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From the 6/4/2021 release of VAERS data:

Found 323,133 cases where Vaccine is COVID19 and Patient Did Not Die



Case Details (Reverse Sorted by Onset Date)

This is page 174 out of 3,232

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VAERS ID: 1282964 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Nebraska  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 004C21A / 1 RA / IM

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

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

Write-up: patient was nervous before the shot then got flushed and dizzy about 5-10 minutes after the shot. this made the patient more anxious and a little nauseous. she laid down with her feet propped up and had cold compresses on forehead and neck with arms crossed and within 5 minutes patient felt a lot better. she remained laying for another 10 minutes just to make sure she was better prior to getting up. after that she waited in the pharmacy in a chair for another 15 minutes for observation with no further complications.


VAERS ID: 1282969 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / UNK - / -

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

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

Write-up: Upon approaching her 30 minutes observation time, patient stood up and felt dizzy. Patient assisted back to chair with legs elevated. EMS evaluated. Vital signs obtained. Glucose checked by EMS. Drink provided to patient. Patient eager to go home and eat as she has not eaten since breakfast. Patient reports no longer feeling dizzy. Patient assisted back to car via wheelchair.


VAERS ID: 1282999 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8731 / 2 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Vision blurred
SMQs:, Anticholinergic syndrome (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

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

Write-up: LIGHT HEADED, BLURRY VISION STARTED RIGHT AFTER ADMINISTRATION, PERSISTS AFTER 4 DAYS


VAERS ID: 1283007 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cold sweat, Dizziness, Hyperhidrosis, Hypotension
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: bp 99 over 79
CDC Split Type:

Write-up: dizzy, sweating, clammy skin, light headed about 5 minutes after getting vaccine, lasted less than 10 min, he got a ride home just to be safe


VAERS ID: 1283023 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046A21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? 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: 17 YEAR OLD RECIEVED MODERNA 19 VACCINATION


VAERS ID: 1283054 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache, Malaise, Myalgia, Pain in extremity
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Patient felt unwell after administration. He complained of headache and muscle soreness in both arms


VAERS ID: 1283059 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-05-02
Onset:2021-05-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 2 RA / SYR

Administered by: Other       Purchased by: ?
Symptoms: 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? 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: none
CDC Split Type:

Write-up: Swelling face , I gave her benadryl around 11:00 am and Tylenol 11:30 am


VAERS ID: 1283121 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: New York  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004C21A / 1 RA / IM

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

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

Write-up: Patients mother filled out vaccination form with the incorrect age stating patient was 19 years old, claim went through insurance with the incorrectly input age, patient did not provide ID stating they did not have ID, event was noticed after the fact when the pharmacist went to vaccinate the brother and noticed their dates of birth were too close and verified with the father the patient was only 16 years old. patient was monitored for over 1 hour and did not exhibit or complain of any adverse events.


VAERS ID: 1283149 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / IM

Administered by: Unknown       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? 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: SYNCOPAL EPISODE. Evaluated by EMS-Refusal to transport.


VAERS ID: 1283208 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / UNK LA / IM

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

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

Write-up: Pt waiting his 15 minutes, cam to the counter asking for a water because patient was filling light headed. Patient fainted, with seconds patient was awake and knew where he was. he was clammy and in the face. Gave patient a water, he immediately felt better.


VAERS ID: 1283209 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 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: PRAVASTATIN AND LISINOPRIL
Current Illness: NOT KNOWN
Preexisting Conditions: NOT KNOWN
Allergies: NKA
Diagnostic Lab Data: UNKWON
CDC Split Type:

Write-up: PATIENT FAINTED AFTER ADMINISTRATION, HE CAME TO , AND WAS FINE BUT EMBARRASSED BY THE INCIDENT


VAERS ID: 1283216 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / N/A LA / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Approximately two minutes after receiving vaccination patient fainted. He came to consciousness within one minute of fainting where he was sweaty. He did not seem disoriented and stated that the injection site radiated and had pain for a moment prior to his fainting.


VAERS ID: 1283366 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030B21A / 1 LA / -

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

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

Write-up: 16 YO RECEIVED 1ST DOSE MODERNA 4/5/21, HERE TO RECD 2ND DOSE. SECOND DOSE GIVEN.


VAERS ID: 1283373 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0171 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: not applicable
Current Illness: not applicable - just feels faint after getting blood drawn and/or getting vaccinations
Preexisting Conditions: not applicable
Allergies: not applicable
Diagnostic Lab Data: The emergency response team checked her sugar and blood pressure and found that the patient was okay.
CDC Split Type:

Write-up: The patient received the shot, and after a few minutes the patient passed out on the chair. After noticing the patient slumped over we made sure the patient was still breathing. We got the emergency equipment and contacted the emergency protocol, and the patient woke back up promptly and communicated that they felt dizzy. We allowed the patient to lay down and waited for the emergency services. She felt better as time passed and by the time her dad made, they refused to go to the hospital and made it home on their own accord


VAERS ID: 1283411 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 RA / IM

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

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

Write-up: The pt was given a 0.5mL Janssen vaccine in his R deltoid by an RN. The RN called the charge nurse over due to "half of the dose coming out of his arm." The provider on call, , was called and said to give the pt 0.2mL of another dose of the Janssen vaccine. This was discussed with the pt, and he was agreeable to this. The same administering RN gave the addition 0.2mL dose in the same arm. The pt was given strict ER and follow up precautions. He then ambulated himself to the observation area. Site manager Will aware of the situation.


VAERS ID: 1283432 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / IM

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

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

Write-up: Patient fainted after he got the J&J vaccine; as per patient, it had happened in the past after getting blood withdrawn or vaccines; Patient was conscious; 911 was called. Patient was fine and denied medical treatment.


VAERS ID: 1283472 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-05-02
Onset:2021-05-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Eye swelling, Lip swelling, 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: None
Current Illness: None
Preexisting Conditions: None
Allergies: PCN
Diagnostic Lab Data: Presented to ER. Given Zyrtec. no additional testing or treatment
CDC Split Type:

Write-up: on day after second shot noted swelling to eyes, lips and cheeks


VAERS ID: 1283475 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: blood pressure checked 126/78 on 5/3/21 blood glucose checked 118 on 5/3/21
CDC Split Type:

Write-up: The 17 year-old patient fainted and lost the consciousness for approximately 3 minutes, 10 minutes after he received his first Pfizer vaccine. He was laid down on the ground, was given water and started to gain his consciousness slowly. He was palpitated, sweating, dehydrated, dizzy and nauseous. Blood pressure was checked 126/78, glucose 118. The reaction could be related to his diet as he has been fasting. He got better gradually when the medical team came. He was advise to keep hydrated and to eat. Patient was taken to the hospital for further check-up


VAERS ID: 1283660 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Kansas  
Vaccinated:2021-04-29
Onset:2021-05-03
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN ER8735 / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: MetFormin HCL 1000mg twice daily
Current Illness: None
Preexisting Conditions: Diabetes
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Approximately 4 days after the second dose, I developed a raised rash in the shape of the band aid which was placed over the injection spot on my upper right shoulder.


VAERS ID: 1283662 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / IM

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

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

Write-up: Patient fainted about a minute after receiving the immunization


VAERS ID: 1283671 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anaphylactoid reaction, Hypertension, Stomatitis, Throat tightness
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (narrow), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anaphylactic/anaphylactoid shock conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypertension (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: n/a
Current Illness: no
Preexisting Conditions: n/a
Allergies: had anaphylactic reaction but not sure what it was from.
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: The patient was given Janssen vaccine @ 11:38am. She stated she had anaphylaxis reaction before after colonoscopy was not sure exactly what from. Made sure this vaccine didn''t have PEG in it. Asked her to stay for 30 minutes after vaccine so I could monitor her. Around 12:10pm she said her mouth felt like anaphylaxis may happen. Asked her if she felt like she could swallow she said yes gave her (2) 25mg diphenhydramine. Had her sit and took her blood pressure which was BP 202/101 hr 70 I asked her if maybe she was anxious she said no she was very calm. Around 12:20pm she said felt throat was closing like before told partner to call 911. Got out Epi pen 0.3mg but she had her own administered 1 dose in right thigh. Shortly after EMS arrived and took over. The whole time she was awake and alert and responsive. Spoke to her around 4pm she was just leaving ER and said she was doing better.


VAERS ID: 1283674 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Feeling abnormal, Immediate post-injection reaction, Injection site pain
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Extravasation events (injections, infusions and implants) (broad), Vestibular disorders (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: None
Current Illness: Cold about 1 month prior
Preexisting Conditions: Exercise induce asthma
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Pain at injection site - immediate and went away within a few minutes Dizziness, fuzzy head - started 10 minutes after shot and has continued consistently (now 6 hours later)


VAERS ID: 1283691 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Alabama  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No other vaccines in past 14 days. Unknown before that time.
Preexisting Conditions:
Allergies: Penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient reported light-headedness approximately 15 minutes after vaccination. He said it was mild, but felt like when he doesn''t eat and gets light-headed. I asked patient to remain seated and got him some water. He drank the water and after approximately 5 minutes said he felt fine. Reported no dizziness or light-headedness. I asked him if he would like to remain in observation for longer, but patient said he was ready to go home and repeated that he felt fine. He said that he would call if he had any questions or concerns.


VAERS ID: 1283712 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: West Virginia  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Malaise
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: Unknown - stated all exposures to needles had this effect
Other Medications: None that pharmacist was made aware of.
Current Illness: None that pt made us aware of
Preexisting Conditions: Pt was aware that he had "low blood pressure" events when exposed to needles. This had happened to him with each exposure but had gotten better over the last several years. As such extra precautions were taken incase a vasovagal event occurred.
Allergies: NKDA
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Pt scheduled appointment for and received correct J&J Covid Vaccine that was requested. There were no issues with processing nor provision. PT advised RPH that he had a problem with needles and experienced low blood pressure every time he was vaccinated or had blood drawn in the past but had done better the last time and did not want to miss out on getting the vaccine. RPH was prepared and patient was cared for properly. Pt arrived at 1244 hrs and was provided vaccine at 1247 hours. Patient was fine for about 1 minute and then reported he was having trouble. Pt remained seated in booth in chair with room to get to floor if needed. RPH remained with patient, brought his significant other into the booth to help calm the patient as he was alert and orientated and continued to improve while removed mask and fanned with papers (pt stated the fanning was helping). Pt was improving slowly and moving/trying different positions as he felt he was improving. At approx 1325 hrs pt knew he needed to lie down and moved himself to floor with the assistance of his significant other and associate (did not fall nor did head impact the floor at any time). Code White was called. PT remained alert and orientated and was talking and stated that this was really helping. Code Team arrived and pt was continuously monitored until he gradually returned to his feet and was able to leave under his own power. Pt refused medical attention and refused Ambulance - never lost consciousness so no EMT was called. Pt''s significant other was able to drive them home. Event concluded at approximate 1345hrs.


VAERS ID: 1283729 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Balance disorder, Cold sweat, Dysstasia, Hypoacusis, Immediate post-injection reaction, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hearing impairment (narrow), Vestibular disorders (broad), Hypersensitivity (narrow), Hypoglycaemia (broad)

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

Write-up: Immediately after getting the shot I broke out in cold sweats, body went limp, arms and hands were tingling very badly and I lost my hearing to fast ?whooshes? couldn?t really speak or move for at least 15-20 minutes. Then got up and couldn?t stand up felt almost drunk. I had another spell exactly the same about 4 hours later


VAERS ID: 1283730 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-02
Onset:2021-05-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Angioedema, Lip swelling, Swelling face
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Angioedema to lips and face within 24 hours of receiving the covid Janssen vaccine


VAERS ID: 1283734 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: New York  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024C21A / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood glucose increased, Drooling, Heart rate decreased, Hyperhidrosis, Incontinence, Loss of consciousness, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Insulin
Current Illness: No
Preexisting Conditions: Diabetes
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: After receiving the immunization patient became unconscious, unresponsive, diaphoretic, incontinent and was drooling from the mouth. The patient did not respond to verbal or physical stimuli and his pulse was weak. Due to the patients position it is unknown if the patient was breathing or not. At this point epinephrine was administered into the patients left thigh. Within a 2-5 minutes the patient regained consciousness. He was alert and oriented at this time. His blood sugar was testing using his continuous glucose monitoring system and was 191. 911 was called and the paramedics took the patient to the hospital.


VAERS ID: 1283743 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Aphasia, Asthenia, Chills, Crying, Dizziness, Dyspnoea, Feeling abnormal, Hot flush, Hyperhidrosis, Hyperventilation, Lacrimation increased, Mobility decreased, Nausea, Painful respiration, Pyrexia
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Depression (excl suicide and self injury) (broad), Vestibular disorders (broad), Lacrimal disorders (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Adderall XR 25mg, Allegra, Sildenafil 50mg
Current Illness:
Preexisting Conditions:
Allergies: Bupropion
Diagnostic Lab Data:
CDC Split Type:

Write-up: Got injected, didn?t hurt much. Was told to wait 15 minutes in case of reaction. They walked away and left me sitting in a chair in a public space with everyone else who was waiting. I texted my wife to check in, when I started tearing up and crying for no real reason, then started feeling nauseous so I closed my eyes. Suddenly I felt like I had been given a shot of adrenaline out of nowhere so I?m just trying to figure out if it?s nerves or a physiological response to something. I?m trying to control my breathing but having a hard time breathing. Then the fever hit. The most intense flash of heat. I was hyperventilating. I couldn?t open my eyes or move or make a sound, I could just sit there struggling to breathe. My phone was in my hand and I couldn?t lift it. I just simply didn?t have the strength or energy to move. At some point I legit thought I was about to die. I managed to angle my wrist so I could check my heart rate with my watch. It was 47bpm. I was fading away but I made myself get control of my breathing and forced myself to take long deep slow breaths. It hurt, and I felt like passing out, but I kept doing it. Fever turned into chills and then I soaked through my jeans and T-shirt in under a minute. I was finally thinking clearly and breathing and getting oxygen. Everyone else near me was fine. Nobody checked on me the entire time including the 3 people who sat there and watched me suffer through this. I told the pharmacist about my reaction and asked if it was normal and didn?t receive any indication that I should be concerned, so I went home since I felt better. It wasn?t until my friend pointed out that this sounds like anaphylaxis that I thought I should report it. So here I am. Hopefully I?ll be okay.


VAERS ID: 1283753 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / UNK LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Epistaxis, Face injury, Fall, Panic attack, Seizure, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

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

Write-up: After receiving vaccine patient was about to sit in observation chair, he started seizing and fainting. Hit his nose and had nose bleed. He was having panic attack due to injection. Called 911. We made him comfortable and then in 5 minutes he started to faint. Ex-Ems was next to him, he started asking him questions and make sure he was awake. Within 5 minutes EMS arrived and they took over, checked all his vitals and found out patient did not eat or drink for whole day and had phobia with needles. Patient refused to go to hospital. Per EMS recommendation patient had drink and a bagel. Patient''s relative came and took him home.


VAERS ID: 1283761 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: dizziness, nausea. Evaluated by EMS-Cleared


VAERS ID: 1283764 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Loss of consciousness, Seizure, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), 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 (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: not available
Current Illness: none known
Preexisting Conditions: none known
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received dose in right arm with no complications. However, about 1-2 minutes after vaccination patient reported feeling lightheaded. As I was instructing her to remain seated, she passed out and was unresponsive. She appeared to be having a seizure immediately after that lasted about 1 minute. Once this episode passed, she became responsive and could talk. EMS arrived and took over.


VAERS ID: 1283990 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Feeling hot, Loss of consciousness, Vertigo
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 (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: ANY VACCINE OR BLOOD DRAW CAUSES THIS REACTION WITH HER (PER PATIENT).
CDC Split Type:

Write-up: PATIENT STARTED TO FEEL "LIKE THE ROOM WAS SPINNING" SO SHE LAID DOWN ON THE FLOOR. HER HUSBAND CAME AND GOT ME AND WHEN I WENT OVER TO CHECK ON HER SHE HAD BLACKED OUT. I GRABBED HER SHOULDER AND CALLED HER BY NAME AND SHE WOKE UP WITHIN A FEW SECONDS. SHE WAS EXTREMELY DIZZY AND HOT SO WE GOT HER AN ICE PACK TO COOL DOWN AND SHE REMAINED LAYING ON THE FLOOR FOR APPROXIMATELY 5 MINUTES UNTIL SHE WAS NO LONGER DIZZY. SHE SAID SHE GETS THIS VASOVAGAL REACTION ANYTIME SHE GETS A SHOT OR BLOOD DRAWS. AFTER 5 MINUTES, SHE WAS ABLE TO BE SEATED IN THE CHAIR WHERE I WATCHED HER FOR 15 MINUTES MORE. SHE WAS OKAY WHEN SHE LEFT.


VAERS ID: 1283993 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / N/A LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cold sweat, Eye movement disorder, Snoring, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Ocular motility disorders (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: Syncope; 4/8/2020; Tdap vaccine; Boostrix
Other Medications: unknown
Current Illness: none
Preexisting Conditions: known vasovagal syncope response to vaccines
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient and wife stated that he has had many vasovagal syncope events when he has had vaccines administered, both more recently, and in the past. The patient was seated in a chair with arms. Within a couple of minutes of administering the vaccine, his eyes rolled back in his head, he broke out in a cold sweat, BP was 75/55, pulse 55. He never stopped breathing (was snoring); epinephrine for an anaphylactic reaction was not indicated. I offered to call 911 multiple times but his wife said this was the normal course of his reaction and held an icepack on his neck for the duration. After 5-10 minutes the patient was once again responsive. He sat for an additional 10 minutes and then said he was ready to leave. His wife walked him out of the store.


VAERS ID: 1283995 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Maine  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Chills, Fatigue, Headache
SMQs:, Guillain-Barre syndrome (broad)

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

Write-up: ~6 hours post vaccine started to have fatigue, chills, and general body weakness, then headache started too


VAERS ID: 1284011 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808609 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre 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: Feeling of near syncope to previous vaccinations.
Other Medications: Patient verbally denied using prescriptions, over the counter medications, herbal remedies, and drug use.
Current Illness: Patient denied any illnesses at time of vaccination.
Preexisting Conditions: Patient reporting having history of feeling of near syncope to vaccinations.
Allergies: Patient denied having any allergies to medications, food, or other products.
Diagnostic Lab Data: Patient was coherent, alert and oriented to person, time, place, and event throughout interaction. Patient denied loss of consciousness at any point throughout Interaction. Patient was negative to all signs of stroke scale. Patient vital signs were as follows, 18:12 - BP: 154/102 mmHg, HR: 80 bpm, spO2: 96%; 18:14 BP: 155/113 mmHg, HR: 76 bpm, spO2: 98%; 18:18 - BP: 156/113 mmHg, HR: 70 bpm, spO2: 98%.
CDC Split Type:

Write-up: At 1809, patient returned to vaccination site as passenger of personal vehicle with complaint of tingling sensation throughout his body that lasted for about 5 minutes. Patient denied loss of consciousness. Patient had received Janssen vaccination to his left deltoid at 17:56. Patient had reported history of feeling near syncope to vaccinations. Patient?s level of consciousness, stroke scale, and vital signs were assessed. Patient was offered a call for emergency services on his behalf but patient denied emergency services. Patient stated that a mild tingling sensation continued on his left arm but that he did not feel any more tingling throughout his body at 18:10. At 18:14 patient stated that he wanted to continue to monitor himself at home and he was encouraged to call for emergency services if symptoms continued or worsened. Patient left as passenger of personal vehicle at 18:18 while his friend was driver of their vehicle.


VAERS ID: 1284049 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Hyperhidrosis
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: patient says he is on insulins and is a diabetic
Current Illness: patient is a diabetic
Preexisting Conditions: patient is a diabetic
Allergies: no known allergies mentioned
Diagnostic Lab Data: I measured patient''s temperatiure which was 96.7. i also took his blood pressure which was elevated at 186/96. and pulse rate was 77. i measured his blood sugar after the candy was eaten. it was 103.
CDC Split Type:

Write-up: Patient left the pharmacy area and when to check out his groceries. While in line, the patient became dizzy and started sweating profusely. The cashier got him a chair so he could sit down. She gave him a cold water and some candy. I came over and asked him about low blood sugar and if he had eaten since I knew he was a diabetic. He sat in the chair for about 20 to 25 minutes. after he drank the water and ate the candy, i did a blood pressure reading, a temperature reading, and a blood glucose reading. The patient was able to leave and drive home after eating the candy and drinking the water.


VAERS ID: 1284298 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Decreased appetite, Diarrhoea, Ear pain, Feeling cold, Headache, Myalgia
SMQs:, Rhabdomyolysis/myopathy (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: Hibiscus tea
Current Illness:
Preexisting Conditions: Mitral valve prolapse Ventricular tachycardia GERD
Allergies: Amoxicillin Acetaminophen
Diagnostic Lab Data:
CDC Split Type:

Write-up: Muscle aches, headache, earache, Sever chills, loss of appetite, diarrhea


VAERS ID: 1284307 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-05-01
Onset:2021-05-03
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0162 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Burning sensation, Dyspnoea, Headache, Influenza like illness, Pain, Pyrexia, Rash, Rash erythematous
SMQs:, Anaphylactic reaction (narrow), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: After about 6-8 hours I began to have flu-like symptoms such as feeling feverish, feeling achy, & having a headache. I also felt like it was hard to breathe. But, today May 3rd, 2021, 2 days after the vaccine I developed a rash on my left side (vaccine side) from my armpit down to the top of my ribs. It?s red & looks & feels like sunburn.


VAERS ID: 1284433 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-04-05
Onset:2021-05-03
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808980 / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Adverse drug reaction, Adverse food reaction, Amnesia, Anaphylactic shock, Blood test, Computerised tomogram, Confusional state, Facial paralysis, Headache, Hypoaesthesia, Magnetic resonance imaging, Paraesthesia, Seizure, Spinal pain, Swelling face, Tremor, Urinary incontinence, Vomiting
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (narrow), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Anaphylactic/anaphylactoid shock conditions (narrow), Dementia (broad), Convulsions (narrow), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hearing impairment (broad), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: anxiety,depression,PTSD
Allergies: Amoxicllian as of 4-7-21 morphine oxycoten oxycoden randome food after vaccinated
Diagnostic Lab Data: Blood work -every er visit MRI - 4-14-21 CAT SCAN
CDC Split Type:

Write-up: 4-5-21 vommiting ,headache 4-6-21 spine pain , headache cont ,vomiting 4-7-21 spine pain , headache cont ,vomiting reaction to morphine and oxy (anaphalactic shock ) x 2 er visits 4-8-21 spine pain , headache cont ,vomiting, seizures/ trimmers ,confussion/memory loss ,bladder incont. numb and teng in right side face and arm. facale swelling and drooping Er Visit 4-9-21 spine pain , headache cont ,vomiting, seizures/ trimmers ,confussion/memory loss ,bladder incont. numb and teng in right side face and arm. facale swelling and drooping 4-10-21 spine pain , headache cont ,vomiting, seizures/ trimmers ,confussion/memory loss ,bladder incont. numb and teng in right side face and arm. facale swelling and drooping ER 4-11-21- 4-14-21 spine pain , headache cont ,vomiting, seizures/ trimmers ,confussion/memory loss ,bladder incont. numb and teng in right side face and arm. facale swelling and drooping 4-14-21 spine pain , headache cont ,vomiting, seizures/ trimmers ,confussion/memory loss ,bladder incont. numb and teng in right side face and arm. facale swelling and drooping went to my PCP she sent me staright to hospital due to facial drooping and swelling in Face and convosiont/trimmeres. 4-22-21 spine pain , headache cont ,vomiting (min), seizures/ trimmers ,confussion/memory loss ,bladder i numb and teng in right side face and arm. facale swelling and drooping Fallow up with pcp waiting to see nerology for sezure activity 4-23-21-5-2-21 spine pain , headache cont ,vomiting, seizures/ trimmers ,confussion/memory loss . numb and teng in right side face and arm. facale swelling and drooping


VAERS ID: 1284439 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Alaska  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Eye movement disorder, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Ocular motility disorders (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:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: Penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient fainted 4 minutes after vaccine given. Patient was able to talk but described "eyes in back of head". Blood pressure reading taken 132/76 pulse 72 then 128/82 pulse 85.Patient was responsive to our questions sitting on floor for 5 minutes. We then we observed him for and additional 15 minutes in our waiting area before he left.


VAERS ID: 1284453 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Mississippi  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / IM

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

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

Write-up: Fever. Body aches. Chills


VAERS ID: 1284488 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-01
Onset:2021-05-03
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dermal filler injection, Sensitive skin, Swelling face, Tenderness
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Doxycycline 100mg Levothyroxine 88mcg
Current Illness: Cortisone injection for shoulder injury week prior.
Preexisting Conditions: Hypothyroidism
Allergies: N/a
Diagnostic Lab Data: N/a
CDC Split Type:

Write-up: Existing facial dermal filler (restylane) became inflamed and sensitive. Swelling lasted throughout the day and had mostly resolved by the same evening with ibuprofen, while still tender to the touch. No medical attention was sought as I determined it was a non-emergency.


VAERS ID: 1284489 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Axillary nerve injury, Immediate post-injection reaction, Injection site pain
SMQs:, Accidents and injuries (narrow), Extravasation events (injections, infusions and implants) (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:
Current Illness:
Preexisting Conditions:
Allergies: nuts
Diagnostic Lab Data: pending
CDC Split Type:

Write-up: I had immediate, sharp, and severe pain at injection site that has not resolved 12 hours later. I suspect injury to my anterior branch of axillary nerve.


VAERS ID: 1284492 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-05-02
Onset:2021-05-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / -

Administered by: Other       Purchased by: ?
Symptoms: Chills, Mobility decreased, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: High Fever Chills Aches, reduced mobility


VAERS ID: 1284502 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Tachycardia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Tachycardia, Covid vaccine
Other Medications:
Current Illness:
Preexisting Conditions: Endometriosis, mitral valve prolapse
Allergies: Zithromax
Diagnostic Lab Data:
CDC Split Type:

Write-up: Tachycardia - ongoing


VAERS ID: 1284511 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 RA / SYR

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

Write-up: Got up in night to use bathroom and fainted.


VAERS ID: 1284518 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-04-26
Onset:2021-05-03
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Injection site erythema, 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: Valcyclavir, Ashwagandha, magnesium,tryptophan
Current Illness: None
Preexisting Conditions: Ehlers-Danlos Syndrome, asthma, mTBI
Allergies: Medicines: penicillin, iodine, sulfa antibiotics, eurythromycin, Tamaflu
Diagnostic Lab Data: None
CDC Split Type:

Write-up: ?Covid Arm?: swelling, redness, heat at site 1 week after vaccine was administered.


VAERS ID: 1284520 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (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: Blood pressure medication
Current Illness: COVID 3 months prior
Preexisting Conditions: High blood pressure
Allergies: No
Diagnostic Lab Data:
CDC Split Type:

Write-up: Shaking / chills


VAERS ID: 1284523 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-05-02
Onset:2021-05-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Sick after flu vaccines
Other Medications: Gabapentin, Pristiq, propranolol, trazadone, armodafinil, omeprazole
Current Illness:
Preexisting Conditions: Asthma, benign liver adenomas, gerd
Allergies: Jalepenos, vesicare, OxyContin, oxycodone
Diagnostic Lab Data:
CDC Split Type:

Write-up: Swollen painful lymph nodes in left armpit and groin Rash on upper extremities and chest - not raised, no heat, very itchy Itchy scalp


VAERS ID: 1284828 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / SYR

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

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

Write-up: Fever above 101.2


VAERS ID: 1284874 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: New York  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0165 / 2 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Abdominal discomfort, Chills, Diarrhoea, Fatigue, Gait disturbance, Limb immobilisation, Muscle spasms, Pain in extremity
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Dystonia (broad), Parkinson-like events (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: n/a
Current Illness:
Preexisting Conditions: treatment resistant depression
Allergies: lactose intolerance, mild shellfilsh allergy
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Shivering and chills despite being 11c outdoors and being inside and in pajamas and under a duvet. Strong muscle spasm cramping in calves, made it difficult to walk to get even get water. Very sore arm, could not lift, and strong fatigue GI issues (slight diarrhea clumps but not many)


VAERS ID: 1285080 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025C21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fall, 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), Accidents and injuries (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Fainting / Unresponsive-Medium, Systemic: fainted but recovered right away, hit back of head on the floor, ice applied-Medium, Additional Details: waited 45 minutes before leaving, wife picked him up so he would not drive, patient stated he had a history of fainting after vaccines or giving blood, his head felt better after applying ice, temp 94.6 before leaving and felt his breathing normalize after incident


VAERS ID: 1285082 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014C21A / 1 AR / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Feeling cold, Flushing, Hyperhidrosis, Nausea, Paraesthesia, Tremor
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypersensitivity (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Chills-Mild, Systemic: Dizziness / Lightheadness-Medium, Systemic: Flushed / Sweating-Severe, Systemic: Nausea-Mild, Systemic: Shakiness-Mild, Systemic: Tingling (specify: facial area, extemities)-Mild, Additional Details: tingling in the hand


VAERS ID: 1285083 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014C21A / 1 LA / IM

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

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

Write-up: Systemic: Dizziness / Lightheadness-Mild, Systemic: Flushed / Sweating-Mild, Systemic: Nausea-Mild, Systemic: Vomiting-Mild


VAERS ID: 1285102 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Unknown  
Location: Indiana  
Vaccinated:0000-00-00
Onset:2021-05-03
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0171 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Fatigue, Lymphadenopathy, Malaise, Nausea
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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Slept for 48 hours
Other Medications:
Current Illness: No
Preexisting Conditions: Diabetes, G.E.R.D., NASH
Allergies:
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Fatigue, nausea, swollen and painful lymph node, generally not feeling well


VAERS ID: 1285127 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 008C21A / 2 LA / IM

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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received 2nd dose of Moderna vaccine 8 days early. No adverse reactions.


VAERS ID: 1285147 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 1 RA / IM

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

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

Write-up: Systemic: Fainting / Unresponsive-Mild, Additional Details: pt was feeling dizzy and put the pt on the floor she was breathing and concious called 911 and the felt better and put her on a sitting position to rest. Her husband said she has dizzinees and fainting problem. we get help they came and assessed her and pt was ok and walked to her car accompanied by her husband. Called her around 5:40p to make sure she is doing ok but no answer


VAERS ID: 1285156 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-05-02
Onset:2021-05-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: 1st dose COVID Pfizer
Other Medications: No
Current Illness: No
Preexisting Conditions: No
Allergies: No
Diagnostic Lab Data: No
CDC Split Type:

Write-up: Headache, low fever


VAERS ID: 1285159 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Chest pain, Chills, Headache, Hypertension, Hyperventilation
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Hypertension (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (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: Chest Tightness / Heaviness / Pain-Mild, Systemic: Chills-Mild, Systemic: Headache-Medium, Systemic: Hypertension-Medium, Systemic: Hyperventilation-Medium


VAERS ID: 1285160 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Injection site muscle weakness
SMQs:

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

Write-up: The patient developed weakness in the left arm 5 minutes after vaccine administration. The issue resolved after observation.


VAERS ID: 1285164 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 1 LA / IM

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

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

Write-up: Systemic: Allergic: Itch (specify: facial area, extremeties)-Mild, Systemic: Allergic: Itch Generalized-Mild, Additional Details: Patient reported itching all over her body, we gave patient 2 tablets of Benadryl and 2 bottles of water and monitored patient for an additional hour. Patient reported that her symptoms subsided after taking the Benadryl and she was comfortable leaving the pharmacy. She reported that she will be staying at her mom''s house in case she required additional assistance.


VAERS ID: 1285167 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 RA / IM

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

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

Write-up: Site: Pain at Injection Site-Mild, Systemic: Dizziness / Lightheadness-Medium, Systemic: Hypertension-Medium, Additional Details: I have been observing patient for 30+ minutes. Patient is feeling better after drinking a bottle of apple juice. It has been about 40 minutes now and patient said she is feeling back to normal 99%. She said she wants to go home herself. I had the nurse from the minute clinic check her blood pressure and systolic was 158. Patient does have hypertension and takes 2 blood pressure medications. Patient does not have pain at injection site, the system made me select something


VAERS ID: 1285171 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 LA / IM

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

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

Write-up: Systemic: Dizziness / Lightheadness-Medium, Systemic: Nausea-Mild, Systemic: Tinnitus-Mild


VAERS ID: 1285173 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 LA / IM

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

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

Write-up: Systemic: Fainting / Unresponsive-Mild, Additional Details: Patient lost consciousness for about 10 seconds. Pharmacist had patient lay down with feet up and patient was conscious and felt better. He ate 2 candies and drank 1 cup of water because pt felt lightheaded. Patient BP was 126/87 after lying down for 15 minutes. Patient insisted on leaving and felt ok to drive home. Patient stated he would grab something to eat before leaving the store.


VAERS ID: 1285175 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Flushing, Hyperhidrosis, Nausea
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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: Chills-Medium, Systemic: Flushed / Sweating-Medium, Systemic: Nausea-Medium


VAERS ID: 1285183 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 LA / IM

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

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

Write-up: Systemic: Chills-Severe, Systemic: Confusion-Severe, Systemic: Dizziness / Lightheadness-Severe, Systemic: Exhaustion / Lethargy-Severe, Systemic: Fainting / Unresponsive-Severe, Systemic: Seizure-Severe


VAERS ID: 1285186 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 041A21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Systemic: Abdominal Pain-Severe, Systemic: Dizziness / Lightheadness-Medium, Systemic: Nausea-Severe, Systemic: Vomiting-Severe, Systemic: Weakness-Medium


VAERS ID: 1285189 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hyperhidrosis, Syncope, Tremor, Unresponsive to stimuli, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant 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), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Fainting / Unresponsive-Medium, Systemic: Vomiting-Medium, Additional Details: patient fainted for several seconds, when he came to, he was shaky and sweating. then vomited several times. completely recovered


VAERS ID: 1285192 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-05-02
Onset:2021-05-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004C21A / 2 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Allergies to bee stings, Codeine, some pets, and a food allergy whose cause has not been determined.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Soreness, knot, itchiness, and heat at injection site, mild rash on both forearms and face.


VAERS ID: 1285194 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? 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: Patient Too Young for Vaccine Administered


VAERS ID: 1285196 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? 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: Patient Too Young for Vaccine Administered


VAERS ID: 1285201 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Condition aggravated, Dizziness, Muscle contractions involuntary, Nausea, Syncope, Unresponsive to stimuli
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), Dystonia (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? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Systemic: Dizziness / Lightheadness-Severe, Systemic: Fainting / Unresponsive-Severe, Systemic: Nausea-Mild, Systemic: Weakness-Medium, Additional Details: Patient fainted 2 minutes after dose administration followed by full body contraction which lasted 30 seconds. Patient indicated post-incident he had a needle phobia and had previously fainted during blood drawing appointments


VAERS ID: 1285207 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 LA / IM

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

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

Write-up: Systemic: Dizziness / Lightheadness-Mild, Systemic: Fainting / Unresponsive-Mild, Systemic: Flushed / Sweating-Severe, Additional Details: IMMEDIATELY UPON INJECT THE PT FAINTED. I GOT HIM ON THE FLOOR AND ELEVATED HIS FEET. CHECKED HIS PULSE AND BREATHING. GAVE HIM WATER. HIS MOTHER KEPT CALLING HIS NAME. WHEN HE SAID HE WAS FINE. HE SAT DOWN THEN FAINTED AGAIN. 911 WAS CALLED. EMT ARRIVED AND TOOK CARE OF HIM. HIS MOTHER DROVE HIM HOME. MOTHER STATED HE DOES THIS EVERY TIME HE GETS A SHOT


VAERS ID: 1285214 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 LA / IM

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

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

Write-up: Systemic: Fainting / Unresponsive-Medium


VAERS ID: 1285223 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Flushing, Hyperhidrosis, Syncope, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), 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: Dizziness / Lightheadness-Mild, Systemic: Fainting / Unresponsive-Mild, Systemic: Flushed / Sweating-Mild, Additional Details: responsive within a minute and recovered within 10 minutes


VAERS ID: 1285233 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: Delaware  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 LA / IM

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

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

Write-up: Error: Wrong Dose of Vaccine - Too Low


VAERS ID: 1285236 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 LA / IM

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

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

Write-up: Systemic: Dizziness / Lightheadness-Severe, Systemic: Fainting / Unresponsive-Medium, Systemic: Flushed / Sweating-Medium, Systemic: Hypotension-Severe, Additional Details: A few minutes after administration, pt was lightheaded and dizzy and reported possibly fainting for a very brief moment. Pt was pale and sweating and reported being short of breath briefly. Pt was hypotensive but blood pressure and heart rate normalized after 10 to 15 minutes after pt lied down and propped up feet in addition to drinking water and juice. Pt reported feeling "normal" after resting for about 30 minutes.


VAERS ID: 1285243 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-05-02
Onset:2021-05-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Chills, Lethargy, Pain, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Our son vomited for 6 hours and ran a moderate fever after 2nd dose. He also was lethargic, weak, and had bad body aches and chills.


VAERS ID: 1285263 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: New York  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Fear of injection, Flushing, Hyperhidrosis, Malaise, Nausea, Tremor, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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: Flushed / Sweating-Mild, Systemic: Nausea-Severe, Systemic: Shakiness-Mild, Systemic: Vomiting-Medium, Systemic: Weakness-Mild, Additional Details: Patient stated prior to the vaccine that he was very nervous and did not like needles. Less than 5 minutes after recieving the vaccine he stated he was not feeling well, I noticed that he had perspiration on his forehead. I gave him a small cup of water, he immediately vomited both the water and contents of his stomach. I gave him a bottle of water. He continued to sit near the pharmacy for roughly 45 minutes after which he stated he was feeling much better and left for home.


VAERS ID: 1285268 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Injection site pain, Pyrexia, Syncope, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Site: Pain at Injection Site-Medium, Systemic: Chills-Medium, Systemic: Fainting / Unresponsive-Medium, Systemic: Fever-Medium, Additional Details: Wife of patient had called the pharmacy hours after patient had recieved his J&J vaccine to inform us of this symptoms a few hours when arrving at home. He experienced fainting, chills, fever, and pain and took a tylenol and symptoms started to subside and has been currently been resting in bed. Wife says they will continue to take tylenol around the clock if needed and will seek medical attention is symptoms worsen.


VAERS ID: 1285280 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 RA / IM

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

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

Write-up: AFTER 5 MINUTES PATIENT RECEIVED THE VACCINE ,PATIENT FAINTED AND SUSTAINED SOME INJURIES AROUND HIS RIGHT EYEBROW WHILE HE IS IN THE WAITING AREA. PARAMESICS ARRIVED AT THE SCENE AND PATIENT REFUSED FURTHER TREATMENT. HE WAITED ABOUT 20 MINUTES AT THE WAITING AREA AND LEFT THE STORE.


VAERS ID: 1285293 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004C21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Patient not taking any medications, but patient did have Juviderm lip fillers done, which she stated she had done over a year ago.
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: Patient came to the pharmacy to get covid vaccine. During screening Patient stated she has juviderm lip fillers got done over 1 year ago. She was informed of risk of swelling near dermal filler site. She was given options to try to get Pfizer vaccine. She declined states she wants to challenge vaccine regardless. Patient was monitored after immunization for over 30 minutes. Only a bit of redness was noted around the inject safe band aid site, which did not seem to progress. She was closely monitored, and sent home since there was no generalized rash and patient felt ok.


VAERS ID: 1285327 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-04-21
Onset:2021-05-03
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 03B21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood culture, Blood lactic acid, Body temperature increased, Chills, Full blood count, Heart rate increased, Metabolic function test, Nausea, Pyrexia, Sepsis, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad), Sepsis (narrow), Opportunistic infections (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: warafin, lisinopril, hydrochlorothiazide, amitriptyline, atorvastatin, omeprazole, aspirin
Current Illness: none
Preexisting Conditions: paroxysmal atrial fibrillation, mechanical aortic valve replacement, GERB, hypercholesterolemia, essential hypertension, valvular heart disease
Allergies: oxycodone-acetaminophen
Diagnostic Lab Data: CBC, CMP, Lactate, Blood cultures
CDC Split Type:

Write-up: Patient presented to the ED via ambulance with fever, nausea, vomiting. Patient noted to have 103 degree temperature at home. Patients heart rate was elevated in the 110s. Patient has rigors. Fever increased while at hospital. Patient admitted to the hospital for sepsis. Started on numerous antibiotics, fluid boluses.


VAERS ID: 1285449 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-04-20
Onset:2021-05-03
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO158 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood glucose increased, Diabetic ketoacidosis, Glycosylated haemoglobin increased, Type 2 diabetes mellitus
SMQs:, Hyperglycaemia/new onset diabetes mellitus (narrow), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: LEVOTHYROXINE
Current Illness: 1. THYROMEGALY 2. ESSENTIAL HYPERTENSION 3. hYPERLIPIDEMIA
Preexisting Conditions:
Allergies: NONE
Diagnostic Lab Data: Hgb A1c (5/3/2021): $g 14 Glucose (5/3/2021): 561
CDC Split Type:

Write-up: PATIENT HAD A NORMAL HGBA1C OF 5.6 ON 3/3/2021 (PRIOR TO RECEIVING ANY VACCINE). HE WAS ADMITTED ON 5/3/2021 FOR DKA AND NEW ONSET DIABETES MELLITUS WITH A HGBA1C OF $g14 AND SERUM GLUCOSE OF 561.


VAERS ID: 1285458 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 LA / IM

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

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

Write-up: Fever, fatigue, body aches starting 8 hours after vaccine administration


VAERS ID: 1285477 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 023C21A / 2 LA / -

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

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

Write-up: 16 YO HAD 1ST DOSE OF MODERNA 3/17/21, RETURNED FOR 2ND DOSE. MED CONSULTATION DONE REGARDING OFF LABEL USE. MOTHER SIGNED CONSENT. PT GOT 2ND DOSE MODERNA.


VAERS ID: 1285553 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-01
Onset:2021-05-03
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Torticollis
SMQs:, Dystonia (narrow), Ocular motility disorders (broad)

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

Write-up: Patient developed right torticollis approx. 2 days after vaccine


VAERS ID: 1285562 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 023C21A / 2 LA / -

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

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

Write-up: PT RECD 1ST DOSE OF MODERNA WHEN HE WAS 16. HERE FOR 2ND DOSE. MOM WAS CONSULTED ON OFF LABEL USE, SIGNED CONSENT. PT RECD 2ND DOSE OF MODERNA.


VAERS ID: 1285570 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-04-29
Onset:2021-05-03
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH E000167 / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Back pain, Blood test, Chest X-ray, Chest pain, Echocardiogram, Electrocardiogram, Pericarditis
SMQs:, Systemic lupus erythematosus (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Multivitamin
Current Illness: None
Preexisting Conditions: None
Allergies: Cats
Diagnostic Lab Data: 2 EKGs (5/3/2021) Chest x-ray (5/3/2021) Bloodwork (5/3/2021) Echocardiogram (5/3/2021)
CDC Split Type:

Write-up: My son woke up with a upper backache in the middle of the night (5/3/21) and shortly after that he said that it felt like someone was squeezing his heart. We called the pediatrician on call who recommended I take him to the ER. At the ER, they performed two EKG''s, a chest x-ray, bloodwork and an echocardiogram. We were discharged from the ER 7 1/2 hours later with the following diagnoses: acute chest pain and acute pericarditis. His treatment consists of taking 600 mg of Advil every eight hours for at least the next, laying low and not exerting himself for the next and following up with his primary care provider and seeing the pediatric cardiologist later this week.


VAERS ID: 1285573 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Dyspnoea, Headache, Injection site discomfort, Pain, Rales
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Infective pneumonia (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: Omeprozole, Bystolic, Rosuvastatin, Prasugrel, Asprin
Current Illness: None
Preexisting Conditions: Coronary artery disease, overweight.
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Shortness of breath with a crackle sound which became more pronounced when lying down. I sat upright for about 1.5 hrs and respiration returned to a normal rhythm at which time I was comfortable enough to return to bed. I did not seek medical attention but monitored closely during that time and was prepared to go to the ER if necessary. As I write this I am at 22 hrs post vaccination. Respiration is fine, I have some discomfort at the injection site, a slight headache and some aches and pains which is expected.


VAERS ID: 1285593 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 1 LA / IM

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

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

Write-up: Dizziness. Stable, released from vaccination site.


VAERS ID: 1285645 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-04-30
Onset:2021-05-03
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

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

Write-up: Headache, body aches


VAERS ID: 1285685 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-05-01
Onset:2021-05-03
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 RA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Injection site erythema, Injection site swelling, Lymphadenopathy, Paraesthesia, Pyrexia
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre 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: prenatal vitamin, vitamin D
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Extremely high fever 106.1 degrees the night of receiving the injection 5/1/2021. Fever controlled with Tylenol but never went below 100 degrees until day 2 (5/3/2021). On 5/3/2021 my arm, armpit, (lymph node area) started tingling. I checked the injection site and notice major swelling and patchy red areas.


VAERS ID: 1285707 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: New Hampshire  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / IM

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

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

Write-up: Patient said she had a history of fainting with other injections and blood draws. She was sitting in a chair when she began to feel faint. She asked her sister to move her to the floor to lay down. She was out for about 3 minutes and then came to. She sat on the floor for a minute and then transitioned to the chair. We offered cold cloths which she refused. She did accept an orange juice. She was fine after waiting 15 minutes and left the store.


VAERS ID: 1285814 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0175 / 2 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthma
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (broad)

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

Write-up: Patient complaints of mild/moderate asthma during the observation period.


VAERS ID: 1285831 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Misc. brand flu shot at age 48 / IM dose
Other Medications: None known.
Current Illness: None known.
Preexisting Conditions: None known.
Allergies: Egg allergy.
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: Patient was given 1 dose 0.5 ml of Janssen COVID 19 vaccine and shortly thereafter became lightheaded and nauseous. She was given cold compresses and asked questions to assess her status. She recovered from the symptoms within 15 minutes.


VAERS ID: 1285845 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Mississippi  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8727 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Blood creatine phosphokinase, Dyskinesia, Dyspnoea, Dystonia, Electrocardiogram, Full blood count, Hypoaesthesia, Magnetic resonance imaging, Metabolic function test, Nervous system disorder, Oropharyngeal discomfort, Paraesthesia, Skin discolouration
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Dyskinesia (narrow), Dystonia (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Vitamin D, singulair, prilosec, crestor, zoloft, trazodone, ambien
Current Illness: none
Preexisting Conditions: insomia, GERD, allergies
Allergies: codeine, erythromycin, keflex
Diagnostic Lab Data: MRI w/o contrast 5/4/21, CBC/BMP 5/3/21,, CPK Total 5/3, EKG 12 lead 5/3/21
CDC Split Type:

Write-up: The patient received her second dose of the Pfizer COVID vaccine around 8 a.m. on 5/3/21 in one of our outpatient clinics. She reported no reaction after her first dose of Pfizer vaccine. Within 20 minutes of receiving the dose, she had some numbness, tingling and uncontrollable jerking movements. She also had some blueish discoloration of toenails. Patient was reportedly weak and had to have assistance getting up onto stretcher prior to transport to hospital ER. Patient also reported "full" feeling in her throat that resolved after being given benadryl IM prior to arrival of EMS. She denied Shortness of breath. Patient was transported to ER and was noted to have dystonia. Patient was given benadryl and cogentin injection for jerking movements. Dystonia improved some, but patient was admitted to hospital for observation. After 24 hours, patient reports dystonia is better but is having some cerebellar issues probably due to medications that were given to stop the dystonia. MRI is to be done and neurology will be consulted.


VAERS ID: 1285878 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: California  
Vaccinated:2021-04-26
Onset:2021-05-03
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / N/A LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test, Computerised tomogram head, Impaired work ability, Loss of personal independence in daily activities, Migraine
SMQs:, Dementia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Bariatric Fusion daily vitamins
Current Illness: Ear infection 2 weeks before
Preexisting Conditions: None
Allergies: Amphicillain Keflex Morphine
Diagnostic Lab Data: Blood work drawn. Ct scan of head
CDC Split Type:

Write-up: Janssen COVID-19 Vaccine EUA. 7 days after shot I have the worst headache/migraine. I have gone to Er for CT scans that show clear so no blog clots. I do not have a history of migraines. I am unable to move. Work. Do anything. This is day 2. Idk how I''m to get thru this!!


VAERS ID: 1285942 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-04-29
Onset:2021-05-03
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6199 / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Pain, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (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: - Hyoscyamine - Famotidine - Ondansetron - Cyproheptadine HCI - Bisacodyl
Current Illness: - Functional Gastrointestinal Disorders (FGID) - Functional Dyspepsia (FD) - Irritable bowel syndrome (IBS) - Functional Neurological Disorder (FND) - Factor V Leiden
Preexisting Conditions: - Nausea - Functional Neurological Disorder (FND) - Irritable bowel syndrome (IBS) - Factor V Leiden
Allergies: - Zantac - Ceftiner
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Shaking of the hands and legs while being in extreme pain and uncontrollable. It started in the morning and got worse overtime throughout the day.


VAERS ID: 1285968 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-05-02
Onset:2021-05-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Back pain, Pain in extremity, Paraesthesia, Pelvic pain
SMQs:, Peripheral neuropathy (broad), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (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: Valsarten, Vit. A,C, D,E and Krill Oil
Current Illness: None
Preexisting Conditions: HBP and IBS
Allergies: No
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: A morning after vaccine, back pain from center of back , down pelvic area and leg on left side. This is day 2 and not getting better. Sharp needle like pain going down left back and legs. I''ve been taking meds that I had from a shoulder surgery. Not wanting to go to Dr right now. Previously had Covid in August 2020


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