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From the 10/15/2021 release of VAERS data:

Found 800,916 cases where Vaccine is COVID19 and Patient Did Not Die



Case Details (Reverse Sorted by Onset Date)

This is page 17 out of 8,010

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VAERS ID: 1772564 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-10-08
Onset:2021-10-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Feeling hot, Immediate post-injection reaction, Taste disorder, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Taste and smell disorders (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: pantaprolol 20mg, pepsid 40mg, montelukast 10mg, abuteral inhaler
Current Illness: none
Preexisting Conditions: hypertension, asthma
Allergies: latex, erythromycin, clyndamycin, penicillin, erythromycin, phenergan, floxcillion, cipro, mold, mildew, grass, trees, pollen, sun
Diagnostic Lab Data: wasn''t provided any, told to take benadryl 50mg every 4 hours for the next 24 hours
CDC Split Type:

Write-up: hives ( told to take 2 benadry tablets every 4 hours by pharmacist), warm sensation all over body, bad taste in mouth (instant), chest (tightness)


VAERS ID: 1772572 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-10-08
Onset:2021-10-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 1 RA / IM

Administered by: Work       Purchased by: ?
Symptoms: Incorrect dose administered, Incorrect product formulation 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: None
Preexisting Conditions: Unknown
Allergies: Unknown
Diagnostic Lab Data: Na
CDC Split Type:

Write-up: Coworker drew up 1.8ml of Sodium Chloride 0.9% and 0.3ml of undiluted vaccine into one syringe. The next nurse then gave the entire amount of 2.1ml to the patient.


VAERS ID: 1772574 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-10-08
Onset:2021-10-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Booster dose missed
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: Mono-linyah birth control, spironactlone
Current Illness:
Preexisting Conditions: Obesity, depression, anxiety, ptsd
Allergies: sulfa, clindamycin, flagyl
Diagnostic Lab Data:
CDC Split Type:

Write-up: I went there to get my booster shot as I received my second shot on 4/5/2021 and am obese, so once the CDC opened up the eligibility, I immediately scheduled my booster once the 6 months hit. Once I spoke to the pharmacist and told him I was there to get the booster, he asked why my reasoning was, I said obesity, and he said obesity is not a valid reason. He said that I had to be a first responder or in crowded public settings in order to get the vaccine and he pointed to some document from 9/27/2021. I said that I knew that was wrong and he was insistent that I was not receiving the booster, so I left.


VAERS ID: 1772584 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-10-07
Onset:2021-10-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30155BA / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Dizziness, Erythema, Headache, Pain, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: chest pain dizzy headache red and sore arm fever
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: patient was possibly given 6 doses of undiluted pfzier. chest pain dizzy headache red sore fever


VAERS ID: 1772586 (history)  
Form: Version 2.0  
Age: 10.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-10-08
Onset:2021-10-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 1 RA / IM

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

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

Write-up: Patient was administered the Pfizer vaccine at age of 10 years. Patient was here past 15 min and no side effects presented. Patient was seen by provider and answered any questions patients mother had.


VAERS ID: 1772590 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-08
Onset:2021-10-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822809 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Allergic to Moderna COVID-19 dose
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Client received the 1st COVID vaccine (Moderna Lot # 041L20A and expiration date: unknown, received dose at Clinic) and is here for the first dose of Janssen. Per client developed an anaphylactic reaction approximately 5-7 minutes after administering Moderna, experiencing closing of the throat, angioedema, difficultly breathing, and blurred vision. Client was transported to the nearest hospital and was given Benadryl and two epi pen injection on site. Per client was not admitted to the hospital. Client presented a letter from primary care provider approving Janssen vaccine. Initial vitals were taken; blood pressure: 116/88, oxygen saturation: 99%, respirations: 16, and heart rate: 81. Client states no known allergies, no underlying conditions and not on any type of medications. Medical team was consulted and okay was given by Doctor to give Janssen dose. Janssen dose was administered by PHN, and client was placed under observation for 30 minutes and laid down on gravity chair. After 30 minute observation, no adverse reactions were noted. Client was provided s/sx of when to seek care, follow up with MD, and the use of V-Safe.


VAERS ID: 1772596 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-10-08
Onset:2021-10-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Incontinence, Loss of consciousness, Tremor, 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), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Right after the injection, the patient felt dizzy and lost consciousness. He became unresponsive and his head was shaking. The patient also had an incontinence episode. After regaining consciousness, he was laid on the floor and started to become more alert as time went on. Paramedic services were called and they assessed the patient after arrival on the scene, He was then taken to hospital.


VAERS ID: 1772597 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-06
Onset:2021-10-08
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 053E21A / 2 LA / IM

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

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

Write-up: Patient called clinic on 10/08/2021 described the area of her injection site very itchy and red bumps surrounding the injection site.


VAERS ID: 1772599 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-08
Onset:2021-10-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048C21A / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Hyperhidrosis, Hypoaesthesia, Lip disorder, Speech disorder
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Dementia (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Hypoglycaemia (broad), Sexual dysfunction (broad)

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

Write-up: 1544 Patient c/o sweating, difficulty talking, "lips feel taped", fingertips numb. Patient instructed to lay down, offered water, Vital signs taken, given 02 6 liters at 100%. Patient symptoms improved. VSS. Patient observed ambulating with husband at 1609


VAERS ID: 1772600 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: California  
Vaccinated:2021-10-08
Onset:2021-10-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / 2 LA / SYR

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

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

Write-up: ADMINISTERED EARLIER THAN THE RECOMMENDED 21 DAY INTERVAL. DOSE ONE OF PFIZER/BIONTECH (LOT #30135BA) WAS ADMINISTERED TO PATIENT ON 09/22/2021 (LEFT ARM, DELTOID, IM). DOSE TWO OF PFIZER/BIONTECH (LOT #FE3590 WAS ADMINISTERED TO PATIENT 5 DAYS TOO EARLY ON 10/08/2021 (LEFT ARM, DELTOID, IM). PATIENT HAD NO ADVERSE REACTION. VAERS REPORT SUBMITTED TO RECORD EARLY VACCINATION.


VAERS ID: 1772602 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-08
Onset:2021-10-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 2 LA / IM

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

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

Write-up: Patient was observed seated on floor. Patient''s mother stated she passed out.


VAERS ID: 1772612 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-09-10
Onset:2021-10-08
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / UNK - / JET

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Interchange of vaccine products
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad), Medication errors (broad)

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

Write-up: Provider gave wrong vaccine. Was given moderna for 1st vaccine and pfizer for second.


VAERS ID: 1772613 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-10-08
Onset:2021-10-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822809 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Patient has history of passing out with blood draws & vaccinations
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient fainted briefly after vaccination


VAERS ID: 1772618 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-10-08
Onset:2021-10-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 2 LA / SYR

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

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

Write-up: Patient was administered expired vaccine. Patient was shortly contacted and informed same day, and came back in to receive correct vaccine that was not expired. He received the same lot number in the right arm.


VAERS ID: 1772621 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-10-08
Onset:2021-10-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2590 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Paraesthesia, Peripheral swelling
SMQs:, Cardiac failure (broad), Angioedema (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

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

Write-up: Patient said arm felt "tingly" and patient said hand appeared to be swelling. Patient was observed for over the 15 minute appropriate wait time. She was given water and the option of Benadryl. After over 30 minutes of observation, the patient said she was fine and was okay to leave. Once the patient informed me that her arm felt ''tingly'' and that her hand look swollen, I had her sit down in the observation zone for another 15 minutes. I contacted my coordinator to see what steps I should take next. I offered the patient water and Benadryl. After sitting for 15 minutes, I asked the patient if she was experiencing any shortness of breath or any other symptom that warranted EMT presence. The patient said she was feeling fine and that she was okay to leave. I made sure to counsel the patient and let her know that if she started to have any a serious reaction, she should head to the ER immediately.


VAERS ID: 1772622 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-10-08
Onset:2021-10-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 027C21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Given wrong vaccination, should be Moderna


VAERS ID: 1772624 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-10-08
Onset:2021-10-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Adrenal disorder, Chest pain, Dyspnoea, Feeling jittery, Heart rate increased, Hypertension
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Hypertension (narrow), Cardiomyopathy (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: CORTISOL, ARMOR THYROID
Current Illness:
Preexisting Conditions: HYPOTHROIDISM, ADDISONS DISEASE
Allergies: NONE
Diagnostic Lab Data: WENT TO URGENT CARE FOR BP CHECK WHICH WAS HIGHER THAN USUAL FOR ME BUT STILL WITHIN NORMAL LIMITS
CDC Split Type:

Write-up: TWENTY MINUTES AFTER THE VACCINE WAS ADMINISTERED I BECAME JITTERY, MY ADRENALINE INCREASED, SAME REACTION I HAD AFTER TAKING HIGH DOSES OF STEROIDS (IN THE PAST FOR PREVIOUS SURGERY). MY HEART RATE INCREASED, SHORTNESS OF BREATH, PAIN IN MY CHEST, ETC?. I DRANK AT LEAST 3 LITERS OF WATER AFTER THE EVENT, TOOK HIGH DOSES OF RESVERATROL, COQ10, MY HEART RATE STARTED TO COME DOWN. STILL JITTERY .


VAERS ID: 1772759 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-10-08
Onset:2021-10-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / 3 LA / IM

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

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

Write-up: Patient was supposed to get Flu shot and accidently got a Covid vaccine. It was his 3rd dose. So far, the patient has not had any adverse affects


VAERS ID: 1772765 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-07
Onset:2021-10-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain, Diarrhoea, Fatigue, Headache, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Noninfectious diarrhoea (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fatigue headache muscle pain Diarrhea with abdominal pain


VAERS ID: 1772770 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-10-07
Onset:2021-10-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: B12, Flintstone complete, naltrecone 50mg, bupropion 150 MG xl, omperazole 40mg xr,
Current Illness: None
Preexisting Conditions: None
Allergies: Allergies to liquid stitches after weight loss surgery
Diagnostic Lab Data: None
CDC Split Type: 10-7-21

Write-up: 1st vaccine redness irration at injection area a few seconds after injection. A week later arm flared up again in same spot. 2nd injection swollen even bigger, fever in location, feel like an insect bit me and I''m allergic to it.


VAERS ID: 1772777 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-04
Onset:2021-10-08
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Metoprolol
Current Illness: None reported
Preexisting Conditions: None reported
Allergies: Figs, Relpax (Eletriptan)
Diagnostic Lab Data: Vitals at 16:40: T98.6F, HR 88, BP 118/79, O2 98% room air. Vitals at 16:53: T98.4, HR 75, BP 112/72, O2 97% room air.
CDC Split Type:

Write-up: At 16:38, the patient reported feeling hives, however denies shortness of breath or feelings of closing airway. Benadryl administered PO, and vitals were taken. Fluids provided. Nurse noted redness to left upper chest, however did not worsen within 30 minutes monitoring period. Second set of vitals taken before patient left monitoring. The patient denied any shortness of breath, feelings of closing airway, or anaphylaxis-type reactions upon leaving. Patient educated to monitor symptoms, take additional Benadryl PO as needed, and to stay hydrated.


VAERS ID: 1772780 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-10-08
Onset:2021-10-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011F21A / 1 RA / IM

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

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

Write-up: patient recieved Moderna covid 19 for very first time. In appoximately 5 minutes later patient passed out. Skin was white. no difficulty in breathing. as time passed patient improved . ems had arrived and released patient into parents care appoximately 15 minutes later


VAERS ID: 1772781 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-09-29
Onset:2021-10-08
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017F 21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cellulitis, Erythema, Feeling hot, Hypersensitivity
SMQs:, Anaphylactic reaction (broad), Angioedema (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: UNKNOWN
Allergies: NONE
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Patient has signs and symptoms of celluitis or allergy in the arm. warmth, redness, spreading started a few days before 10/8/21 and the vaccine was administered on 9/29/21


VAERS ID: 1772782 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-10-08
Onset:2021-10-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 212A21A / 1 LA / IM

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

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

Write-up: Currently, Janssen COVID19 vaccine is only approved under EUA for use in those 18 years of age and older. Patient was age 13 at time of immunization. No treatment was given. Mother was informed that administration of the vaccine was a medication error and to contact their HCP with any concerns.


VAERS ID: 1772788 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-10-08
Onset:2021-10-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD0810 / 1 LA / IM

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

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

Write-up: PATIENT RECEIVED A PFIZER VACCINATION - WHEN THE PATIENT WAS IN THE WAITING AREA FOR THE 15 MINUTE POST VACCINATION WAIT PERIOD. MEMBER STOOD UP AND ENDED UP FAINTING AND HITTING HIS HEAD ON THE FLOOR. TECHNICIAN CALLED 911 AS I RAN TO ASSIST. MEMBER WAS WAKING UP ON THE FLOOR WITH HIS MOTHER AND STEP FATHER AROUND HIM. MEMBER CAME TO AND PARAMEDICS ARRIVED. WHEN THEY MOVED HIM TO A SEATING POSITION. HE HAD ANOTHER SYNCOPAL/SEIZURE TYPE EPISODE. MEMBER WENT WITH PARAMEDICS TO MEDICAL CENTER.


VAERS ID: 1772792 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-10-08
Onset:2021-10-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Ear discomfort, Nasal discomfort, Tinnitus
SMQs:, Hearing impairment (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Tick infections
Allergies: Bendaryl/Reglan
Diagnostic Lab Data: None needed at this time. Just reporting, to let you know.
CDC Split Type:

Write-up: Pressure in nose {mild} Pressure and ringing in ears {moderate}


VAERS ID: 1772794 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-10-08
Onset:2021-10-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 019F21A / 2 LA / IM

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

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

Write-up: She was here to get her second moderna shot and was given the pfizer by mistake. She is fine. I have checked on her twice and I spoke with Moderna and they said she would not need to be revaccinated at this time. The pfizer lot was ff8839 exp 12/21


VAERS ID: 1772977 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-10-08
Onset:2021-10-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Dyspnoea, Paraesthesia
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Vestibular disorders (broad)

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

Write-up: Patient experienced dizziness and tingling in extremities shortly after vaccination (within approximately 5 minutes of injection). Stated shortly after, she was also having trouble breathing at the time. Patient sat down in the waiting room with feet raised for several minutes after experiencing side effects. After approximately 5 minutes of resting patient stated symptoms were abating. Tingling in the extremities and dizziness seemed to resolve completely approximately 15 to 20 minutes after vaccine administration. Patient did not describe any issues with breathing. At 30 to 45 minutes after vaccination, patient stated she was no longer experiencing any side effects and she felt safe taking herself home.


VAERS ID: 1772981 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: California  
Vaccinated:2021-10-08
Onset:2021-10-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 053E21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: The second dose was actually due on 10/14/2021, but as the date on the card for the 1st dose was written wrong, the 2nd dose was given 6 days earlier than the actual due date.


VAERS ID: 1772983 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-10-08
Onset:2021-10-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 019F21A / 2 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: Patient had nausea and vomiting about 5 minutes after receiving her second dose of Moderna COVID 19 vaccine. It lasted about 20 minutes, then she felt fine and left the pharmacy.


VAERS ID: 1772987 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-10-08
Onset:2021-10-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 2 LA / IM

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

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

Write-up: Itching, rash.


VAERS ID: 1772988 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-10-08
Onset:2021-10-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822809 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anxiety, Dizziness, Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), 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: nkda
Diagnostic Lab Data:
CDC Split Type:

Write-up: After getting the shot pt became light headed and passed out. We laid him down and elevated his feet and he came back immediately. We had him rest on the ground for about 5 minutes then sat him in a chair for about 20 more minutes at which time pt said he felt fine and wished to go home. We advised for him to have a driver take him but he declined. Pt was very sure he was fine. Prior to the shot he expressed anxiety and hesitation about the shot but wanted to proceed. The adverse effect was most likely anxiety related. We followed up with him at home approx 1 hour later and he was fine. We advised he discuss reaction with MD.


VAERS ID: 1773151 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-10-08
Onset:2021-10-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 3 LA / IM

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

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

Write-up: Pt was at the pharmacy to receive third dose Moderna for immunocompromised. She was inadvertantly given Pfizer.


VAERS ID: 1773461 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-10-05
Onset:2021-10-08
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / -

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

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

Write-up: On Friday October 8th, 2021, three days after receiving my first dose My left side of my face began to swell and form a rash. As a couple of hours went by the rash spread to the right side of the face. Jaw line and neck as well as hands and arms. I contacted the local clinic to inform them of my symptoms and they suggested to go to the hospital. I went to the hospital and received medication to help the swelling and slow down the spread of the rash.


VAERS ID: 1773470 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-08
Onset:2021-10-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK RA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Headache, Nausea, Pain, Pain in jaw, Pelvic pain, Yawning
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Osteonecrosis (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Moderna second shot, 42 years old
Other Medications: Vitamin d3, calcium, melatonin
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Lightheadedness within 15 minutes that remained intermittent and low. Nausea within 15 minutes that was transient. 9 hours after injection body aches hear through pelvis. Excessive yawning and stretching. Headaches. Right side worse than left. Jaw pain especially right side


VAERS ID: 1773476 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-10-05
Onset:2021-10-08
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301358A / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Atenolol25mg, Amphetamine/dextroamphepamine 30mg IR, amlodipine 10mg, hydrochlorothiazide 25mg, abilify 5mg.
Current Illness: None
Preexisting Conditions: Binge eating disorder, high blood pressure, clinical depression
Allergies: Shellfish
Diagnostic Lab Data: None
CDC Split Type:

Write-up: My ears are ringing. Like a high frequency test tone. It?s constant in both ears. I have never experienced tinnitus before nor diagnosed with it. What I?m experiencing is not of an orthostatic nature. It?s constant laying down or standing/walking.


VAERS ID: 1774062 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-10-04
Onset:2021-10-08
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 RA / -

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

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

Write-up: Severe right ear tinnitus and some hearing impairment


VAERS ID: 1774916 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-10-07
Onset:2021-10-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Hyperhidrosis, Malaise, Somnolence
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (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: Folic Acid Simvastatin Bystolic Lisinopril Methotrexate
Current Illness: None
Preexisting Conditions: Obesity High blood pressure
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Felt sick, drowsy and sweating


VAERS ID: 1774922 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-10-07
Onset:2021-10-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Burning sensation, Fatigue, Hyperhidrosis, Injection site pain, Lymph node pain, Lymphadenopathy, Myalgia, Pain in extremity, Pruritus, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Hypoglycaemia (broad)

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

Write-up: Very swollen and painful lymph nodes in armpit, chest, neck, and breasts; severe pain at injection site that spread to entire left arm, hand and fingers; sporadic full body muscle aches and pains; burning and itchy feet; sudden onset sweating and sporadic fever; fatigue;


VAERS ID: 1774926 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-10-08
Onset:2021-10-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Hyperhidrosis, Nausea, Pallor, Presyncope, Skin discolouration
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: MCV4
Other Medications: none
Current Illness: cold-like s/s; negative covid
Preexisting Conditions: herpes simplex; hx of vasovagal syncope
Allergies: PCN
Diagnostic Lab Data: none
CDC Split Type:

Write-up: pt had very near syncopal event - she''s had previous syncopal events following vaccination so precautions were taken such as having pt at a decline for vaccination,deep breathing exercises, and gave pt a lolipop after for some sugar to help with blood pressure, had pt remaining at decline post-vaccination, pt reported she was feeling well, apx 10 minutes later pt bc extrememly nausiated and had near-syncopal event; immediately laid pt all the way flat and got pt cold compresses; pt had extreme pallor and was green around mouth; pt was diaphoretic, event lasted apx 10 mintues


VAERS ID: 1774932 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-10-06
Onset:2021-10-08
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK LA / IM

Administered by: Private       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: Diltiazem 60 mg Citalipram 40 mg Tramadol 50mg Omeprazole DR 40mg cap
Current Illness: None
Preexisting Conditions: None
Allergies: Penicillin Sulfa Iodines Adhesives
Diagnostic Lab Data:
CDC Split Type:

Write-up: None stated.


VAERS ID: 1774934 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-10-08
Onset:2021-10-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Injection site pruritus
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: Losartin, Bupropion, low dose aspirin, Citalopram
Current Illness: No
Preexisting Conditions: No
Allergies: No
Diagnostic Lab Data:
CDC Split Type:

Write-up: Injection site on left upper arm itching.


VAERS ID: 1774935 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-10-07
Onset:2021-10-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, Fatigue, Injection site pain, Myalgia, Oropharyngeal pain
SMQs:, Rhabdomyolysis/myopathy (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Extravasation events (injections, infusions and implants) (broad), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Pravastatin sodium 40 mg Calcium + D 400 Prevagen
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Muscle pain Joint pain Injection site pain Fatigue Sore throat


VAERS ID: 1774938 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-10-07
Onset:2021-10-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301558A / 2 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Chills, Headache, Oropharyngeal pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (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: Cymbalta
Current Illness: None
Preexisting Conditions: Major Depression
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: I woke up approximately 5:00a.m. on 10/08/2021 with chills, fever of 99.3 and headache with sore throat. This continued for approximately 16 hours with my fever climaxing at 101.9. I started taking Tylenol around 8:00a.m.


VAERS ID: 1774941 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-10-08
Onset:2021-10-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301358A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Urinary tract disorder
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: Calcium (Last dose Oct, 7, 2021)
Current Illness: none
Preexisting Conditions:
Allergies: Ibuprofen Sulfa Drugs Levaquin Mangos Morel Mushrooms
Diagnostic Lab Data:
CDC Split Type:

Write-up: Urinary Tract Symptoms


VAERS ID: 1774948 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Nebraska  
Vaccinated:2021-10-08
Onset:2021-10-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Burning sensation, Headache, Injection site urticaria, Nausea, Pruritus, Taste disorder, Urticaria
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Peripheral neuropathy (broad), Taste and smell disorders (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: At time of vaccination no prescription was taken 2 weeks prior.
Current Illness: None I was perfectly fine before I had this mandated vaccine that I never would have got if I wasn''t coerced and forced.
Preexisting Conditions: No
Allergies: Vicodin, sunlight, topical meds, flu shot
Diagnostic Lab Data: No I called the ER and they don''t have a protocol for this except to wait it out especially me tasting this medicine. I do not wish this on anyone.
CDC Split Type:

Write-up: 15 min after receiving the shot I could taste it meaning I could literally taste the medicine in my mouth. A couple hours later I experienced itching throughout my body more on my arm back and neck. I thought these things would go away and this morning I can still taste the vaccine. It tastes bitter. It tastes mediciney like saline mixed with something which in turn is making me nauseated because I can''t get this taste out of my mouth. I can taste foods n things just fine but it''s like the medicine is absorbed through my skin or something. I am also itching everywhere. My back on the right side mainly but also other parts of my body but it kind of hurts and burn a little on that whole right side kinda like hives but no red rash on the backside just injection site. I also am experience headaches. I went to work at 6:40 am and my head was pounding. I rarely have headaches but I was completely healthy before this. I was living my best health life before this. This vaccine was not made for me. This is also causing me to lose hours because I can''t think if I''m in this much turmoil behind it.


VAERS ID: 1774950 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-10-06
Onset:2021-10-08
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Lymphadenopathy, Pain, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: axilar adenomegaly and swelling, mild pain


VAERS ID: 1774953 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-10-06
Onset:2021-10-08
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Axillary pain, Lymphadenopathy, Tenderness
SMQs:, 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: Omega 3 Multivitamins Lorazepam Nucleotidos
Current Illness: No
Preexisting Conditions: None
Allergies: No
Diagnostic Lab Data:
CDC Split Type:

Write-up: Adenomegaly axilar, pain, tenderness in underarm


VAERS ID: 1774960 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-10-08
Onset:2021-10-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0150 / 1 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Erythema, Full blood count, Headache, Heart rate increased, Metabolic function test, Pharyngeal swelling, Pruritus, Rash macular, Urine analysis
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Amlodipine Lipitor
Current Illness:
Preexisting Conditions: Asthma, sjogrens, primary, high blood pressue, high cortisol
Allergies: Hay fever, demoral, sulfa, pcn, ibuprofen, liquibid-d, codiene, keflex, cipro, tcn, cleocin, erythromycin, macrobid
Diagnostic Lab Data: Cbc, metabolic panel, urinalysis
CDC Split Type:

Write-up: Itching, headache, red blotches on skin, raised heart rate, swelling throat


VAERS ID: 1774963 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Louisiana  
Vaccinated:2021-10-07
Onset:2021-10-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cerebrovascular accident, Dysstasia, Eye irritation, Speech disorder, Vision blurred
SMQs:, Anticholinergic syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Dementia (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Glaucoma (broad), Lens disorders (broad), Corneal disorders (broad), Retinal disorders (broad), Hypoglycaemia (broad)

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

Write-up: Patient came in pharmacy 10/8/21 (evening) complained of feeling as if something was in his left eye and wanted an eye wash. After questioning patient, had patient take blood pressure (171/94). Patient said sight was blurry in left eye. Advised patient and spouse to seek medical attention. Patient started having trouble with speaking and standing. Patient''s wife brought to hospital. Called patient''s wife to inquire status on 10/9/21. Patient had a stroke and is still in hospital.


VAERS ID: 1774976 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-10-08
Onset:2021-10-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH N/A / 3 - / IM

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

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

Write-up: Administration error, mixed series mRNA vaccines Pfizer and Moderna


VAERS ID: 1774978 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-10-08
Onset:2021-10-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH N/A / 3 - / IM

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

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

Write-up: Administration error, mixed series mRNA vaccines Pfizer and Moderna


VAERS ID: 1774979 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-10-08
Onset:2021-10-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH N/A / 3 RA / IM

Administered by: Unknown       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: Administration error, mixed series mRNA vaccines Pfizer and Moderna


VAERS ID: 1774981 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-10-08
Onset:2021-10-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH N/A / 3 - / IM

Administered by: Unknown       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: Administration error, mixed series mRNA vaccines Pfizer and Moderna


VAERS ID: 1774982 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-10-08
Onset:2021-10-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH N/A / 3 - / IM

Administered by: Unknown       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: Administration error, mixed series mRNA vaccines Pfizer and Moderna


VAERS ID: 1774985 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-10-08
Onset:2021-10-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH N/A / 3 - / IM

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

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

Write-up: Administration error, mixed series mRNA vaccines Pfizer and Moderna


VAERS ID: 1774989 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-10-08
Onset:2021-10-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH N/A / 3 - / IM

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

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

Write-up: Administration error, mixed series mRNA vaccines Pfizer and Moderna


VAERS ID: 1774991 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-10-08
Onset:2021-10-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH N/A / 3 - / IM

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

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

Write-up: Administration error, mixed series mRNA vaccines Pfizer and Moderna


VAERS ID: 1774992 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-10-08
Onset:2021-10-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH N/A / 3 - / IM

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

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

Write-up: Administration error, mixed series mRNA vaccines Pfizer and Moderna


VAERS ID: 1775042 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2021-10-08
Onset:2021-10-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 3013SBA / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site urticaria
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Desonide, pre-natals
Current Illness:
Preexisting Conditions: Psoriatic arthritis
Allergies: Shellfish, gluten
Diagnostic Lab Data:
CDC Split Type:

Write-up: Giant hive at injection site and pain


VAERS ID: 1775044 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-07
Onset:2021-10-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / UNK - / -

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

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

Write-up: Chills, low grade fever, headache, body aches


VAERS ID: 1775045 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-07
Onset:2021-10-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache, Palpitations, Sleep disorder
SMQs:, Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: levothyroxine sodium 75 mcg
Current Illness: N/A
Preexisting Conditions: Hypothyroidism
Allergies: N/A
Diagnostic Lab Data: None...did not go to ER or call emergency
CDC Split Type:

Write-up: I woke up out of a dead sleep with a severe headache and my heart was pounding so hard that I thought it was going to explode out of my chest. Lasted for several hours during the night long and did not feel somewhat OK until approximately 4-5 PM on 10/08/2021.


VAERS ID: 1775048 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-10-07
Onset:2021-10-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Aura, Heavy menstrual bleeding, Menstruation irregular, Pain, Pyrexia
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Convulsions (broad), Fertility disorders (broad), Generalised convulsive seizures following immunisation (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: Fever, body aches, sight auras, early unscheduled menstrual cycle - heavy bleeding


VAERS ID: 1775077 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-10-07
Onset:2021-10-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD0810 / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Chills, Lethargy
SMQs:, Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Arthritis (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Atorvastatin , Chlorthalidone , Amlodipine Besylate , Benazepril Hcl, Latanoprost, Prilosec, Aspirin
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Extreme chills, lethargic, joint pain


VAERS ID: 1775087 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-02-20
Onset:2021-10-08
   Days after vaccination:230
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / 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? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Tested positive for Covid-19 on 10/8/21


VAERS ID: 1775095 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-10-07
Onset:2021-10-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Lymph node pain, Lymphadenopathy
SMQs:, 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: Simvastatin, Levothyroxine, Gummy multi vitamin, Airborne
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Enlarged and tender lymph nodes under left arm


VAERS ID: 1775099 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-10-08
Onset:2021-10-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Fatigue, Lethargy, Malaise, Paraesthesia, Somnolence
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Dizziness / Lightheadness-Medium, Systemic: Exhaustion / Lethargy-Mild, Systemic: Tingling (specify: facial area, extemities)-Mild, Additional Details: Tingling and pinprick feelings of hands, feet, and neck. Felt dizziness, generally unwell, and like he could fall asleep.


VAERS ID: 1775117 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: California  
Vaccinated:2021-10-08
Onset:2021-10-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301558A / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, 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? 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: Chest Tightness / Heaviness / Pain-Medium, Additional Details: Patient reported trouble breathing for several minutes after being administered second dose of Pfizer. Water was given and patient recovered within 5 minutes


VAERS ID: 1775118 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: California  
Vaccinated:2021-10-08
Onset:2021-10-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301558A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, 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? 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: Chest Tightness / Heaviness / Pain-Medium, Additional Details: Patient reported trouble breathing after being administered second dose of Pfizer COVID19 vaccine. After being given water, patient recovered within 10 minutes.


VAERS ID: 1775119 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-10-08
Onset:2021-10-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 AR / SYR
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / 1 - / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Extra dose administered, Pain in extremity
SMQs:, Arthritis (broad), Tendinopathies and ligament disorders (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: Hydrocortisone, Fludrocortisone, vitamin C, Vitamin D, Phenergan, Pantropazole, Levothyroxine, Topiramate, Cimetedine
Current Illness: No
Preexisting Conditions: Addison?s disease, Hashimoto?s thyroiditis
Allergies: Vicodin, vicks vapor inhaler, vinyl gloves, Levaquin, Zithromax, Prednisone, Lidocaine, Percoset
Diagnostic Lab Data: None
CDC Split Type:

Write-up: I received my third Pfizer (booster) Covid -19 shot at the same time as my annual flu shot. One vaccine was in my left arm, one in my right arm. My left arm hurt significantly worse. The night of the vaccine administration, I developed joint pain. The joint pain was significant in both of my knees. I could hardly sleep. I took Tylenol 500 mg x 2, but this did not affect the pain. On 10-9-2021 I took some 12 hour naproxen, ( 2 pills- max 3 in one day) and this helped significantly.


VAERS ID: 1775125 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-10-08
Onset:2021-10-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Confusional state, Injection site erythema, Injection site pruritus, Loss of consciousness, Tremor
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (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: Site: Itching at Injection Site-Mild, Site: Redness at Injection Site-Mild, Systemic: Confusion-Mild, Systemic: Shakiness-Mild, Additional Details: I have him the shot around 7.15 pm. he has stated that he passed out after the first dose as well and I told him we will monitor him for at least half hour. He sat on the outside chair and passed out, his wife held him and we had him lay on the floor. 911 was called and he was taken to the hospital. He came back to his consciouness after about 2 minutes.


VAERS ID: 1775127 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-10-08
Onset:2021-10-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / 3 LA / IM

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

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

Write-up: Systemic: Fainting / Unresponsive-Mild


VAERS ID: 1775133 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-10-08
Onset:2021-10-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301458B / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Burning sensation, Dizziness, Flushing, Hyperhidrosis, Paraesthesia
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad), Hypersensitivity (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Burning sensation-Medium, Systemic: Flushed / Sweating-Medium, Systemic: Tingling (specify: facial area, extemities)-Mild, Additional Details: Pt felt light headed and a burning sensation for 4 minutes. Ice pack and juice were provided, pt felt okay after 10 mins


VAERS ID: 1775135 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-10-08
Onset:2021-10-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 3 LA / IM

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

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

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


VAERS ID: 1775138 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-10-08
Onset:2021-10-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 3 LA / IM

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

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

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


VAERS ID: 1775139 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-10-08
Onset:2021-10-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2590 / 3 AR / IM

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

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

Write-up: Error: Wrong Patient (documentation in EMR)-


VAERS ID: 1775142 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: California  
Vaccinated:2021-10-08
Onset:2021-10-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / N/A LA / IM

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

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

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


VAERS ID: 1775143 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: California  
Vaccinated:2021-10-08
Onset:2021-10-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / 3 LA / IM

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

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

Write-up: Error: Incorrect Reconstitution-


VAERS ID: 1775144 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-10-07
Onset:2021-10-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Headache, Oropharyngeal pain, Pain
SMQs:, Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Vestibular disorders (broad)

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

Write-up: Dizzy, body aches, headache, sore throat,


VAERS ID: 1775145 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-10-08
Onset:2021-10-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 2 LA / SYR

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

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

Write-up: Systemic: Dizziness / Lightheadness-Medium, Systemic: Fainting / Unresponsive-Medium, Systemic: Nausea-Medium, Systemic: Vomiting-Medium


VAERS ID: 1775152 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: New York  
Vaccinated:2021-10-08
Onset:2021-10-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 3 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Arthralgia, Chills, Fatigue, Injection site pain, Neck pain, Oropharyngeal pain, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Extravasation events (injections, infusions and implants) (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: Same symptoms after 1st and 2nd dose of same Pfizer/Moderna vaccine
Other Medications: Lamotrigine Vyvanse Venlafaxine
Current Illness: None
Preexisting Conditions:
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Progressing injection site soreness extending down arm and up left side neck. Fatigue, body ache and chills starting apps 3 hours later, joint pain, fever mild sore throat next morning


VAERS ID: 1775156 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-10-07
Onset:2021-10-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BAPFIZER / UNK LA / SYR
FLU4: INFLUENZA (SEASONAL) (FLUZONE QUADRIVALENT) / SANOFI PASTEUR UT7330NA / UNK LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Dizziness, Injection site pain, Pain, Pyrexia, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Extravasation events (injections, infusions and implants) (broad), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Lightheaded and dizzy, Pfizer dose 2, February 26, 2021, 26 years old
Other Medications: None
Current Illness: Soy
Preexisting Conditions: Irritable Bowel Syndrome Polysistic Ovarian Syndrome
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Dizzy, lightheaded, fever, shakes, soreness in injection sights and aches in my lower body


VAERS ID: 1775158 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-08
Onset:2021-10-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Benadryl 50 mg IM
Current Illness: none reported by patient
Preexisting Conditions: pre diabetes, recent Bariatric surgery,
Allergies: Nsaids
Diagnostic Lab Data: advised patient to follow up with primary care doctor.
CDC Split Type:

Write-up: patient complains of itching inside throat and need to keep clearing throat soon after receiving 2nd dose of vaccine. symptoms relived few minutes after Benadryl 50 mg IM dose given. at 1800 patient was discharged home symptoms free in stable condition. boyfriend with patient. follow-up care instructions given to both.


VAERS ID: 1775163 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-09-27
Onset:2021-10-08
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 2 RA / IM

Administered by: Military       Purchased by: ?
Symptoms: Chest pain, Palpitations
SMQs:, Arrhythmia related investigations, signs and symptoms (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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vit B12 and Calcium
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Chest pain and palpitations


VAERS ID: 1775179 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-29
Onset:2021-10-08
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 076C21A / UNK RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Injection site erythema, Peripheral swelling, Rash, Rash pruritic
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: sulfa, occasional rash with eggs- mild
Diagnostic Lab Data: none
CDC Split Type:

Write-up: patient presented with a red spot at injection site about 4x4 area. She stated also having rash on back ,legs, and breast that itches. She stated that she has gotten dizzy also. Patient has taken Zyrtec and applied ice to area. Pharmacist suggested benadrylas it is a better choice for itching and can bring down swelling of arm and to continue using ice.


VAERS ID: 1775203 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: California  
Vaccinated:2021-10-08
Onset:2021-10-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301458A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, General physical condition abnormal
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: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: While waiting for 15 minutes after the first covid vaccine, patient slumped down the chair but did not hit his head to the floor. Patient was awake the whole time and reported lightheaded as well as dizzy. Pharmacy called 911 and provided a bottle of water while monitoring patient closely. No signs and symptoms of allergic reactions. EMS arrived and checked patient''s vitals which were all normal and released patient home with parents.


VAERS ID: 1775217 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-10-08
Onset:2021-10-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006C21A / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chills, Diarrhoea, Dizziness, Feeling abnormal, Headache, Insomnia, Migraine, Muscle spasms, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Pseudomembranous colitis (broad), Dystonia (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Metoprolol Synthroid Zoloft
Current Illness: None
Preexisting Conditions: Hypertension, NSVT arrhythmia, hypothyroid, depression
Allergies: Tramadol
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Fever with chills, muscle aches, muscle cramps, muscle spasms, severe headache, insomnia, migraines, diarrhea, dizziness, ?brain fog?


VAERS ID: 1775219 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-10-08
Onset:2021-10-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / 1 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Burning sensation, Feeling hot, Hypoaesthesia oral, Pharyngeal swelling, Pruritus, Rash, Rhinorrhoea, Tremor, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), 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: Plaquenil: Take 1 tablet (200 mg total) by mouth 2 (two) times daily.. Tizanidine: Take 1 tablet (4 mg total) by mouth every 6 (six) hours as needed.
Current Illness: N/A
Preexisting Conditions: Sjogrens Syndrome, Fibromyalgia, Hypoglycemia
Allergies: Acyclovir, Valtrex, Prozac, Sulfa
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Covid vaccine given at 1:17pm. At 1:48pm initial signs of reaction was noted. The time of reaction was at 2:15pm. Symptoms: 1. heat and burning sensation in the face (lips and and cheek), neck and abdomen 2. rash (urticaria) in my neck, lips and abdomen 3. runny nose 4. heaviness or swollen throat 5. shaking and tremors 6. itchiness in the face and abdomen 7. numbness in the lips This happened after 40 minutes of having had received the vaccine. 2:15pm: 25mg PO -Benadryl 2:35pm: 25mg PO- Benadryl **At the beginning it was very hard to measure my blood pressure because I was trembling a lot. However after being treated with two Benadryl tablets they were able to get a reading on my blood pressure. Medical facility was unsure if to apply the epi-pen. Symptoms subsided and I was sent home. They recommended to take a two Benadryl every six hours.


VAERS ID: 1775233 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Idaho  
Vaccinated:2021-09-30
Onset:2021-10-08
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -

Administered by: Private       Purchased by: ?
Symptoms: Erythema, Feeling hot, Pain, Pruritus, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Swollen, red, hot to touch, painful and itchy


VAERS ID: 1775244 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-08
Onset:2021-10-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 1 RA / IM

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

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

Write-up: At 1705 36 year old female stated she has itchy throat and also noticed facial redness, denied other symptoms. Vital signs: b/p: 107/81, p: 70, O2: 100% Room air, R:17, Benadryl 25 mg capsule given at 1710. Patient stated she felt better at 1725 and husband came to drive her home.


VAERS ID: 1775259 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-10-07
Onset:2021-10-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Fatigue, Headache, Lymph node pain, Nausea, Pain
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Atenolol, sertraline, hydrochlrothiazide, Lipitor, fish oil, lysine, vitamin b, resveratol, quercetine, bromide, zinc, l-theanine
Current Illness: None
Preexisting Conditions: High blood pressure, NPS
Allergies: Penicillin, sulfa, diflucan
Diagnostic Lab Data:
CDC Split Type:

Write-up: Headache, body aches, nausea, sore lymph nodes, fatigue


VAERS ID: 1775262 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-01
Onset:2021-10-08
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Headache, Myalgia, Nausea, Pain in extremity
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Cholesterol lowering statin Diltiazem Baby Aspirin Vitamin K Vitamin D Magnesium Probiotic
Current Illness: None
Preexisting Conditions: Coronary Artery Disease
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Severe arm pain, severe headache, horrible muscle pain, nausea, fatigue,. Unable to get relief with ibuprofen or acetaminophen.


VAERS ID: 1775269 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-10-08
Onset:2021-10-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 3 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Chills, Dizziness, Fatigue, Injection site pain, Injection site swelling, Lymph node pain, Lymphadenopathy, Malaise, Nausea, Pain in extremity, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: 47 yrs old, 2nd Covid-19 Vaccine, 01/22/2021, Pfizer
Other Medications: Duloxetine 80mg Daily, cetirizine 10 mg tablet daily, CHOLEcalciferol 1000 UNITS tablet; Take 2 Tabs Daily,,
Current Illness: None
Preexisting Conditions: Obesity, Anxiety, Fibromyalgia, Obstructive Sleep Apnea
Allergies: None
Diagnostic Lab Data: None this far.
CDC Split Type:

Write-up: Swollen and very sore Right arm, excessive tiredness, general malaise and nausea noticed within 3 hours after booster vaccination administration. Then, in the evening, at about 7-8 hours after booster administration, Right arm and axila tenderness and swollen. Pain felt all the way down the Right forearm, wrist and hand. Feverish and chills. Took 2-200mh ibuprofen before bed. Today( Day 2), continued above symptoms, began to worsen about 26 hrs post administration and if not resting, I felt weak and dizziness. Took 2-200mg of ibuprofen and took a nap.


VAERS ID: 1775273 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Florida  
Vaccinated:1974-07-09
Onset:2021-10-08
   Days after vaccination:17258
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Venlafaxine, Gemfibrozil, Novalin 70/30, oxcarbazepine, meloxicam, ezetimibe, gabapentin
Current Illness: Diabetes, high cholesterol, mental health
Preexisting Conditions:
Allergies: PCN, tetracyclines, Vicodin, Percocet,
Diagnostic Lab Data:
CDC Split Type:

Write-up: Extreme headache after the 2021 flu shot. Extremely persistent even 24 hrs later.


VAERS ID: 1775290 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-05-02
Onset:2021-10-08
   Days after vaccination:159
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

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

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

Write-up: Janssen 5/2. Positive on 10/6


VAERS ID: 1775316 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-10-08
Onset:2021-10-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain upper, Arthralgia, Chest pain, Dyspepsia
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific dysfunction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Arthritis (broad)

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

Write-up: Severe burning, searing pain in stomach, stabbing chest pains intermittently, 8/10 pain in major joints


VAERS ID: 1775318 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-10-07
Onset:2021-10-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822811 / 1 LA / UN

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Felodipine, 20mg Benazapril, 10mg
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pain, swelling and sensitivity in injection site fever, chills for 24 hours after injection


VAERS ID: 1775334 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: California  
Vaccinated:2021-10-08
Onset:2021-10-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Incorrect product formulation 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: patient was sent to the ER
CDC Split Type:

Write-up: the patient was given 0.3ml of the undiluted vaccine


VAERS ID: 1775338 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-07
Onset:2021-10-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / -

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

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

Write-up: Swollen lymph nodes in breast and arm pit. Fever of 102. Chills, sweating, headache.


VAERS ID: 1775342 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-10-08
Onset:2021-10-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006D21A / 3 LA / IM

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

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

Write-up: A woman brought her husband to the pharmacy to get an influenza vaccination. While he was completing the paper work for the influenza vaccination she said her rheumatologist wanted her to go ahead and get her third Covid vaccination. I ask her when did she get her second Covid vaccination and it was over 6 months. I told her that we only had the Moderna Vaccine. She told me that was the vaccine that was the vaccine that she had gotten for her first two doses. She completed the complete paperwork and I gave her the vaccination. I ask for her card and noticed that her first two vaccination were Pfizer.


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