptoms. Patient was informed if symptoms return or worsen to be evaluated in the ED. Patient had no other problems and walked out on her own without difficulty. RN


VAERS ID: 1515737 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-07-29
Onset:2021-07-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 091021A / UNK LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Chills, Fatigue, Headache, Injection site pain, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Rasagiline (1 mg), multivitamin, vitamins K2, B6, E, D3, B12,
Current Illness: Parkinson?s
Preexisting Conditions: Treated for reoccurring prostate cancer from August 2017 until May 2021.
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pain at injection, fever, chills,tiredness,headache, joint pain and muscle pain


VAERS ID: 1515747 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknow
Current Illness: None- Had COVID on April
Preexisting Conditions:
Allergies: Not that the patient know
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient felt Dizzy and passed out for about 30 seconds to a minute. Also patient vomit after vaccination about 3-5 minutes after vaccination.


VAERS ID: 1515760 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: New York  
Vaccinated:2021-07-27
Onset:2021-07-30
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821287 / N/A 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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: psoriasis
Allergies: none known
Diagnostic Lab Data: unknown
CDC Split Type:

Write-up: Rash on face


VAERS ID: 1515762 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 LA / IM

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

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

Write-up: No adverse events but administered vaccine to a patient who is under 12 years age


VAERS ID: 1515769 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0153 / N/A LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Interchange of vaccine products, 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: Erroneously administered a Pfizer instead of a Moderna


VAERS ID: 1515770 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Muscle strength abnormal, Nausea, Pallor
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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: no
Current Illness: no
Preexisting Conditions: no
Allergies: no
Diagnostic Lab Data:
CDC Split Type:

Write-up: Shortly after getting 2nd dose of Pfizer, patient felt dizzy, nauseous, and faint. She had been walking around the store and was brought by her family to sit down. She was given some Gatorade to drink and had a chair to put her feet up. Patient remained sitting for a while and left after feeling better. She regained color and strength and was able to walk out with some support from her family. Per her mom, she had not had any negative reactions on her first dose, nor has she ever had a reaction to a vaccine. Her mom also said that she had not had much to drink today. The other family members getting the vaccine were fine.


VAERS ID: 1515771 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040C21A / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Dyspnoea, Paraesthesia, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Vestibular disorders (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: PATIENT HAD INCREASED BREATHING, DIZZYNESS, TIGHTNESS IN THROUT, AND TINGLING ADMINISTERED EPI-PEN TO PATIENT AND CALLED 911. PATIENT WAS TAKEN TO THE ER.


VAERS ID: 1515772 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040C21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Tylenol (4 hours) prior to vaccine as he had mild headache
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: Amoxicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: he felt light headed/panic attack few minutes after getting the shot , he laid down on the floor , breathing was ok pulse was ok , called 911 , was no need for EpiPen/CPR/AED/ DIPHENHYDRAMINE


VAERS ID: 1515773 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7938 / 1 LA / IM

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

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

Write-up: Nausea, dizziness, weakness.


VAERS ID: 1515774 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 078C21A / 1 LA / IM

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

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

Write-up: Patient already received complete vaccination of COVID Pfizer vaccines. 2nd dose of Pfizer received on 04/14/2021 from a Pharmacy


VAERS ID: 1515777 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 2 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: unknown
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient fainted shortly after receiving vaccine. She was sitting on bench next to her brother and slowly began to slide down the bench. She felt extremely dizzy so laid on the floor with her feet on the bench for a short time until she felt ok to sit up. She was given water and sat with her mother for an extra 15 minutes or so until she felt well enough to leave.


VAERS ID: 1515787 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 LA / IM

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

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

Write-up: Patient underage at time of vaccination (incorrectly entered into consent form and verbally stated incorrect DOB)


VAERS ID: 1515920 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017B21A / 1 - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: There were no adverse events, just reporting Moderna given to teenager under the age of 18
CDC Split Type:

Write-up: I thought parents said patient was 18 years old, and thought he could have either Moderna or Pfizer. I did not check the vaccine information sheet.


VAERS ID: 1515923 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939902 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood pressure increased, Dizziness, Dyspnoea, Pruritus, Vomiting
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Pharmacy gave vaccine to patient and right after few minutes patient said she she feeling dizzy so pharmacy put on her head and neck her ice pack and one tech stayed with patient then right after patient started itching, vomiting. Pharmacy called 911 right away. After vomit patient started shortness of breath. pharmacy stayed with patient till EMS came. Patient got severe reaction to vaccine. EMS took patient to hospital. patient was little better after EMS gave her nebulizer albuterol. Patient called around 4.27pm to update Pharmacy that she is doing ok and getting discharge. she mention that her blood pressure went up While EMS was taking her to hospital. she Also mention that she is really thankful Pharmacy staff for prompt action and saving her life.


VAERS ID: 1515924 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EY0584 / 1 LA / IM

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

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

Write-up: Patient started to feel lightheaded then experienced seizing like motions then passed out.


VAERS ID: 1515926 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chronic obstructive pulmonary disease, Condition aggravated, Dyspnoea
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: copd meds - list unk
Current Illness: copd exacerbation resulting in hospitalization w/in 30 days
Preexisting Conditions: copd
Allergies: n/a
Diagnostic Lab Data: bp check - $g190/100
CDC Split Type:

Write-up: pt waited in store over 30 minutes before exiting. on his way out of the store, he started having trouble breathing. pt then came over to pharmacy to let pharmacist know. pt was seated, bp was checked $g190/100, EMS was contacted, and pt was given water. pharmacist stayed with pt until ems arrived to take him to the hospital. he believed it was just another copd exacerbation like he experienced a few weeks ago.


VAERS ID: 1515930 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE ON FILE
Current Illness: Factor 5 blood disorder
Preexisting Conditions: asthma
Allergies: NO
Diagnostic Lab Data: none at this time
CDC Split Type:

Write-up: Patient received her first dose of Pfizer today (7/30/21). Five minutes after administration, patient reported feeling very hot and throat closing up. She said it felt like something was slithering from her brain to her neck.


VAERS ID: 1515937 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 1 LA / IM

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

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

Write-up: Patient fainted about five minutes after shot while standing. No injuries were sustained. Patient was immediately put in supine position on floor with knees raised. Mother was nurse and promptly checked pulse at 55 then again a couple minutes later at 70. Patient was slowly brought to sitting position and given water and orange juice. Patient reports only eating a granola bar all day. Patient waited 30 minutes after vaccination and was able to leave on his own. No injuries reported and no medication attention was taken.


VAERS ID: 1515938 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 LA / IM

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

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

Write-up: Snycope


VAERS ID: 1515941 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-07-29
Onset:2021-07-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027D21A / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9266 / 2 - / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Extra dose administered, Interchange of vaccine products, No adverse event
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Naproxen Tablet 250 MG, Simvastatin Tablet 40 MG, metFORMIN HCl Tablet 500 MG, Lidoderm Patch 5 % (Lidocaine), Metoclopramide HCl Tablet 5 MG, Ondansetron HCl Tablet 4 MG, Fluticasone-Salmeterol Aerosol Powder Breath Activated 500-50 MCG/DO
Current Illness:
Preexisting Conditions: Dysphagia, Severe Protein-Calorie Malnutrition, Ataxia, CHRONIC OBSTRUCTIVE PULMONARY DISEASE, Unspecified Asthma, TYPE 2 DIABETES MELLITUS WITH DIABETIC CHRONIC KIDNEY DISEASE, GASTROSTOMY STATUS, DYSPHAGIA, OROPHARYNGEAL PHASE, MUSCLE WEAKNESS (GENERALIZED), ESSENTIAL (PRIMARY) HYPERTENSION, OLD MYOCARDIAL INFARCTION, HYPERLIPIDEMIA, UNSPECIFIED, UNSPECIFIED SEQUELAE OF CEREBRAL INFARCTION, NON-ST ELEVATION (NSTEMI) MYOCARDIAL INFARCTION, PERSONAL HISTORY OF COVID-19 , CHRONIC KIDNEY DISEASE, STAGE 3 UNSPECIFIED, Dehydration, Cognitive Communication deficit, Pneumonitis due to inhalation of food and vomit, PERSONAL HISTORY OF TRANSIENT ISCHEMIC ATTACK (TIA), AND CEREBRAL INFARCTION WITHOUT RESIDUAL DEFICITS
Allergies: Crab
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Patient was given two doses of Pfizer (1/24/2021 and 2/18/2021) and one dose of Moderna on 7/29/2021. No adverse effects noted at this time. Injection site clear and intact. Patient reports no soreness or any adverse affects. Patient remains afebrile.


VAERS ID: 1515942 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 1 UN / IM

Administered by: Other       Purchased by: ?
Symptoms: Chest pain, Electrocardiogram normal
SMQs:, Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Patient denied taking any medications within the past 12 hours. Prescribed medication in medical record include; Wellbutrin 150mg Albuterol 90 mcg Imitrex 25 mg Naproxen 500 mg Prenatal Vitamin
Current Illness: Patient reported having angina at the end of June. She sought medical treatment in the ER.
Preexisting Conditions: ARNOLD CHIARI TYPE 1 MIGRAINE MAJOR DEPRESSIVE DISORDER, RECURRENT EPISODE POSTTRAUMATIC STRESS DISORDER SLEEP APNEA, EVALUATION ANXIETY DISORDER ABNL CERVICAL PAP LGSIL (LOW GRADE SQUAMOUS INTRAEPITHELIAL LESION) HX OF PULMONARY EMBOLUS MULTIPLE PULMONARY NODULES CONTRACEPTIVE SURVEILLANCE HX OF SPOUSE OR PARTNER VIOLENCE, PHYSICAL ABNL GLUCOSE TOLERANCE IN PREGNANCY CASE / CARE MGMT, ANTICOAGULATION HX OF CORONAVIRUS COVID-19 DISEASE
Allergies: Penicillin''s class Nickle
Diagnostic Lab Data: EKG- Please see patient chart.
CDC Split Type:

Write-up: Patient received her first dose of the Pfizer vaccine lot number EW0178 at about 304. Approximately 5 minutes after receiving the vaccine she reported having "chest pain". She stated she had a history of angina in the past over the last two months. Since being diagnosed with COVID. Lung sounds are clear. No stridor indicated. No s/s of allergic reaction or anaphylaxis. VS Stable BP= 128/71 Pulse= 84 O2+ 98% Resp 16 Pain varies from 4-6 "sharp pain in the middle of her chest." EMS called. Repeat vital signs remain stable 1530 BP= 114/80 HR= 89 O2= 99% Resp= 20 Medics arrived at 1535 and took over care. EKG acquired. Follow up VS BP=122/67 P=84 O2=98% Resp= 22 Patient transported to the ER


VAERS ID: 1515945 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hyperhidrosis, Hypotonia, Loss of consciousness, Presyncope
SMQs:, Torsade de pointes/QT prolongation (broad), Peripheral neuropathy (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), 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: Unknown
Current Illness: None
Preexisting Conditions: none
Allergies: None listed
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient received the first dose of Moderna vaccine in his left arm around 6:25pm and them moved over to the observation area At 6:30 pm, the patient went limp in the observation chair. I had my technician on duty call 911 and request EMS as I grabbed the emergency crash kit and headed out to check on him. I shook him a little and asked if was okay and he started to regain consciousness, but was sweating profusely. I checked his blood pressure and it was 127/86 with a heart rate of 77. A physician that was shopping stopped by and offered assistance and talked with the patient and stated to the patient that he believed the patient experienced a vagal response from the shot. I told patient that we called for paramedics and that they would perform some vital checks to make sure he was okay. Paramedics arrived around 6:40 pm and did vitals on the patients and recommended that he drink something as his vitals were normal and patient seemed to have recovered. The paramedics asked if he wanted to go to be evaluated at the hospital but patient refused to treatment. The patient waited at the pharmacy for an additional 20 to 30 minutes. We asked if we could call anybody to come get him, but he said he felt fine and would be okay and left


VAERS ID: 1515946 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-07-28
Onset:2021-07-30
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017C21A / 2 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Chest discomfort, Chest pain, Hypopnoea, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Respiratory failure (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: None.
Current Illness: None.
Preexisting Conditions: None known.
Allergies: None known.
Diagnostic Lab Data: None
CDC Split Type:

Write-up: The day following injection had symptoms consistent with CDC-published information. My normal body temp is about 97. Fever increased as the day went on, reaching 99.7 at about 11:00 pm, reaching 100.4 at about 12:30 am, and it was at this time I could feel a mild burning, almost clutching feeling in my upper chest, and my breathing was much shallower. No medications were used, but I put a damp washcloth on my forehead. Waking up again 12 hours later, my temp had returned to about normal and no adverse effects were felt at that time.


VAERS ID: 1515948 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-07-23
Onset:2021-07-30
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site erythema, Injection site paraesthesia, Injection site pruritus, Injection site warmth, Vaccination site reaction
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: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: ?COVID arm? developed 1 week after first dose: itching, redness, warmth, and tingling at site of injection.


VAERS ID: 1515949 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: None reported
Preexisting Conditions: Unknown
Allergies: Sulfa
Diagnostic Lab Data: Reported stating patient received Janssen COVID Vaccine on 03/07/2021
CDC Split Type:

Write-up: Patient came in today (7/30/21) and requested for a Pfizer COVID vaccine. Patient marked she has not received any other COVID vaccines on her consent form. Counseled and confirmed with patient that this Pfizer shot would be her first COVID vaccine while inside the immunization room prior to giving the shot. When the vaccine was processed later in the day, there was a rejection from the insurance stating patient already received a COVID vaccine by a different manufacturer. It was checked and patient received Janssen (J&J) on 03/07/21. Called patient, no answer, left VM for patient to call back the pharmacy. Has cancelled patient''s 2nd dose appointment.


VAERS ID: 1515953 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: California  
Vaccinated:2021-03-27
Onset:2021-07-30
   Days after vaccination:125
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Chest X-ray, 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: asa 81 lipitor 80 metoprolol 50mg bid protonix 40mg daily ibuprofen prn
Current Illness:
Preexisting Conditions: CAD, HTN, HLD
Allergies: bactrim, sulfa
Diagnostic Lab Data: tested positive for covid 7/24 CXR
CDC Split Type:

Write-up: patient got breakthrough COVID 19 infection and required hospitalization


VAERS ID: 1515966 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-07-29
Onset:2021-07-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Axillary pain, Cough, Headache, Nausea, Pain, Pain in extremity
SMQs:, Anaphylactic reaction (broad), 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: Aimovig 140mg monthly and cyclobenziprene 5mg daily
Current Illness:
Preexisting Conditions: Migraines
Allergies: Allergy to darvacet, codiene
Diagnostic Lab Data:
CDC Split Type:

Write-up: Severe body aches, constant headache, nausea, sore arm, sore arm pits, slight cough


VAERS ID: 1516154 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Burning sensation, Pain
SMQs:, Peripheral neuropathy (broad)

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

Write-up: Patient is complaining of a burning arm that is not red or warm to the touch. She says the burning is in her whole arm and very painful and constant


VAERS ID: 1516155 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040C21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal distension, Feeling hot, Flushing
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (broad)

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

Write-up: Patient became flushed and said she felt hot and that her stomach felt tight. She was given a cool compress (water bottle) and stayed in the pharmacy area 30 minutes and did not require further treatment.


VAERS ID: 1516156 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
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: Unknown
Current Illness: Unknown other than patient stated that he is immunocompromised.
Preexisting Conditions: Unknown other than patient stated that he is immunocompromised.
Allergies: unknown
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient spoke with my technician and informed her that he was getting his first covid vaccine and he wanted Moderna. I went over his consent form and discussed possible side effects and gave him the vaccine. Afterwards, he laughed and told me he "fibbed" a little. He said this was actually his third Moderna vaccine. He said he is an ex-doctor. He said that he is immunocompromised and taking cellcept. He said his doctor told him to get a booster. He waited 15 minutes after the vaccine. He said he was fine and left. He did not think it was a big deal that he "fibbed."


VAERS ID: 1516157 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Kansas  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 LA / IM

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

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

Write-up: Pt had filled out consent requesting meningitis vaccine, not covid.


VAERS ID: 1516161 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006D21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Feeling abnormal, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (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: He states after most injections he faints
Other Medications: Methylphenidate
Current Illness: none
Preexisting Conditions: ADHD
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient fainted approximately 5 minutes after he received the vaccine. He stumbled to pharmacy counter saying he was not feeling right. Then he began to faint. He was grabbed and guided to the floor slowly, paramedics were called. Patient did not go to the hospital and did not experience any other adverse effects. EMS checked vitals and they were WNL


VAERS ID: 1516165 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Alaska  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 1 LA / IM

Administered by: Military       Purchased by: ?
Symptoms: Back pain, Chest discomfort, Dizziness, Fatigue, Feeling abnormal, Full blood count normal, Human chorionic gonadotropin negative, Metabolic function test, Metabolic function test normal, Pruritus, Throat tightness, Tryptase, Urine analysis, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Vestibular disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Claritin
Current Illness: None
Preexisting Conditions: polycystic ovarian disease mild fatty liver disease
Allergies: Allergy to soy, avocado, Zoloft, possible allergy to pork
Diagnostic Lab Data: Tryptase was drawn; CBC and CMP were WNL. UA was WNL, beta hCG negative.
CDC Split Type:

Write-up: Several minutes after receiving the vaccine, the patient began to feel dizziness, and her throat began to tighten up. She then developed pruritis (generalized), a rash that was described as urticarial on the anterior neck. She said she also developed some chest tightness, but then described it as more in the upper back. She did not receive any medications for this--she appeared to be spontaneously improving in the ER. She said that she felt tired and foggy.


VAERS ID: 1516166 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050C21A / 1 LA / IM

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

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

Write-up: Not an actual adverse event. Patient came for vacation from another state. They filled out the consent form for a COVID vaccine and stated on the form they hadn''t received any COVID vaccines beforehand. Dose of Moderna was given in the AM. Billing took place in the PM and insurance rejected the claim stating the patient got something different. After investigation, it turns out the patient had already finished their Pfizer COVID series.


VAERS ID: 1516168 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-07-29
Onset:2021-07-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / N/A LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Migraine, Neck pain, Pain in extremity, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Severe left arm and neck pain. Fever and migraines. Currently having symptoms treating with ibuprofen and acetaminophen. Hot and cold compresses. Health department says no need to see a doctor unless symptoms continue over several days.


VAERS ID: 1516169 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 2 RA / IM

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

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

Write-up: Patient reported to clinic stating he wanted to get his first dose of Janssen vaccine in order to obtain a $100 grocery gift certificate being offered as an incentive. He was given the vaccine with no issues during or after. Another staff member mentioned that this person reported having had gotten Janssen earlier in the day to her. The staff member did not notify me about this until after the patient had gotten a second dose. The patient denied getting a first dose on the screening form. By checking database I was able to determine that he did get a J&J vaccine on 4/28/21. Patient appears to have waited for the end of the day to get another vaccine so that he could get the incentive gift card.


VAERS ID: 1516171 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006D21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Loss of consciousness, Syncope, Tremor
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (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: patient fainted shortly after receiving his first dose of Moderna. Patient reports being anxious prior to his vaccination. Patient was shaking uncontrollable on chair for approximately 2-3 seconds when I approached him, he may have had seizure but it also may have been the way he fainted in his chair. patient seemingly lost consciousness for approximately 10-15 seconds and possible had a seizure. EMS was called and they checked his vitals which were WNL and he was released under his own power


VAERS ID: 1516175 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 LA / IM

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

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

Write-up: Guardian filled out consent form. Listed child''s age as 12 on consent form. Upon reviewing paperwork, child''s date of birth was listed as 9/10/2009, making him 11 years and 10.5 months; not required age of 12 for vaccine.


VAERS ID: 1516177 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None noted as per consent form
Allergies: No known drug allergies as per Consent form
Diagnostic Lab Data: Blood Pressure 93/67 Pulse 86
CDC Split Type:

Write-up: Patient was given the Pfizer COVID-19 vaccine in his left arm around 1:34pm. Patient left the immunization room and sat down in front of the pharmacy with his mother. About 5 minutes later, the mother notified me that the patient was not feeling well and had become lightheaded and dizzy. I immediately went out to examine the patient and as we were walking back to the immunization room the patient fainted. His mother and I gently lowered him to the ground. He immediately gained consciousness and after checking for any injury I went and got a yoga mat while his mother remained by his side. We moved him onto the yoga mat and had him lie down on his back and elevate his feet. There was no injury and he said that he was feeling ok. After several minutes I had him sit up slowly and remain in that position for another several minutes before standing. He was able to stand up without assistance and walked to the bench to sit down for more monitoring. I went back into the pharmacy but was soon notified by the patient that he felt like he might faint again. I immediately had him lie back down on the mat. He did not faint again and said that the fainting feeling had gone away. Once again he stood up unassisted and I moved him into the immunization room to check his blood pressure (93/67 with a pulse of 86) and monitor him. He said he felt better, had something to eat, and drank some water. While waiting his mother notified his pediatrician who said they would call back. He was able to stand up and walk around without feeling dizzy or lightheaded. His mother said they felt comfortable enough to leave. I told them to continue to follow up with the patient''s pediatrician and to ask about getting the second vaccine. I made sure she understood that if his symptoms worsened to seek medical attention. I followed up with the patient''s mother around 7:00pm and she said that the pediatrician office called her back and said that they think he will be ok and that it might have been anxiety related to receiving the immunization.


VAERS ID: 1516178 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004D21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Eye pruritus
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: unknown
Current Illness: unknown
Preexisting Conditions: asthma
Allergies: aspirin, PCN
Diagnostic Lab Data:
CDC Split Type:

Write-up: patient reported itchy eyes after 5 minutes of getting vaccine. itchiniess dissipated within 15 minutes to almost zero itching within 15 minutes.


VAERS ID: 1516182 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040C21A / 1 LA / IM

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

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

Write-up: 15 YEAR OLD PATIENT ADMINISTERED MODERNA


VAERS ID: 1516183 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-03-09
Onset:2021-07-30
   Days after vaccination:143
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Eczema, Food allergy, Mouth swelling, Rosacea, Swelling, Urinary tract infection, Urine analysis abnormal
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lisenipril 10 mg
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Utis tested positive. No other testing
CDC Split Type:

Write-up: Nov 20. 2020. uti. Apr2021 eczema. April 2021 Roseacea. June 2021 uti. July 2021 food allergy. Severe swelling. July 2021 another food allergy, severe swelling mouth area. 70 years old now and never had these issues.


VAERS ID: 1516186 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fall, Pallor
SMQs:, Accidents and injuries (narrow), 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: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Few minutes after the vaccine patient was sitting on a chair. She fell to the side and dad caught her before she got to the floor. I ran out and we laid her on the floor. Her blood pressure was 108/82 and heart rate-88, her color had disappeared from her face for a minute and she felt better and breathing well after a minute or so. Ems arrived.


VAERS ID: 1516191 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 2 RA / IM

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

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

Write-up: Patient came in to get second dose of Covid19 vaccine. She did not have her vaccination card and wanted us to look up what she had. technician looked up and saw she had Moderna covid19 vaccine but proceeded to label the patient''s consent form with Pfizer Covid 19 vaccine label. Pharmacist verified with patient before injecting and she confirmed pfizer thinking that the technician had properly looked up and labeled her consent form. She was administered one dose of Pfizer today instead of Moderna. Verified on the CDC website that patient can receive one of each of the mRNA vaccines as long as they''re minimum 28 days apart. Patient does not need to finish series of either vaccines. she is sufficiently protected at this time with one dose of moderna and one dose of pfizer.


VAERS ID: 1516200 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 059E21A / 1 RA / IM

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

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

Write-up: Patient is not quite18 years old yet, she will be 18 soon


VAERS ID: 1516204 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Hawaii  
Vaccinated:2021-03-02
Onset:2021-07-30
   Days after vaccination:150
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9810 / 1 UN / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6205 / 2 UN / IM

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

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

Write-up: Fully vaccinated and tested positive for COVID-19


VAERS ID: 1516205 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: New York  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 AR / IM

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

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

Write-up: At about 10:50am vaccinator administered 0.3ml of Janssen to the client and clients wife. After sending them to observation vaccinator realized she only administered 0.3ml which is not the correct dose. Janssen''s recommended dose is supposed to be 0.5ml. Vaccinator walked over to Observation where the client was being monitored for 15mins post vax and explained the error to the client and his wife who were willing and okay to receive the remainder of the dose that was supposed to be administered of 0.2ml. Client left fully vaccinated no signs and symptoms of adverse reactions.


VAERS ID: 1516208 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Louisiana  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NA
Current Illness: NONE REPORTED
Preexisting Conditions: NONE
Allergies: ALLGERGIES TO BEES REPORTED AFTER VACCINATION
Diagnostic Lab Data: PT. GIVEN EPIPEN
CDC Split Type:

Write-up: SWELLING OF EYES CLOSING SHUT.


VAERS ID: 1516210 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: New York  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 UN / IM

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

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

Write-up: At about 10:50am vaccinator administered 0.3ml of Janssen to the client and clients wife. After sending them to observation vaccinator realized she only administered 0.3ml which is not the correct dose. Janssen''s recommended dose is supposed to be 0.5ml. Vaccinator walked over to Observation where the client was being monitored for 15mins post vax and explained the error to the client and his wife who were willing and okay to receive the remainder of the dose that was supposed to be administered of 0.2ml. Client left fully vaccinated no signs and symptoms of adverse reactions.


VAERS ID: 1516349 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Dizziness, Dyspnoea
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Vestibular disorders (broad)

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

Write-up: PATIENT FELT LIGHTHEADED AFTER RECEIVING THE VACCINE, CHILS, EXPERIENCE DIFFICULTY BREATHING. BECAUSE OF THIS. 911 WAS CALLED, AND ONE SHOT OF EPIPEN 0.3 WAS ADMINISTERED TO THE PATIENT. WHEN EMS CAME IN SHE WAS ASKED SEVERAL QUESTIONS AND WAS TAKEN TO A NEARBY HOSPITAL FOR FURTHER OBSERVATION.


VAERS ID: 1516350 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Electrocardiogram, Fall
SMQs:, Anticholinergic syndrome (broad), Accidents and injuries (narrow), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: NO
Preexisting Conditions: NO
Allergies: NONE PER PATIENT PROFILE
Diagnostic Lab Data: Blood pressure, pule and "mini" EKG.
CDC Split Type:

Write-up: Patient received vaccine in vaccination room. Upon walking out patient was dizzy and fell into the end of a shelf with his mother helping to keep him from completely falling. Patient did not hit head. After the patient was caught he sat in a chair upon arrival of the EMS.


VAERS ID: 1516351 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-07-29
Onset:2021-07-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 053C21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Rash, Rash erythematous, Rash pruritic, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Similar to this, but more delayed and more minor to 1st moderna covid 19 dose
Other Medications: Prescriptions for this patient were transferred out 12/29/2020. at that time included Methotrexate 2.5mg, 8 tabs once a week, Colestipol 1g 2bid, Tizanidine 4mg at hs, Omeprazole 20mg daily, Hydroxychloroquine 200mg bid, Folic acid 1mg dai
Current Illness: none known
Preexisting Conditions: She circled ''No'' on the immunization form, but her medication history suggests rheumatoid arthritis.
Allergies: NKDA
Diagnostic Lab Data: None Known.
CDC Split Type:

Write-up: Red, swollen, itchy rash all over her body the morning/day after vaccination. Pt reports this also happened after first dose, but much milder. Pt had not treated with anything yet, recommended Benadryl and hydrocortisone applied to the reddest/itchiest areas.


VAERS ID: 1516352 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Mississippi  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 091D21A / 1 LA / IM

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

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

Write-up: CHEST PAIN AND SHORTNESS OF BREATH


VAERS ID: 1516353 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE REPORTED
Current Illness: NONE REPORTED
Preexisting Conditions: NONE REPORTED
Allergies: NONE REPORTED
Diagnostic Lab Data: BP 96/60
CDC Split Type:

Write-up: PATIENT GIVEN DOSE BY CERTIFIED INTERN, PATIENT PUT HER SWEATER BACK ON AND THEN GOT UP WALKED 3-5 STEPS AWAY AND FELL, SHE BANGED HER HEAD, HERE COLOR LOOKED PALE THEN WITHIN 5 MINS SHE LOOKED BETTER SHE WAS CONSCIUOS AND BREATHING AND COHERENT. HER FAMILY MEMBER IS A NURSE AND ASSESSED HER VITALS, PARAMEDICS WERE CALLED IN FIRST 2 MINUTES OF EVENT.THEY CHECKED HER ATABOUT 7MIN POST VACCINATION BP 96/60, THEY TOOK HER INTO THE AMBULANCE . 1 HOUR LATER I CALLED THE MOTHER THE MOTHER SAID SHE WAS FINE AND WAS GRATEFUL FOR THE CALL. PARAMEDICA ASSESSMENT SYNCOPE AND FEAR OF NEEDLES.


VAERS ID: 1516359 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-07-29
Onset:2021-07-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Body temperature increased, Lymphadenopathy
SMQs:, Neuroleptic malignant 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:
Current Illness: not known
Preexisting Conditions: no known
Allergies: no known allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient states temperature of 101 and swelling under her left arm (she states it may be her lymph nodes) Advised the patient to take OTC ibuprofen or acetaminophen and if the fever does not resolve with-in 24 hours to visit the urgent care or ER


VAERS ID: 1516363 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-07-29
Onset:2021-07-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 LA / IM

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

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

Write-up: Nausea, vomiting, fatigue


VAERS ID: 1516366 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Back pain, Chills, Fatigue, Heart rate increased, Injection site pain, Pain
SMQs:, Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Extravasation events (injections, infusions and implants) (broad), Arthritis (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: Pseudoephedrine Allegra birth control
Current Illness: None
Preexisting Conditions: Mild upper back scoliosis
Allergies: Nka
Diagnostic Lab Data:
CDC Split Type:

Write-up: Sore injection site Body ache Chills Sustained heart rate greater than 120 BPM Lower back/hip ache Fatigue


VAERS ID: 1516368 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-07-27
Onset:2021-07-30
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Back pain, Pain, Pain in extremity, Vision blurred
SMQs:, Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

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

Write-up: Pt called the pharmacy on 7/30/21 after having received the vaccine 7/27/21.Pt reported strong back pain radiating to the right leg. Pt stated he received shot in left arm but was having right shoulder pain. Pt also reported blurry vision for the last two days. Pt was advised to seek medical care immediately.


VAERS ID: 1516372 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 1 LA / IM

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

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

Write-up: Attendee received first dose Pfizer vaccine at 16:44 in the left arm. Lot# EW0182. Attendee was directed to observation area. At 16:49 attendee passed out in her chair and her mother called for a nurse. Attendee''s skin was Diaphoretic. Attendee''s respirations were not tachypneic or dyspneic. Attendee assisted to the cot to lie down, legs elevated. Icepack applied to face and neck. 16:50 ? EMS called. Unconscious x 1 minute. Aroused to alert and oriented. HR: 62 BP: 188/88 RR: 16 O2Sat%: 98 Temp: 97.3 Oxygen Sat probe left on attendee HR 60-62 and O2 Saturation 98 ? 100. 16:57 ? EMS arrived and took over care of the attendee. 17:02 - EMS transported attendee to Hospital per mom''s request.


VAERS ID: 1516376 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: Sulfa
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient immunization record from registry indicated that patient received first dose of Pfizer COVID-19 vaccine on 2/3/2021. No second dose was listed. Infection Prevention RN from the facility where she is currently admitted for rehabilitation requested second dose of Pfizer COVID-19 Vaccine to be given on 7/30/2021. Upon entering data into patient record it was discovered that a late entry was added to Registry for a missed record of second vaccination having been received on 3/3/2021. Patient was monitored for 30 minutes to ensure no adverse reaction from additional dose received today.


VAERS ID: 1516378 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-04-05
Onset:2021-07-30
   Days after vaccination:116
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Exposure to SARS-CoV-2, Paraesthesia oral, Peripheral swelling, SARS-CoV-2 test negative, Throat tightness, Urticaria
SMQs:, Cardiac failure (broad), Anaphylactic reaction (narrow), Angioedema (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions:
Allergies: None
Diagnostic Lab Data: Covid PCR July 30, 2021. Negative.
CDC Split Type:

Write-up: Completed 2 doses of Moderna on March 5 and April 5, 2021. I developed hives, swelling in hands, tingling tongue, and tightness in throat at exposure to person positive with COVID-19. Children living in home developed symptoms of COVID on Monday, July 26th. My hives developed at 3am, July 30, 2021. Currently still have hives, but they are being managed successfully with benadryl. Prednisone was prescribed at ER to take if Benadryl is ineffective.


VAERS ID: 1516380 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Chest discomfort, Nausea
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

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

Write-up: chest tightness, nausea


VAERS ID: 1516381 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-07-29
Onset:2021-07-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: 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: unknown
Current Illness: unknown
Preexisting Conditions: none
Allergies: topiramate valproic acid
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Patient called pharmacy on 7/30/21 reporting they received the Pfizer Covid vaccine on Thursday 7/29/21 and then woke up on Friday 7/30/21 with fever, body ache, and headache. They were asking what they could take for these symptoms. I recommended Tylenol, however the patient said they did not have any Tylenol at home and only had Nyquil with acetaminophen as one of three ingredients. The patient said they would just take the Nyquil so they wouldn''t have to go to the store to get any medication.


VAERS ID: 1516382 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-07-28
Onset:2021-07-30
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: COVID 19
Preexisting Conditions:
Allergies: No known allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: 1st dose of COVID 19 vaccine administered on 7/28/2021 and 2nd dose of COVID 19 was erroneously provided early on 7/30/2021. reported no signs or symptoms at this time.


VAERS ID: 1516527 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: New Jersey  
Vaccinated:2021-07-01
Onset:2021-07-30
   Days after vaccination:29
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Illness
SMQs:

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

Write-up: Sick


VAERS ID: 1516530 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: Mississippi  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / UNK LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NOT KNOWN
Current Illness: RIGHT LEG FRACTURE BELOW KNEE
Preexisting Conditions: NOT KNOWN
Allergies: NOT KNOWN
Diagnostic Lab Data:
CDC Split Type:

Write-up: APPROXIMATELY FIVE MINUTES(550PM) AFTER ADMINISTRATION OF VACCINE PATIENT CAME BACK TO ME STATING THAT HE FELT FAINT. I SAT HIM DOWN AND PUT ICE PACK ON NECK. HE STILL COMPLAINED OF SWEATS AND NAUSEA AND THEN I GAVE ANOTHER ICE PACK. SLOWLY RECOVERING, I CALLED 911 AND NOTIFIED STORE MGMT OF THE INCIDENT. EMT ARRIVED AT 601PM AND LEFT AT 615PM AFTER ASSESING PATIENT''S CONDITION AND STATE OF MIND. CONCLUDING IT WAS MORE THAN LIKELY ANXIETY


VAERS ID: 1516532 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal discomfort, Burning sensation, Dizziness, Feeling hot, Flushing, Malaise, Nervousness, Panic attack, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypersensitivity (broad), Hypoglycaemia (broad)

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

Write-up: Patient received first dose of Pfizer COVID vaccine today, 7/30/21. Immediately after immunization was administered, patient stated that she was dizzy and stated it was due to being nervous about getting a shot. Patient moved to the waiting area, where she complained of being hot and "flushed". I gave her an ice pack from the pharmacy. Patient denied other symptoms at that time other than a burning sensation in the arm that she received the vaccine. I tested the patient''s blood pressure, which was 127/101, pulse 102. A repeat measurement approximately 5 minutes later was 124/82, pulse 94. Patient again denied any difficulty with breathing, but did state that she was "upset to her stomach.". Patient was moved to the counseling area for additional privacy and began to vomit, dizziness and that "she was not feeling good". Patient became less alert at this time and I asked the pharmacy team to call EMS/Code White. EMS arrived and evaluated patient, stating that it was likely this was due to a "panic attack". EMS took patient out of store on a stretcher.


VAERS ID: 1516534 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Electrocardiogram normal, Fall, Hyperhidrosis
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Accidents and injuries (narrow), Vestibular disorders (broad), Hypoglycaemia (broad)

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

Write-up: Shortly after adminsteration, patient was walking over to the waiting area and got dizzy and fell to the ground. Was sweating profusely. Called the paramedics. Heart rate, blood pressure, and EKG was normal upon their arrival (with in 5-7 minutes from administration)


VAERS ID: 1516535 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Dizziness, Fatigue, Feeling abnormal, Headache, Lethargy, Pain, Pain in extremity
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Arthritis (broad), 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: None
Allergies: Amoxicillin, penicillin, narcotic based medicines
Diagnostic Lab Data:
CDC Split Type:

Write-up: Head ache, dizzy, lethargic, excessively tired, extreme pain from left shoulder to pinky fingers with pain down the entire left side, almost felt like I took some kind of mind altering medicine


VAERS ID: 1516536 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cough, Diarrhoea, Dizziness, Hypotension, Mouth swelling, Paraesthesia, Pruritus, Swollen tongue, Tachycardia, Throat irritation, Vomiting
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), Pseudomembranous colitis (broad), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Vestibular disorders (broad), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad), Hypokalaemia (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: Unknown- possibly typhoid or yellow fever. Anthrax
Other Medications: Zyrtec, Zoloft, omeprazole, lyrica, Celebrex
Current Illness: No
Preexisting Conditions: Ehler danlos, asthma, allergies, undiagnosed autoimmune syndrome- gulf war illness
Allergies: Penicillins, doxycycline, higher doses of sertraline, celexa, clindamycin, anthrax vaccine, some other vaccines in the military. Not sure which ones
Diagnostic Lab Data:
CDC Split Type:

Write-up: Tongue and mouth swelling, tingling, throat itchy, cough, generalized itching, tachycardia, dizziness, hypotension, vomiting and diarrhea. Took albuterol, Zyrtec, Benadryl. Symptoms still ongoing. If worsening will go to ER


VAERS ID: 1516541 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Headache, Injection site pain
SMQs:, Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Flintstone multivitamin cayenne pepper tumeric vitamin C vitamin D
Current Illness: None
Preexisting Conditions: Asthma
Allergies: Amoxicillin penicillin Allegra-D Seafood
Diagnostic Lab Data:
CDC Split Type:

Write-up: Headache, arm soreness at location, lightheaded


VAERS ID: 1516543 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 3 RA / IM

Administered by: Other       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: None
Current Illness: None
Preexisting Conditions: None
Allergies: Shrimp
Diagnostic Lab Data:
CDC Split Type:

Write-up: Youth received an erroneous 3rd dose of Pfizer COVID-19 immunization.


VAERS ID: 1516545 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821287 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dyskinesia, Seizure, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Dyskinesia (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Customer had seizures couple of minutes after administration of vaccine, she was not unconscious, breathing normal but not responded when we talk and had frequent jerking movements. Paramedical arrived and took her to the hospital


VAERS ID: 1516546 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 3 RA / IM

Administered by: Other       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: None
Current Illness: None
Preexisting Conditions: None
Allergies: Fish & Onion
Diagnostic Lab Data: None at this time
CDC Split Type:

Write-up: Youth erroneously received a third dose of COVID-19 immunization


VAERS ID: 1516548 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Allegra Singulair Hydrozyne Xyzal Alvesco Cosentyx Nasonex Patanol Fish oil
Current Illness:
Preexisting Conditions: Psoriasis & psoriatic arthritis Asthma Hypoglycemia
Allergies: Corn, apples, cephalsporins and a few other antibiotics, some shell fish
Diagnostic Lab Data:
CDC Split Type:

Write-up: Allergic reaction with tightening of throat


VAERS ID: 1516709 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 1 LA / IM

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

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

Write-up: The patient & father stated patient''s age was 12 with a DOB 1/19/2009. After administering the shot, upon billing the insurance, it was discovered the patient''s DOB on file is 11/19/2009, therefore the patient is not yet 12 years old for whom the vaccine is indicated for.


VAERS ID: 1516714 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-29
Onset:2021-07-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Musculoskeletal stiffness, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: I have a slight Fever, Fatigue and body aches. Left Arm is stiff and I feel some pain (not really bad) with movement.


VAERS ID: 1516716 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-07-01
Onset:2021-07-30
   Days after vaccination:29
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Ageusia, Feeling of body temperature change, Hot flush, Oropharyngeal pain
SMQs:, Taste and smell disorders (narrow), 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: Turmeric and fish oil. Also zirtec and Flonase.
Current Illness: None
Preexisting Conditions: Stress?
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Got the shot last night. Starting sometime before lunch (mid morning) I?ve been having a ton of hot flashes. Been going from hot to cold really fast. Not uncommon right before my period, but it only happens once or twice then. Probably over 30 times today. Also sore throat and loss of taste. Maybe I just have covid? Dunno - will figure it out tomorrow. This is ongoing.


VAERS ID: 1516724 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-29
Onset:2021-07-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Nausea, Pyrexia, Sleep disorder, Vertigo, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (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: Morning of vaccination took Vitamine D3 2000IU - 2 tablets also 1 Zinc 50mg
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: I contacted my doctor and they just said some people have reactions I must have had covid before. I have not had covid I have donated blood twice in the last year to see if I happen to have antibodies thinking maybe I was symptomatic. I have taken covid test 2 times when I was not feeling well and no covid. The last blood donation was well after the 2 tests.
CDC Split Type:

Write-up: woke up at 1:30 AM on 7/30/2021 from a deep sleep with something I can only explain as the spins. I had believe I had a fever because my husband gave me wet cold towels to try and cool my body and my body warmed them immediately. I could not move or the spins would worsen, I couldn''t even move my head to either side I had to keep laying down, if I tried to sit up it got worse. After about 30 minutes I had to vomit so my husband got the trash can because I could not even attempt to get to the restroom. I began to vomit profusely. I needed something to hold me up so my husband helped me to the floor. We considered calling 911. I vomited intermittently for the next 4 hours. I could not sleep because a slight movement in my head would send me spinning. At about 5 AM I was able to slowly get to a chair in my room to try and sleep. By 8 AM I could walk. Up until about 7 PM (on 7/30) I still felt nausea. I could only sip water or Gatorade, I have managed to eat some soup and crackers.


VAERS ID: 1516735 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Blepharospasm, Chest pain, Head discomfort, Headache, Heart rate increased, Injection site hypoaesthesia, Pruritus, Sensory loss, Throat tightness
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Peripheral neuropathy (narrow), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dystonia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Periorbital and eyelid disorders (narrow), Ocular motility disorders (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: N/A I was monitored and given benadryl in case of allergic reaction
CDC Split Type:

Write-up: Numbness and loss of sensation in left side where shot was injected. Headache on left side. Uncontrollable eye twitching, fast heart beat, pain in chest, pressure in head. Throat closing and itchiness on left side of body.


VAERS ID: 1516739 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-07-27
Onset:2021-07-30
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 098C21A / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Bone pain, Erythema, Immediate post-injection reaction, Nausea, Neck pain, Oropharyngeal pain, Swelling face, Urticaria
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Osteonecrosis (broad), Hypersensitivity (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Ibuprofen and Benadryl at night, Alive! Women''s 50+ multivitamin.
Current Illness: None
Preexisting Conditions: None
Allergies: Aspirin, Codeine, over the counter cold medicines (NyQuil, Comtrex, Sudafed, Tylenol cold) to name a few.
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: I immediately started feeling nauseous, then my face got puffy and red. I started to get a pain from my right ear down my neck and into my collar bone. This area then turned red and hives started appearing. My throat got sore also. The Pharmacist had me take 2 Benadryl before I left the store and then 2 more in 4 hours. I have been taking Benadryl every 4 to 8 hours since due to breaking out in hives down my neck and back. If this continues I will need to seek medical treatment.


VAERS ID: 1516745 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Fatigue, Feeling cold, Pain in extremity, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Fever, chill, arm pain, fatigue


VAERS ID: 1517355 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-29
Onset:2021-07-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Dehydration, Electrocardiogram, Eye movement disorder, Seizure like phenomena, Staring, Syncope, Tremor, Unresponsive to stimuli, Urine analysis
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Dehydration (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Flovent
Current Illness: EoE, complained of headache& stomach pain due to upcoming period
Preexisting Conditions: EoE
Allergies: Penicillin, sulfa, eggs, dairy, beef, peanuts, tree nuts
Diagnostic Lab Data: Urine and ekg
CDC Split Type:

Write-up: Stared, eyes wiggled, shook, unresponsive ( looked like a seizure) ER dr seemed to think it was syncope. However, she didn?t faint. No bloodwork was done. Daughter seemed to have been dehydrated.


VAERS ID: 1518200 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006D21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain upper, Diarrhoea
SMQs:, Acute pancreatitis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Venlafaxine 37.5mg
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Diarrhea (with stomach cramps preceding it) at 9:00 PM on 7/30/2021 and again at approximately 4:05 AM on 7/31/2021


VAERS ID: 1518347 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Limb injury, Pain, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Accidents and injuries (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: Shoulder Joint Injury (prolonged pain, tingling, etc.)-


VAERS ID: 1518348 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Injection site pain, Neck pain, Nerve injury, Paraesthesia, Product administered at inappropriate site
SMQs:, Peripheral neuropathy (broad), Drug abuse and dependence (broad), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Extravasation events (injections, infusions and implants) (broad), Arthritis (broad), Medication errors (narrow)

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

Write-up: Patient received her shot around 3:30pm 7/30/21. She states that she felt a sharp pain instantly at site upon injection which she stated to pharmacist who gave the shot. She states that the pain has been continuous and progressive over the past 12 hours since and is calling in at 3:30AM 7/31/21 to complain of severe pain in her arm keeping her wake. She states that there is also tingling that goes to her fingers and she feels it is affecting the use of her arm. She is concerned there is nerve issues. Patient says the pain also goes up her shoulder to her neck. This is her 2nd dose and she says the first dose she did have pain in the injection area but the onset was gradual (next day) and it was more localized. She feels that the shot was given higher up on her shoulder this time than past immunizations.


VAERS ID: 1518349 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 0584 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Condition aggravated, Dehydration, Dizziness
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Dehydration (narrow)

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

Write-up: Systemic: Dizziness / Lightheadness-Medium, Additional Details: Patient states she was dehydrated which caused her to be dizzy, patient states she has had history of dizziness/fainting due to dehydration. Paramedics took her to local hospital for dehydration.


VAERS ID: 1518350 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 059E21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Chest pain, Dizziness, Dysphagia, Dyspnoea, Flushing, Hyperhidrosis, Hyperventilation, Hypotension, Injection site pain, Nausea, Panic attack, Rash, Throat tightness, Tremor
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (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: Site: Pain at Injection Site-Mild, Systemic: Allergic: Difficulty Breathing-Severe, Systemic: Allergic: Difficulty Swallowing, Throat Tightness-Severe, Systemic: Allergic: Rash Generalized-Severe, Systemic: Chest Tightness / Heaviness / Pain-Severe, Systemic: Dizziness / Lightheadness-Severe, Systemic: Flushed / Sweating-Medium, Systemic: Hyperventilation-Severe, Systemic: Hypotension-Medium, Systemic: Nausea-Mild, Systemic: Shakiness-Medium, Additional Details: Patient Reported Difficulty breathing. 911 was called, Patient was moved to sitting position to assess breathing. Breathing became progressively worse until severely short of breath. Epinephrine given, then EMS arrived and continued assessment. Breathing stabilized, EMS said it was likely a panic attack.


VAERS ID: 1518352 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Grip strength decreased, Hypoaesthesia, Hypotonia, Injected limb mobility decreased
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Systemic: Numbness (specify: facial area, extremities)-Severe, Additional Details: Within minutes after getting the Pfizer vaccine in his left arm, patient reported numbness and limpness in left arm. He was having difficulty lifting his arm, and when I asked him to squeeze my hand he was unable to squeeze it. I instructed his guardian to immediately take him to emergency/urgent care. Patient was not having any additional symptoms when they departed the pharmacy. I will follow up with the patient at end of day.


VAERS ID: 1518354 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site pain, Presyncope, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Extravasation events (injections, infusions and implants) (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Site: Pain at Injection Site-Mild, Additional Details: Paint had vasovagal reaction and fainted after administering shot


VAERS ID: 1518355 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site erythema, Injection site pain, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Extravasation events (injections, infusions and implants) (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Site: Pain at Injection Site-Mild, Site: Redness at Injection Site-Mild, Additional Details: Patient fainted.


VAERS ID: 1518357 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Rhode Island  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Flushing, Hyperhidrosis, Loss of consciousness, Syncope, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), 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: Dizziness / Lightheadness-Severe, Systemic: Fainting / Unresponsive-Severe, Systemic: Flushed / Sweating-Severe, Additional Details: Patient stood up to ask where the bathroom was about 5 minutes after receiving his shot, he felt dizzy and light headed and passed out. An employee was nearby and was able to gently lower him to the floor. He was unconscious for only a few seconds, he was light headed and sweating a lot. He said he felt fine, but after a minute felt lightheaded again and had to sit down. We got him some water and then the paramedics arrived. They checked his blood pressure and sugar level and took him to ER


VAERS ID: 1518359 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 059E21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Aggression, Confusional state, Dehydration, Dizziness, Fatigue, Hyperhidrosis, Immediate post-injection reaction, Lethargy, Loss of consciousness, Seizure, Syncope, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Convulsions (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (narrow), Hypoglycaemia (broad), Dehydration (narrow)

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

Write-up: Systemic: Confusion-Severe, Systemic: Dizziness / Lightheadness-Severe, Systemic: Exhaustion / Lethargy-Severe, Systemic: Fainting / Unresponsive-Severe, Systemic: Seizure-Medium, Additional Details: Patient initially lost consciousness within a minute of vaccine administration. Patient then proceeded to have a seizure for about ten seconds. patient woke up, but did not recognize surroundings. Patient did not recognize his wife nor me (I administered the vaccine). Patient became violent and aggressive. I called 911. After ambulance arrived, patient returned to normal and recognized his surroundings. Patient complained of lightheadedness, dehydration, and severe sweating.


VAERS ID: 1518360 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-07-29
Onset:2021-07-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0164 / 2 LA / SYR

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

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

Write-up: Dizziness, fever, headache, body aches


VAERS ID: 1518361 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Nausea-Mild, Systemic: Vomiting-Mild


VAERS ID: 1518366 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 088D21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Hyperventilation, Hypotension, Malaise, Respiratory rate increased, Vision blurred, Visual impairment
SMQs:, Anaphylactic reaction (narrow), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Eosinophilic pneumonia (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

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

Write-up: Systemic: Dizziness / Lightheadness-Severe, Systemic: Hyperventilation-Medium, Systemic: Visual Changes/Disturbances-Severe, Additional Details: Within about five minutes of vaccine, patient started to not feel well, was breathing rapidly and felt dizzy with blurry vision. Blood pressure was taken and was low (in the 90s over 50s). Had patient lie down. Took BP after five minutes, had gone up to 117. After 30 minutes patient was feeling much better, was able to sit down. Blurry vision and dizziness were gone. Stayed an additional 15 minutes and then went home with his mom and girlfriend. would not be driving


VAERS ID: 1518369 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Epistaxis, Fall, Tremor, Unresponsive to stimuli
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (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), Accidents and injuries (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Dizziness / Lightheadness-Mild, Systemic: Fainting / Unresponsive-Medium, Systemic: Bloody nose possibly caused by the fall-Mild, Systemic: Shakiness-Mild, Additional Details: Patients parents had yelled that he had fallen. Once pharmacy staff went to check on him, the mom was already on the phone with 911. Parents became belligerent and threatened bodily harm the pharmacy staff, so we retreated to the pharmacy for our own safety. Patient was at that point sitting up against a chair so we then waited for paramedics to arrive.


VAERS ID: 1518370 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 059E21A / 1 LA / IM

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

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

Write-up: Systemic: Fainting / Unresponsive-Mild, Additional Details: patient passed out after a few minutes of injected the vaccine in the left arm. Patient was unresponsive for about 5 seconds but regain consciousness. Blood pressure was taking 163/95 and heart rate: 92. Called 911 for medical response team and firefighter team came to check out the patient. Patient said that he is ok and declined to be taking to the hospital for check up. Patient sat in the waiting room until 1pm for further observation and evaulated. Patient left the pharmacy with family membe


VAERS ID: 1518372 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Confusional state, Dizziness, Feeling abnormal, Flushing, Hyperhidrosis, Hypotension, Immediate post-injection reaction, Unresponsive to stimuli
SMQs:, Anaphylactic reaction (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

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

Write-up: Systemic: Confusion-Mild, Systemic: Dizziness / Lightheadness-Medium, Systemic: Fainting / Unresponsive-Medium, Systemic: Flushed / Sweating-Medium, Systemic: Hypotension-Mild, Additional Details: The patient became faint immediately after vaccination and before the needle was removed from the left deltoid. The patient was responsive enough to say "things are fuzzy". Did not lose conciousness that RPh is aware. RPh got some water for patient and laid them down on back. Patient was observed for 30 minutes. Pulse taken 60 bpm and BP 84/46.


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