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

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



Case Details (Reverse Sorted by Onset Date)

This is page 177 out of 6,611

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VAERS ID: 1514829 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052C21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Back pain, Chest pain, Dyspnoea, Feeling hot, Musculoskeletal stiffness, Neck pain, Respiratory tract irritation
SMQs:, Anaphylactic reaction (broad), Retroperitoneal fibrosis (broad), Dystonia (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Arthritis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Levothyroxine Albuteral inhaler
Current Illness:
Preexisting Conditions: Asthma Thyroid condition Severe central cervical spinal stenosis & severe foraminal cervical stenosis
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Approximately 3-4 hours after receiving the shot I had stiffness and pain in neck , shoulders, upper back and chest. Also started feeling very hot but did not show fever on thermometer. Approximately 4 1/2 hrs after shot I started having a bit of difficulty breathing, and my lungs feel itchy like they do when I?m about to go into an asthma attack. It?s now approximately 7 1/2 hrs since shot and I still feel the same. Have taken albuteral inhaler one time when breathing started to feel difficult but the feeling in my lungs did not and still have not changed.


VAERS ID: 1514831 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-07-28
Onset:2021-07-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Diarrhoea, Dyspnoea, Headache, Heart rate increased
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Noninfectious diarrhoea (narrow), Dehydration (broad)

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

Write-up: Diarrhea, chest pain, fast heartbeat, shortness of breath, severe headache


VAERS ID: 1514835 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-01-14
Onset:2021-07-29
   Days after vaccination:196
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3302 / 1 LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9269 / 2 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Blood culture, Blood gases, Blood lactic acid, Cough, Dyspnoea, Exposure to SARS-CoV-2, Fibrin D dimer, Full blood count, Metabolic function test, Respiratory viral panel, Serum ferritin, Sick relative, Urine analysis
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: albuterol inhaler PRN, Dulera 200mcg/formoterol 5mcg inhaler 2 puffs BID, fluticasone nasal spray, gabapentin 800mg tid, indomethacin 25mg TID, losartan 100mg daily, simvastatin 40mg daily, CBD+THC 3 drops per night
Current Illness:
Preexisting Conditions: HTN, COPD, seasonal allergy, hypothyroidism, hyperlipidemia,
Allergies: codeine - burning sensation
Diagnostic Lab Data: blood gas, D-Dimer, ferritin, Lactate, cbc, cmp, blood culture, resp panel upper, UA
CDC Split Type:

Write-up: 72yo female presenting to the ER complaining of sob and cough. ss x 1 day. +hx copd. patient states her family member was dx with covid 1 week ago. Chief Complaint: Visit CC: COVID, SOB SPO2 39% (SON positive covid at home)


VAERS ID: 1514839 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Condition aggravated, 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:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Systemic: Dizziness / Lightheadness-Mild, Additional Details: she is scared of needles and has history of dizziness after a blood withdrawl or after administration of a shot and didnt inform about it before administration of covid vaccine.she was little dizzy,laid her head over the chair for few seconds, but didnt loose consciousness-she is alert,blood pressure was normal-15/80mm Hg.we reached out to emergency services but we never used them as she is alright by then. called the pharmacy back after reaching home.


VAERS ID: 1514840 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041C21A / 1 LA / IM

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

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

Write-up: Systemic: Dizziness / Lightheadness-Mild, Additional Details: patient has history of dizzines after flu shots or blood withdrawls-she is scared of needles. as soon as vaccine is give she was little dizzy,rested her head on chair for few seconds, reached out to emergency services but she is back to normal and alert. so we ended the call with 911. The blood pressure was checked and is normal(125/88mm hg), reached the pharmacy back after going home-she is perfectly alright-since we reached out to emergency services filing an event report.


VAERS ID: 1514843 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-07-27
Onset:2021-07-29
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 LA / IM

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

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

Write-up: Systemic: Fainting / Unresponsive-Medium, Additional Details: AFTER giving the vaccine, his mother told me he has vasovagel syndrome and she was expecting him to faint afterwards.


VAERS ID: 1514844 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8736 / 1 LA / SYR

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

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

Write-up: Systemic: Fainting / Unresponsive-Medium, Additional Details: passed out, ems and mother called. no injury. said that she reacts to all shots this way


VAERS ID: 1514846 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Underdose
SMQs:, Medication errors (broad)

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

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


VAERS ID: 1514847 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 1 RA / 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

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


VAERS ID: 1514848 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 1 LA / IM

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

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

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


VAERS ID: 1514850 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 1 LA / IM

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

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

Write-up: Site: Pain at Injection Site-Medium


VAERS ID: 1514851 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: New York  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain, Confusional state, Dizziness, Flushing, Hyperhidrosis, Nausea
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypersensitivity (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Abdominal Pain-Medium, Systemic: Confusion-Medium, Systemic: Dizziness / Lightheadness-Severe, Systemic: Flushed / Sweating-Mild, Systemic: Nausea-Mild


VAERS ID: 1514852 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Dizziness, Headache, Hot flush, 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:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hot flashes, nausea, headache and lightheaded.


VAERS ID: 1514853 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EY0584 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, 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: Fainting / Unresponsive-Mild, Systemic: Flushed / Sweating-Mild, Additional Details: Five minutes after vaccination the patient fainted in the restroom. Patient also had symptoms of lightheadedness and sweating. Pt was picked up by family and taken to urgent care as an added precaution to be checked.


VAERS ID: 1514854 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 059E21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Dizziness, Flushing, Hyperhidrosis, Hypotension
SMQs:, Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular disorders (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: Chills-Medium, Systemic: Dizziness / Lightheadness-Medium, Systemic: Flushed / Sweating-Mild, Systemic: Hypotension-Mild


VAERS ID: 1514855 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypotension, Syncope, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (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), 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: Fainting / Unresponsive-Mild, Systemic: Hypotension-Mild, Additional Details: Patient fainted twice and called 911 but patient left for home afterwards


VAERS ID: 1514859 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-07-28
Onset:2021-07-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7585 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Eye swelling, Injection site swelling, Mouth swelling, Rash, Swelling face, Swollen tongue
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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: Swelling at Injection Site-Mild, Systemic: Allergic: Rash Generalized-Mild, Systemic: Allergic: Swelling of Face / Eyes / Mouth / Tongue-Mild, Additional Details: n/a


VAERS ID: 1514860 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-07-28
Onset:2021-07-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7585 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Lip pain, Mouth swelling, Pain in extremity, Peripheral swelling, Rash, Swelling face, Swelling of eyelid, Swollen tongue
SMQs:, Cardiac failure (broad), Anaphylactic reaction (narrow), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Periorbital and eyelid disorders (narrow), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Systemic: Allergic: Rash Generalized-Mild, Systemic: Allergic: Swelling of Face / Eyes / Mouth / Tongue-Mild, Additional Details: MILD PAIN FROM SWOLLEN LIPS AND HANDS


VAERS ID: 1514861 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-07-22
Onset:2021-07-29
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

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

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

Write-up: Red swollen circle around shot site. Itchy and painful.


VAERS ID: 1514863 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: New Hampshire  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 1 LA / IM

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

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

Write-up: Patient presented to vaccine clinic and reported to 2 separate staff that he had never received a covid 19 vaccine. Upon attempting to document vaccination in VAMS, patient was listed as having received the Janssen vaccine on 3/7/2021. Clinic called patient to verify this information was correct. Patient stated to staff "I know it was deceitful on our part, but we wanted to receive a booster because of the delta variant. We lied to your staff to get an extra dose, because that is what the media and our family and friends recommended." Patient reported a health care facility that is giving out booster doses. Patient was advised by clinic staff that this was considered an adverse event, as it was not the current recommendations for vaccination and that the clinic would not see them for a second dose of the pfizer series and to seek medical care if patient becomes ill. Patient verbalized understanding of the situation. Information was provided to the registry, and documented in that system by Dept of Health was notified as well and a VAERS was requested.


VAERS ID: 1514865 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: New Hampshire  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: pt reported being in good health at time of vaccine administration
Preexisting Conditions: none reported
Allergies: none reported
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient presented to medical facility and reported to 2 separate staff that he had never received a covid 19 vaccine. Upon attempting to document vaccination, patient was listed as having received the Janssen vaccine on 3/7/2021. Clinic called patient to verify this information was correct. Patient stated to staff "I know it was deceitful on our part, but we wanted to receive a booster because of the delta variant. We lied to your staff to get an extra dose, because that is what the media and our family and friends recommended." Patient reported a health care facility in that is giving out booster doses. Patient was advised by clinic staff that this was considered an adverse event, as it was not the current recommendations for vaccination and that the clinic would not see them for a second dose of the pfizer series and to seek medical care if patient becomes ill. Patient verbalized understanding of the situation.


VAERS ID: 1514866 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-03-23
Onset:2021-07-29
   Days after vaccination:128
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030A21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: aspirin enteric coated tablet albuterol ZyrTEC Claritin multivitamin Multiple Vitamins tablet testosterone gel Vitamin D3 2000 intl units capsule rosuvastatin Tablet metoprolol tartrate tablet CoQ10 capsule tamsulos
Current Illness: Coronary artery disease I11.9 Hypertensive heart disease E78.9 Lipid disorder G47.33 Obstructive sleep apnea R73.03 Prediabetes D12.6 Benign neoplasm of colon E88.81 Dysmetabolic syndrome M47.812 Cervical spondylarthritis K57.90 Diverticular disease K44.9 Hiatal hernia T78.3XXA Angioedema D35.2 Pituitary microadenoma E29.1 Androgen deficiency C43.30 Melanoma of face I83.10 Stasis dermatitis N20.0 Kidney stone on left side M47.816 Degenerative arthritis of lumbar spine N40.1 Enlarged prostate with lower urinary tract symptoms (LUTS) J43.9 Emphysema of lung M19.90 Acute arthritis A49.02 Infection of skin due to methicillin resistant Staphylococcus aureus (MRSA) U07.1 COVID-19
Preexisting Conditions: Coronary artery disease I11.9 Hypertensive heart disease E78.9 Lipid disorder G47.33 Obstructive sleep apnea R73.03 Prediabetes D12.6 Benign neoplasm of colon E88.81 Dysmetabolic syndrome M47.812 Cervical spondylarthritis K57.90 Diverticular disease K44.9 Hiatal hernia T78.3XXA Angioedema D35.2 Pituitary microadenoma E29.1 Androgen deficiency C43.30 Melanoma of face I83.10 Stasis dermatitis N20.0 Kidney stone on left side M47.816 Degenerative arthritis of lumbar spine N40.1 Enlarged prostate with lower urinary tract symptoms (LUTS) J43.9 Emphysema of lung M19.90 Acute arthritis A49.02 Infection of skin due to methicillin resistant Staphylococcus aureus (MRSA) U07.1 COVID-19
Allergies: lisinopril: angioedema ACE Inhibitors: angioedema metformin: renal insufficiency
Diagnostic Lab Data: Patient seen in office for symptoms and tested positive for COVID-19 7/29/21.
CDC Split Type:

Write-up: Patient was fully vaccinated, receiving 2nd dose of Moderna on 3/23/21 at clinic. Patient had received 1st dose of Moderna vaccine on 2/23/21. Patient tested positive for COVID-19 on 7/29/21.


VAERS ID: 1514867 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Delaware  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026C21A / 2 RA / IM

Administered by: Military       Purchased by: ?
Symptoms: Dizziness, Loss of consciousness, Seizure
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), 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? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Pt refused to be transported.
CDC Split Type:

Write-up: Pt began feelin g light headed and then went unconscious and had a seizure involving her arms, bilaterally as well as her legs, bilaterally.


VAERS ID: 1514868 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-03-23
Onset:2021-07-29
   Days after vaccination:128
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030A21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Singulair 10 mg tablet Levoxyl 88 mcg (0.088 mg) Tablet telmisartan 20 mg tablet omeprazole 20 mg delayed release capsule Fluticasone propionate 50 mcg/inh Spray albuterol 90 mcg/inh aerosol sertraline 50 mg tablet Vitamin D3 2
Current Illness: Hypothyroid K22.4 Esophageal spasm K21.9 GERD (gastroesophageal reflux disease) J45.30 Mild persistent asthma, uncomplicated E11.9 DM (diabetes mellitus) F41.8 Anxiety and depression E55.9 Vitamin D deficiency I10 Essential (primary) hypertension K20.9 Esophagitis U07.1 COVID-19
Preexisting Conditions: Hypothyroid K22.4 Esophageal spasm K21.9 GERD (gastroesophageal reflux disease) J45.30 Mild persistent asthma, uncomplicated E11.9 DM (diabetes mellitus) F41.8 Anxiety and depression E55.9 Vitamin D deficiency I10 Essential (primary) hypertension K20.9 Esophagitis U07.1 COVID-19
Allergies: latex amoxicillin: rash
Diagnostic Lab Data: Patient seen in office for symptoms and tested positive for COVID-19 on 7/29/21.
CDC Split Type:

Write-up: Patient received 2nd dose of Moderna vaccine on 3/23/21 at facility; she has received 1st dose of Moderna vaccine on 2/23/21. Patient was fully vaccinated. Patient tested positive for COVID-19 on 7/29/21.


VAERS ID: 1514992 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-07-28
Onset:2021-07-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / IM

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

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

Write-up: Headache, nausea, soreness, muscle soreness, dizziness, arm pain,


VAERS ID: 1514993 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-12
Onset:2021-07-29
   Days after vaccination:167
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9267 / 2 RA / IM

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

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

Write-up: Patient had a positive COVID test on 7/29/2021


VAERS ID: 1515011 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Maine  
Vaccinated:2021-03-11
Onset:2021-07-29
   Days after vaccination:140
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6199 / 2 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8737 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Pulmonary embolism
SMQs:, Embolic and thrombotic events, venous (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Coumadin, Amlodipine, Glucosamine
Current Illness: none
Preexisting Conditions: long standing mitral valve. No history of Pulmonary Embolism or DVT
Allergies: Atenolol, Atorvastatin, Lisinopril, Losartan, Crestor, Spironlactone
Diagnostic Lab Data:
CDC Split Type:

Write-up: Received two doses of Covid 19 Pfizer and now has a pulmonary embolism . No previous history or pulmonary embolism


VAERS ID: 1515012 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache, Injection site pruritus, Neck pain, Pain in extremity
SMQs:, Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Moderna, 7/1/2021, 12PM dose 1 age 50, left arm, arm pain
Other Medications: metoprolol tartrate 50MG tab X2 daily, Losartan Potassium 100mg X1 daily, Amlodipine Besylate 5mg tab. Ibuprophen 200mg X2 at 1pm 7/29 and at 9am 7/30
Current Illness:
Preexisting Conditions: High blood pressure, Hashimotos, Elevated liver enzymes (blockage in liver)
Allergies: aspirin, Ct Contrast, latex, shellfish
Diagnostic Lab Data:
CDC Split Type:

Write-up: second shot, headache, neck pain (feels like a pinched nerve) and arm pain, injection site itching: Ibuprophen 200mg X2 7/29/2021 1pm, 200mg X2 7/30/2021 9am, ongoing.


VAERS ID: 1515027 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-07-20
Onset:2021-07-29
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site erythema, Injection site swelling, Injection site warmth, Vaccination complication
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: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: penicillins, sulfa
Diagnostic Lab Data: none
CDC Split Type:

Write-up: 9 days after vaccine, patient received "covid arm" -- red, warm, swollen 2-4 inch diameter around injection site on left deltoid. not painful, but swollen and warm to the touch. patient was told to use warm/cold compress as needed for pain/swelling- take benadryl + antihistamine and contact physician if any further adverse effects occur from the vaccine.


VAERS ID: 1515041 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: New York  
Vaccinated:2021-07-28
Onset:2021-07-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH CVS549 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Feeling abnormal, Hypersomnia, Ocular hyperaemia
SMQs:, Anaphylactic reaction (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Glaucoma (broad), Depression (excl suicide and self injury) (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: CVS 549

Write-up: On July/28/2021 my daughter woke up very early to tell me,that she feels weird. He eyes looked bloodshot and strange looking, was not herself, I asked her if she was okay but she kept saying I don''t know.I asked her if she was thirsty and she just kept replying I don''t know. I asked her if she wanted to rest,she relied I don''t know,but she also stayed very close to me,which she never does.I asked is she hungry,she said I don''t know. Then she said she thought she saw my wire on the floor move,then she would ask me What is that,it seemed very weird how she acted yesterday.Ot is just about 10am and she has not woken up yet,this also strange because she always wakes up early to feed to animal(betta fish). My daughter was not herself and I was very worried and concerned and this is all because she had the covid shot yesterday. I hope she is better today.


VAERS ID: 1515054 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Multiple co-morbidities. Unspecified.
Preexisting Conditions: Multiple co-morbidities. Unspecified.
Allergies: None listed on vaccination form
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Patient came to vaccination clinic - stated that he needed 2nd dose of Pfizer. Writer verified that he needed Pfizer (he did not have his vaccination card). Writer administered Pfizer vaccine. When entering into WIR today, we found that he had first dose Moderna.


VAERS ID: 1515060 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Minnesota  
Vaccinated:2009-07-29
Onset:2021-07-29
   Days after vaccination:4383
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 1 LA / IM

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

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

Write-up: Mixed the Pfizer vaccine incorrectly. Mixed with 0.8ml of the diluent instead of 1.8ml of diluent


VAERS ID: 1515062 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8731 / 2 LA / IM

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

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

Write-up: Pfizer vaccine was requested by patient and administered by staff before confirming first dose on patient vaccination card. Patient had received the first dose with Moderna vaccine.


VAERS ID: 1515064 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: New York  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Heart rate increased, Rash, Throat irritation, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

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

Write-up: Rash and hives across chest over heart approximately 10 mins after vaccination, elevated heart rate for approximately 2 hours after vaccination (typically heart range is between low 70s to low 80s bpm, after vaccination was in the upper 90s to low hundreds bpm [heart rate measured by Fitbit health monitor], and itchy throat approximately 45 mins after vaccination. At the vaccination site the immunizer on site gave one Benadryl tablet to me.


VAERS ID: 1515069 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Heart rate increased, Hyperhidrosis, Malaise
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Vestibular disorders (broad), Hypoglycaemia (broad), Dehydration (broad)

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

Write-up: These events occurred on 07/29/21. I gave the patient the shot at 5:05 pm, about 2 minutes later she said she wasn''t feeling good and asked if it was normal. I told her that I would grab the Pharmacist on duty and get her some water. When the pharmacist came over the patient was increasingly getting worse. The patient said that she felt like she was going to pass out. She took sips of water and the pharmacist put ice packs on her to cool her down. We had an EpiPen on hand ready to administer if she was feeling like she couldn''t breathe. About 2 minutes passed and the pharmacist decided it was time to call 911. Her heart rate increased and she was sweating. After 10 minutes the ambulance arrived and assessed her vitals. When the ambulance arrived she was visibly better and able to stand and walk around. She did not have to go to the hospital and she ended up going home with her husband driving. I called her this morning 07/30/21 and she said she felt fine.


VAERS ID: 1515075 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-03-25
Onset:2021-07-29
   Days after vaccination:126
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Ferrous Sulfate 325mg PO daily Ocrevus IV infusion q 6 months primidone 50 mg PO bid
Current Illness:
Preexisting Conditions: Multiple Sclerosis Anemia
Allergies: Keflex
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient had completed the vaccine series (3/25/2021 and 4/22/2021). She tested COVID positive on 7/29/2021 and was found to have COVID-19 pneumonia and was admitted to the hospital.


VAERS ID: 1515079 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-07-28
Onset:2021-07-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Dizziness postural, Headache, Nausea, Pain in extremity, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: I take daily birth control pills. I took Tylenol and Ibuprofen 1 hour before shot and again every 6 hours after that until 9pm on 7/29 when I went to bed.
Current Illness: None
Preexisting Conditions: None
Allergies: None that I''m aware of
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Got shot 2p on 7/28. Felt fine until I went to bed at 10p. Woke up at 6a and felt extremely nauseous, lightheaded when laying/wanting to pass out when standing or walking, had a fever of 101 (normal temp when not feeling well is lucky to get to 99), painful arm, and headaches. Felt all these symptoms until I went to bed at 930p. Woke up 7/30 at 6a and felt back to normal minus sore arm and slight headache.


VAERS ID: 1515083 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-07-28
Onset:2021-07-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 044A21A / 2 LA / IM

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

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

Write-up: Fever, body aches, chills, headache, fatigue, loss of appetite


VAERS ID: 1515090 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-07-28
Onset:2021-07-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 2 RA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Body temperature increased, Chest X-ray, Dyspnoea, Fatigue, Full blood count, Metabolic function test, Oxygen saturation decreased, Urine analysis
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (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: Heparin Inj; Coreg; Pepcid; Plavix; Melatonin; Sevelamer HCl; tramadol HC, Lipitor, trazodone, Midodrine, Cinacalcet, Sodium Polystyrene Sulfonate Powder; Lactobacillus Rhamnosus (GG) Capsule; Nephrocaps Capsule 1 MG (B Complex-C-Folic Acid
Current Illness: UNKNOWN
Preexisting Conditions: Renal Failure
Allergies: NKDA; NKFA
Diagnostic Lab Data: Chest x-ray, CBC, BMP, UA C&S, (results pending)
CDC Split Type:

Write-up: Resident has temp 101.6 ; treated with Tylenol and temp trended down to 99.8; fatigue; Shortness of breath treated with 2 liters of oxygen; spo2 started at 94% and maintained at 97%. Respirations regular and unlabored. Resident verbalized feeling a little better but still fatigued.


VAERS ID: 1515104 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0162 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Client''s stated date of birth on paperwork was 05/01/2009 and age stated was 12. Nurse asked client how old she was while talking over paperwork with client. Client stated she was 12 years old. First dose of Pfizer vaccine was given. Mother went to the vehicle while client waited the 15 minutes required after vaccination. began to input vaccine into OSIIS and noticed date of birth was actually 05/01/2010 making client 11 years old instead of 12. AA confirmed date of birth. All dates showed the client''s birthday and 11 years old. The client was asked to get her mother from the car and the mother was then asked to provide proof of age/birthdate for the client. She stated she did not have anything on her and that she had just recently moved so she would go and try to find something and bring it back. She never came back.


VAERS ID: 1515118 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8727 / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Overnight after getting the vaccine pt started having fever and chills.


VAERS ID: 1515131 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Headache, Hypoaesthesia, Injection site pain, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Diabetes Type 2 Hypertension
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: pain at injection site, headache, generalized muscle aches, numbness on left arm


VAERS ID: 1515146 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007C21A / 1 RA / IM

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

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

Write-up: Patient was intaken asked if he had received COVID vaccine prior. patient answered no. Once vaccination was given and education that patient is to return in 28-42 days to receive 2nd vaccine and possible side effects that may occur, patient states wait I received 1 dose already. When asked what vaccine he received he stated Janssen. When asked how long ago, patient states a month or so, I don''t remember exactly. Patient was monitored for 15 min. No s/s and released back to his room.


VAERS ID: 1515154 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Blood pressure increased, Dysarthria, Heart rate increased, Rash, Sensory loss, Stupor, Swollen tongue
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Peripheral neuropathy (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypertension (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Premarin 0.625 mg Allergra D 180/250 mg ER Levothryoxine 200 mg Airborne Ginger Root Vitamin C Zinc D3 and K2 complex Tumeric Juice Plus - Fruit Blend, Vegetable Blend, Berry Blend, and Omega Blend
Current Illness: None
Preexisting Conditions: Thyroid
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: came in to get vaccine and was very anxious about vaccine before getting it. Did well with vaccine administration. She waited with her husband for the required 15 minutes (timed by a timer). When the timer went off she was feeling fine and left to go back to work. This RN got a call from her work partner at 11:15am stating that they were in route to the ER. was complaining of a swollen tongue and was having slurred speech. She was evaluated in the ER. She had symptoms of stupor, swollen tongue, rash to the neck, decreased feeling in arms and legs and elevated HR and BP. She was treated with IV fluids and Solu-medrol and then started feeling much better. Was discharged home with prescriptions for Benadryl, Steriods, and Pepcid. Talked to her today on the phone and she is feeling much better. Stayed home from work today. Tongue is still not quite down to the normal size yet.


VAERS ID: 1515161 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-01-28
Onset:2021-07-29
   Days after vaccination:182
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA NOT LISTED IN C / 1 LA / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA NOT LISTED IN C / 2 RA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Cough, Dyspnoea, Intensive care, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: Received Moderna vaccines on 12/31/20, 1/28/21 per report, vaccine lot #s not listed in chart. Tested positive for COVID-19 by PCR on 7/29/21. Admitted to Hospital/Clinic on 7/29/21 w/ 2 wks of increasing cough, SOB. In ICU for one day. Treating with Remdesivir.


VAERS ID: 1515178 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-02-26
Onset:2021-07-29
   Days after vaccination:153
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9264 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Anticoagulant therapy, Asthenia, Atelectasis, Blood lactic acid increased, COVID-19 pneumonia, Cardio-respiratory arrest, Chest X-ray abnormal, Cough, Deep vein thrombosis, Exposure to SARS-CoV-2, Fluid overload, Hyperlipidaemia, Hypertension, Incontinence, Lung consolidation, Lung opacity, Nasopharyngitis, Nausea, Obesity, Oedema, Pulmonary congestion, Pyrexia, SARS-CoV-2 test, Type 2 diabetes mellitus, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (broad), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (broad), Dyslipidaemia (narrow), Lactic acidosis (narrow), Hyperglycaemia/new onset diabetes mellitus (narrow), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypertension (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Lipodystrophy (broad), Chronic kidney disease (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: PROCEDURE: XR CHEST PORTABLE VIEW(S): AP DATE: 7/29/2021 4:42 PM COMPARISONS: Priors, most recently 02/13/2016 CLINICAL INDICATION: 80 years Male cough, fever FINDINGS: The cardiac silhouette is enlarged and the pulmonary vascular appears congested. No apparent pleural effusion or pneumothorax. Low lung volumes resulting in crowding of bronchovascular structures.. Scattered ill-defined bilateral airspace opacities and retrocardiac consolidation. IMPRESSION: 1. Findings suggesting fluid overload/heart rate with mild edema. 2. Bilateral airspace opacities, which could relate to atelectasis, edema or an infectious process/pneumonia given clinical history. Contains critical data ED RAPID CORONAVIRUS (COVID-19) SOFIA ANTIGEN TEST W/ REFLEX Order: 273048746 Status: Final result Specimen Information: NASAL 0 Result Notes Ref Range & Units 7/29/21 1728 CORONAVIRUS ANTIGEN IA NEGATIVE POSITIVEPanic Comment: NO CONFIRMATION TESTING REQUIRED Contains critical data ED RAPID CORONAVIRUS (COVID-19) SOFIA ANTIGEN TEST W/ REFLEX Order: 273048746 Status: Final result Specimen Information: NASAL 0 Result Notes Ref Range & Units 7/29/21 1728 CORONAVIRUS ANTIGEN IA NEGATIVE POSITIVEPanic Comment: NO CONFIRMATION TESTING REQUIRED
CDC Split Type:

Write-up: Date of Hospitalization: 7/29/2021 2:41 PM CC: Cough and more weak The below information was obtained directly from the patient and the below portions of the epic record was reviewed and confirmed with the patient. Patient is an 80-year-old male, who states that the reason for coming into the ER cough was increased weakness. Had a cold-like symptoms more weakness. Patient has been trying to stay out of the public not doing much but on Sunday he went to his mother''s birthday and lots of family members were present. From that party two other people have turned positive for Covid. + nausea -patient did have an episode of vomiting today yellow emesis did have 2 episodes of incontinence. This is unlikely the patient''s baseline. ASSESSMENT/PLAN: SARS-CoV-2 viral pneumonia/COVID-19: POA Dexamethasone 6 mg daily for total of 10 days No need for repeat Covid test -to confirm negative. Appropriate PPE was used to see the patient daily (N95, gown, gloves) Elevated lactic acid - POA - IV hydration and follow Diabetes mellitus type 2 POA -start on insulin per protocol Hyperlipidemia POA Hypertension POA Obesity BMI 39 POA Acute on Chronic DVT POA - started on Xarelto on 7/23 DVT prophalaxsis - Xarelto We will hospitalized this patient to the Hospitalist''s service, with the diagnosis of SARS Covid viral pneumonia and fully vaccinated patient. The patients current condition is serious. The patient requires Hospitalization because of treatment of SARS Covid. The patient is a FULL CODE. The anticipated duration of length of stay will be 3-5 days.


VAERS ID: 1515187 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-07-28
Onset:2021-07-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Blood glucose increased, Hyperhidrosis, Nausea
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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: Patient received 2nd dose of vaccine on 07/28/21. Started having symptoms the next day. Nausea, elevated blood sugars (type 1 diabetic), diaphoresis


VAERS ID: 1515198 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-01-18
Onset:2021-07-29
   Days after vaccination:192
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1283 / 2 - / SYR

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

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

Write-up: breakthrough covid case. Became positive 7/29/21. Completed series in january


VAERS ID: 1515204 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-07-25
Onset:2021-07-29
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Decreased appetite, Heart rate increased
SMQs:, Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Thyroid booster with Iodine. Mens daily vitamin. Daily Fexofenadine for allergies.
Current Illness:
Preexisting Conditions:
Allergies: morphine, pennicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: -Sharp pain in chest -increased Heart Rate -Loss of appetite


VAERS ID: 1515208 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-03-05
Onset:2021-07-29
   Days after vaccination:146
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012M20A / 1 LA / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011A21A / 2 LA / SYR

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

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

Write-up: Received Moderna vaccines on 2/4/21, 3/5/21; tested positive for COVID-19 by PCR on 7/29/21. Admitted to Hospital on 7/27/21. History of duodenal cancer. Appears to be asymptomatic for COVID, admitted for bowel obstruction.


VAERS ID: 1515215 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-01-25
Onset:2021-07-29
   Days after vaccination:185
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1283 / 2 AR / IM

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

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

Write-up: COVID positive after vaccination


VAERS ID: 1515233 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026C21A / 1 LA / IM

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: none reported
Current Illness: none reported
Preexisting Conditions: none reported
Allergies: none reported
Diagnostic Lab Data: none
CDC Split Type:

Write-up: The patient was not of age to receive the vaccine.


VAERS ID: 1515234 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Seizure like phenomena
SMQs:, Convulsions (narrow)

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

Write-up: patient received her pfizer covid vaccine on 07/29/2021 . she was about to leave the medical center that''s when she started to have what seemed to be a seizure like activity. rapid response was requested by the pharmacist and the patient was taken to a clinic where she had medical attention. she went home about 45 minutes after


VAERS ID: 1515240 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-01-19
Onset:2021-07-29
   Days after vaccination:191
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041L20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010M20A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen (TYLENOL) 500 mg oral tablet amLODIPine (NORVASC) 10 mg oral tablet donepezil (ARICEPT) 10 mg oral tablet doxepin (SINEQUAN) 10 mg oral capsule DULoxetine (CYMBALTA) 30 mg oral delayed release capsule
Current Illness:
Preexisting Conditions: Alzheimer''s disease Depression DM High cholesterol HTN Neuropathy Oligodendroglioma, WHO grade II
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: POSITIVE COVID TEST 7/29/21. INCREASED FALLS


VAERS ID: 1515251 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Fatigue, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Triamcinolone .1% Ointment Cetirizine 10mg Albuterol Sulfate
Current Illness:
Preexisting Conditions: Asthma Eczema
Allergies: Eggs Seafood Nuts
Diagnostic Lab Data:
CDC Split Type:

Write-up: Muscle Ache Fatigue Tightness in left side of chest


VAERS ID: 1515256 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-07-27
Onset:2021-07-29
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Inappropriate schedule of product administration, Tuberculin test negative
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: covid injection given on 7-22-2021 and ppd tb skin test given on 7-27-2021. Results of tb skin test negative. No reactions with either injection, however spacing interval is to close.


VAERS ID: 1515259 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-03-04
Onset:2021-07-29
   Days after vaccination:147
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9266 / 1 LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6199 / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Cough, Fatigue, Myalgia, Respiratory tract congestion
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: Received Pfizer vaccines on 2/11/21, 3/4/21; tested positive for COVID-19 on 7/29/21. Onset 7/27/21 with cough, congestion, fatigue, myalgia. Plans to receive monoclonal antibodies.


VAERS ID: 1515284 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0164 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown - this person is not established with this clinic.
Current Illness: Unknown - this person is not established with this clinic.
Preexisting Conditions: Unknown - this person is not established with this clinic.
Allergies: Unknown - none stated on immunization screening form - this person is not established with this clinic.
Diagnostic Lab Data: Unknown if patient presented to another clinic for further evaluation, but no further testing was done by SCHC.
CDC Split Type:

Write-up: This patient received his first dose of Moderna on 7/1/21. He presented to the clinic for the second dose and received 0.3mL given in the Left deltoid by medication error from RN on 7/29/21. Patient was notified after error was recognized.


VAERS ID: 1515289 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: New York  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: No adverse event, Product storage error
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: Eq Multivitamin Children''s Gummy
Current Illness: Mixed Receptive Expressive Language Disorder
Preexisting Conditions: N/A
Allergies: Seasonal
Diagnostic Lab Data: No laboratory tests ordered at this time. Provider will order antibody titers prior to next dose and 3 weeks after patient receives the second dose.
CDC Split Type:

Write-up: Pt was given a dose of the Pfizer COVID 19 vaccine from a vial that had been diluted over 24 hours ago (27.5 hrs exactly) and had remained refrigerated within a medical fridge between (8`C - 25`C). At this time family has been notified, and patient is showing no adverse effects at this time. Facility has been in contact with vaccine manufacturer for further discussion of course of action.


VAERS ID: 1515290 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026C21A / 1 RA / IM

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: none reported
Current Illness: none reported
Preexisting Conditions: none reported
Allergies: none reported
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Patient not of age to receive vaccine.


VAERS ID: 1515317 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-07-27
Onset:2021-07-29
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Dreamy state, Feeling abnormal, Mobility decreased, Pain in extremity, Sleep disorder
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Convulsions (narrow), Parkinson-like events (broad), Vestibular disorders (broad), Generalised convulsive seizures following immunisation (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: Xanax .5 2 Tylenol 500 mg
Current Illness: No
Preexisting Conditions: Anxiety No other
Allergies: KNA
Diagnostic Lab Data: I did not have any related to this incident.
CDC Split Type:

Write-up: Day 1-2 sore arm to where I could not move it well. Day 3-4 dizziness waking me up at night, also, during day. Day 3-4 Brain Fog( hard to stay focused. Or feels like I?m dreaming.


VAERS ID: 1515320 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-07-28
Onset:2021-07-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / -

Administered by: Private       Purchased by: ?
Symptoms: Unevaluable event
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Amlodipine, Montuklast, Sudafed, Zyrtec, Vitamin D, IASO Tea
Current Illness: None
Preexisting Conditions: High blood pressure
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: None stated.


VAERS ID: 1515351 (history)  
Form: Version 2.0  
Age: 9.0  
Sex: Female  
Location: Montana  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 LA / IM

Administered by: 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? 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 receiving vaccine was 9 years old, only indicated down to 12 years old


VAERS ID: 1515352 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / N/A LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, Hyperhidrosis, Nervousness, Pallor
SMQs:, Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (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: No medications
Current Illness: none reported
Preexisting Conditions: none reported
Allergies: No known allergies
Diagnostic Lab Data: none
CDC Split Type:

Write-up: At approximately 1130, RN assisted patient to anti-gravity chair. RN reported patient started leaning on her when they were walking to the anti-gravity chair. RN and EMT assisted patient into anti-gravity chair. RN assessed patient. Patient was diaphoretic and pale. Patient stated she was "nervous about getting the vaccine". Patient reported previous episodes of fainting due to menstrual cramps. Patient denied itchiness, rashes, hives, difficulty swallowing, and difficulty breathing. At 1133, EMT assessed patient vital signs: blood pressure 105/65 mmHg and pulse 51 beats/minute. Patient reported eating in the morning. RN utilized breathing techniques with patient. At 1138, EMT assessed patient vital signs: blood pressure 124/76 mmHg and pulse 51 beats/minute. Patient stated she was "feeling better". At 1141, EMT reassessed patient vital signs: blood pressure 115/61 mmHg and pulse 55 beats/minute. At 1146, EMT reassessed patient vital signs: blood pressure 98/62 mmHg and pulse 61 beats/minute. Patient stated she felt "normal". Patient offered chips. Patient ate chips. At 1156, EMT reassessed patient vital signs: blood pressure 109/63 mmHg and pulse 63 beats/minute. Patient stated she felt "fine" and "normal". RN educated patient on signs/symptoms of when to seek emergency care, to follow up with primary care provider and to sign up on v-safe. Patient called grandmother to drive patient home. Patient waited for grandmother to arrive at facility. At 1215, patient left facility with unlabored respirations and steady gait.


VAERS ID: 1515357 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 2 LA / IM

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

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

Write-up: Patient was scheduled for second dose of Pfizer vaccine on 7/29/2021. Second dose of vaccine was given 6 days early. Second dose of vaccine was due to be given on 8/4/2021.


VAERS ID: 1515375 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-28
Onset:2021-07-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Erythema, Haematoma, Injection site extravasation, Pruritus, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemorrhage terms (excl laboratory terms) (narrow), Extravasation events (injections, infusions and implants) (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: stomach contraction/Covid Pfizer 1st dose/ 6-30-21
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Sulfa drugs
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pharmacy technician administered the vaccine. The needle was not all the way in. Technician was informed. As the needle was being removed, notice some of vaccine coming out of the arm. Post vaccine, redness, swelling, itching, and a large hematoma. Concerned that it was not correctly done and if fully vaccinated.


VAERS ID: 1515386 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-01-23
Onset:2021-07-29
   Days after vaccination:187
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3302 / 2 LA / IM

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

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

Write-up: COVID + result on 7/30/2021, symptom onset on 7/29/2021


VAERS ID: 1515393 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 026C21A / 1 LA / IM

Administered by: Unknown       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: no adverse event after waiting 15 minutes. But patient was under age of 18. Parents came up to the site and requested Moderna. medic was overwhelmed at the time and did not check patients age before administering shot


VAERS ID: 1515401 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Fatigue, Flushing, Hyperhidrosis, Injection site pain, Lethargy
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Vestibular disorders (broad), Hypersensitivity (broad), Hypoglycaemia (broad)

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

Write-up: Site: Pain at Injection Site-Mild, Systemic: Dizziness/Lightheadedness-Medium, Systemic: Exhaustion/Lethargy-Medium, Systemic: Flushed/Sweating-Mild, Additional Details: It was 100 degree temperature outside. Patient said she had been outside all day. I fanned her, gave her water to drink and observed her for 20 minutes. She was fine in 15 minutes.


VAERS ID: 1515407 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-03-25
Onset:2021-07-29
   Days after vaccination:126
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016B21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: albuterol 90 mcg/inh 2 puffs QID PRN for wheezing Aspirin daily Advair Diskus 250 mcg-50mcg BID Lasix 40mg BID Lisinopril 10mg HS Metoprolol Succinate Er 50mg Daily Paxil 20mg Daily Simvastatin 20mg HS
Current Illness: 3/3/2021 Fatigue and dizzy spells
Preexisting Conditions: Hypertension, Hyperlipidemia, Moderate persistent asthma, Heart failure with normal ejection fraction, Obstructive Sleep Apnea, History of prostate cancer, Severely obese, Lymphedema of bilateral lower limbs, Coronary artery disease
Allergies: No known allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient contracted COVID-19 on 7/29/2021


VAERS ID: 1515419 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-02-13
Onset:2021-07-29
   Days after vaccination:166
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK RA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Herpes zoster
SMQs:, 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? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Shingles


VAERS ID: 1515431 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-04-01
Onset:2021-07-29
   Days after vaccination:119
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0150 / 1 LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0171 / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Chills, Cough, Exposure to SARS-CoV-2, Myalgia, Pyrexia, Respiratory tract congestion, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: Received Pfizer vaccines on 4/1/21, 4/22/21 tested positive for COVID by PCR on 7/29/21 Onset date 7/26/21 w/ cough, fever, chills, myalgias, congestion; known exposure to COVID


VAERS ID: 1515446 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0175 / 2 LA / IM

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: Patient reported she felt dizziness after her first dose Pfizer vaccination. Patient stated dizziness went away later in the day
Other Medications: Daily vitamins; unspecified
Current Illness: none reported
Preexisting Conditions: none reported
Allergies: no known allergies
Diagnostic Lab Data: none
CDC Split Type:

Write-up: At 1412 , patient was vaccinated in anti-gravity chair. At 1427, patient reported dizziness to EMT. Patient reported dizziness after her first dose. Patient reported she did not alert EMTs on site and dizziness went away when she got home. Patient reported not following up with primary care provider for her first dose reaction. At 1427, EMT assessed patient vitals: blood pressure 130/89 mmHg and pulse 82 beats/minute. RN assessed patient. Patient denied itchiness, rashes, hives, difficulty swallowing, and difficulty breathing. Patient advised to drink water. Patient offered water. Patient drank water. At 1432, EMT assessed patient vitals: blood pressure 124/94 mmHg and pulse 88 beats/minute. Patient reported feeling less dizziness. At 1441, EMT reassessed patient vital signs: blood pressure 133/87 mmHg and pulse 84 beats/minute. Patient reported feeling less dizziness and stated she was "feeling better". At 1451, EMT reassessed patient vital signs: blood pressure 128/88 mmHg and pulse 88 beats/minute. Patient reported feeling less dizziness. Patient reported she can drive herself home and stated "I''m okay". RN educated patient on signs/symptoms of when to seek emergency care, to follow up with primary care provider and to register with v-safe. At approximately 1257, patient left facility with unlabored respirations and steady gait.


VAERS ID: 1515447 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Blood glucose normal, Dizziness, Electrocardiogram normal, Pallor, Presyncope, Vision blurred
SMQs:, Anticholinergic syndrome (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: "10 minutes after first pfizer vaccine shot (11:32), pt started having blurry vision, dizziness, and per staff, pt was pale. Per witnesses, pt had a near syncope. Never fully passed out. Helped to the ground. Initial vitals BP 102/74, HR 64-174, RR 18. 911 called @ 11:35. In the ED: Pt feels better now upon arrival to ED. No seizure-like activity or convulsions. Patient has no complaints at this time, states he feels back to normal. He denies injury or pain. POC Glucose - 90 12 lead EKG Normal @12:47. Vitals BP 112/61, HR 67, RR 22, SpO2 100%, Temp 98.4. ED MD concludes that the episode was likely vasovagal syndrome."


VAERS ID: 1515448 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-28
Onset:2021-07-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 1 LA / IM

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

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

Write-up: Headaches, dizziness, nausea and vomiting (w/dry heaving)


VAERS ID: 1515449 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-02-08
Onset:2021-07-29
   Days after vaccination:171
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1283 / 1 LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9262 / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Anosmia, COVID-19, Headache, SARS-CoV-2 test positive
SMQs:, Taste and smell disorders (narrow), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

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

Write-up: Patient vaccinated w/ Pfizer vaccines on 1/18/21, 2/8/21 Tested positive for COVID19 by PCR on 7/29/21 after 2-3 wk h/o loss of smell, headache. To receive monoclonal antibodies on 7/30/21.


VAERS ID: 1515460 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-03-18
Onset:2021-07-29
   Days after vaccination:133
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024M20A / 1 UN / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031A21A / 2 UN / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Cough, Myalgia, Pyrexia, Respiratory tract congestion, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: Received Moderna vaccines on 2/18/21, 3/18/21 Positive for COVID by PCR on 7/29/21 known exposure to COVID; symptom onset 7/25/21 w/ myalgia, fever, cough, congestion


VAERS ID: 1515463 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-07-26
Onset:2021-07-29
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052C21A / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site bruising, Injection site pain
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Extravasation events (injections, infusions and implants) (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: IMIQUIMOD 5% CRE, FLUCONAZOLE 150MG TAB, HydrALAZINE 100MG TAB, XANAX 0.5MG TAB, CANDESARTAN 16MG TAB, METOLAZONE 5MG TAB, LANTUS SOLOSTAR INJ, TORSEMIDE 20MG TAB, COREG 6.25MG TAB, KLOR-CON M10 ER
Current Illness: none
Preexisting Conditions: Diabetes, RA
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient''s arm presented extremely bruised from her elbow to her shoulder and was very painful.


VAERS ID: 1515476 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Hawaii  
Vaccinated:2021-04-23
Onset:2021-07-29
   Days after vaccination:97
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0175 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: lisinopril 2.5 mg, atorvastatin 40 mg, warfarin 2.5 mg, carvedilol 12.5 mg
Current Illness: asthma, atrial fibrillation, cardiomyopathy, prediabetes
Preexisting Conditions: asthma, atrial fibrillation, cardiomyopathy, prediabetes
Allergies: spironolactone, dust
Diagnostic Lab Data: SARS-COV2, NAA
CDC Split Type:

Write-up: positive Covid test after having cough, congestion


VAERS ID: 1515488 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-05-11
Onset:2021-07-29
   Days after vaccination:79
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0169 / 1 RA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 2 LA / SYR

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

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

Write-up: received Pfizer vaccines on 4/20/21/5/11/21; tested positive for COVID by PCR on 7/29/21 Unknown if symptoms


VAERS ID: 1515528 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-04-20
Onset:2021-07-29
   Days after vaccination:100
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0169 / 2 LA / SYR

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

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

Write-up: Received Pfizer vaccines on 3/30/21, 4/21/21 tested positive for COVID by PCR on 7/29/21.


VAERS ID: 1515530 (history)  
Form: Version 2.0  
Age: 8.0  
Sex: Male  
Location: Oklahoma  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0175 / 1 LA / IM

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

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

Write-up: No adverse reactions. Client is doing well.


VAERS ID: 1515574 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: New York  
Vaccinated:2021-07-28
Onset:2021-07-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Hypoaesthesia, Injection site hypoaesthesia, Injection site pain, Pain in extremity, Peripheral swelling, Pruritus
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sexual dysfunction (broad)

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

Write-up: After15minutes of injection numbness and stabbing pains in left forearm. 24hrs after injection numbness and itch in both forearms. 40hrs after injection continued numbness in both forearms and swelling/pain/numbness at the fingertips of both hands.


VAERS ID: 1515577 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Headache, Hypoaesthesia, Injection site pain
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Sexual dysfunction (broad)

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

Write-up: Headache; numbness on left arm; pain on injection site.


VAERS ID: 1515594 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-02-24
Onset:2021-07-29
   Days after vaccination:155
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6203 / 2 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: received Pfizer vaccines on 2/3/21, 2/24/21 Tested positive for COVID by PCR on 7/29/21 Will receive monoclonal antibodies on 7/30/21


VAERS ID: 1515598 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0175 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Flushing, Oral pruritus, Pruritus, Rash
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Vestibular disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: levothyroxine; no other medications reported
Current Illness: none reported
Preexisting Conditions: hypothyroidism
Allergies: Rash on face, hands, and forearm due to Toradol
Diagnostic Lab Data: none
CDC Split Type:

Write-up: At 1440, patient reported to EMT and stated she had a "face rash" and feels "itchy" and "dizzy". RN assessed patient. Patient denied swelling of tongue/lips, difficulty swallowing and difficulty breathing. Patient reported she felt itchiness on her left and right cheeks. Patient appeared flushed. Patient reported history of allergic reaction to Toradol. Patient reported she had rashes on her face, hands and forearm. Patient reported history of hypothyroidism and current medication includes levothyroxine. Patient offered intramuscular diphenhydramine. Patient agreed to intramuscular diphenhydramine. Patient offered EMS. Patient declined EMS. At 1440, EMT assessed patient vital signs: blood pressure 135/101 mmHg and pulse 87 beats/minute. At 1447, RN administered intramuscular diphenhydramine 50 mg/1 ml in the right arm. At 1452, EMT reassessed patient vital signs: blood pressure 143/93 mmHg and pulse 82 beats/minute. Patient stated she felt "better". At 1457, EMT reassessed patient vital signs: blood pressure 140/93 mmHg and pulse 84 beats/minute. Patient denied itchiness and appeared less flushed. At 1502, EMT reassessed patient vital signs: blood pressure 142/91 mmHg and pulse 87 beats/minute. Patient denied itchiness, dizziness, lightheadedness and difficulty swallowing/breathing. At 1510, EMT reassessed patient vital signs: blood pressure 138/94 mmHg and pulse 80 beats/minute. RN assessed patient. Patient reported she felt "nothing" on her face. Patient denied itchiness and rashes on face. Patient''s face was free from redness and flushing. Patient denied difficulty swallowing and difficulty breathing. RN asked patient if she had anyone to drive her home. Patient reported there was no one to drive her home. Patient reported she can drive herself home. Patient denied sleepiness and drowsiness. RN educated patient on signs/symptoms of when to seek emergency care, to follow up with primary care provider, and to sign up with v-safe. At approximately 1517, patient left facility with unlabored respirations and steady gait.


VAERS ID: 1515606 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: New York  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Hx of Mild Intermittent Asthma (well-controlled)
Allergies: Hx of allergies to dust mites and cat dander.
Diagnostic Lab Data: None
CDC Split Type:

Write-up: About 20 minutes after vaccination, patient complained of feeling really tired initially. About another 5-10 minutes later, patient complained that her "throat hurt" and subsequently complained of "tightness" in her throat. Pt was given 15 ml of Liquid Benadryl (12.5mg/5ml) and subsequently given an IM injection of Epinephrine 0.3mg in office with reported improvement. EMS was called immediately for patient to be taken by ambulance to the Emergency Department for further observation and evaluation.


VAERS ID: 1515607 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-01-14
Onset:2021-07-29
   Days after vaccination:196
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1686 / 1 LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1283 / 2 LA / SYR

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

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

Write-up: received Pfizer vaccines on 12/23/20, 1/14/21 Tested positive for COVID by PCR on 7/29/21


VAERS ID: 1515619 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / N/A LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Hyperhidrosis, Hypoacusis, Pallor, Vision blurred
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Hearing impairment (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: When receiving vaccine was very nervous and brother held his hand. Went to sit in observation area and after a few minutes became diaphoretic, pale and claimed he had blurred vision and muffled hearing. Drank some water and two cans of Coca Cola. NP was present with him. Sat for 1/2 hour and left with brother. Called on 7/30/21 at 4PM and spoke with brother who said his brother was "fine since they left last night".


VAERS ID: 1515628 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-01-06
Onset:2021-07-29
   Days after vaccination:204
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK5730 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK9231 / 2 - / IM

Administered by: Work       Purchased by: ?
Symptoms: COVID-19, Headache, Influenza A virus test negative, Influenza B virus test, Productive cough, Respiratory tract congestion, SARS-CoV-2 test positive
SMQs:, Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Obesity, prediabetes
Allergies: NKDA
Diagnostic Lab Data: 072921: Influenza A/B (-) for both, COVID-19 Abbott ID NOW (+)
CDC Split Type:

Write-up: PFIZER COVID-19 EUA: fully vaccinated patient presented 072921 with a 3-day history of congestion, headache and productive cough


VAERS ID: 1515635 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test, Electrocardiogram abnormal, Palpitations
SMQs:, Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: CIPRO, ERYTHOMYCIN, PENICILLIN
Diagnostic Lab Data: EKG IN AMBULANCE 7/29/2021, EKG AT MD OFFICE 7/30/2021, LABORATORY BLOODWORK 7/30/2021
CDC Split Type:

Write-up: PATIENT DID NOT HAVE ANY ADVERSE EFFECTS 15 MINUTES POST-VACCINATION. AFTER LEAVING, PATIENT IMMEDIATELY RETURNED TO THE PHARMACY COMPLAINING OF HEART PALPITATIONS. AFTER 15 MINUTES, SHE FELT BETTER AND ATTEMPTED TO LEAVE BUT THE HEART PALPITATIONS RETURNED AND 911 WAS IMMEDIATELY CALLED. PARAMEDICS SOON ARRIVED AND TRANSPORTED THE PATIENT TO THEIR AMBULANCE.


VAERS ID: 1515648 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / UNK LA / IM

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

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

Write-up: Patient got Janssen in April (location unknown to us) and came and got Pfizer at our pharmacy 7/29/21. He told us afterwards that his doctor recommended him to get Pfizer as a booster. Called patient today and he reported no side effects and is aware this is currently not recommended. He will not received second Pfizer dose.


VAERS ID: 1515686 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Oklahoma  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0162 / 1 LA / IM

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

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

Write-up: THE PATIENT CAME TO THE SCHOOL POD - HE CAME TO GE THE PFIZER VACCINE - WHEN ASKED IF IT WAS HIS FIRST DOSE HE SAID YES - DID NOT PRESENT A CARD - GAVE HIM HIS FIRST PFIZER DOSE - HE WAITED HIS 15 MINUTES THEN LEFT, UPON ENTERING THE DOSE IN INFORMATION SYSTEM, IT WAS BROUGHT TO THE NURSES ATTENTION THE PATIENT ALREADY HAD A J&j IN INFORMATION SYSTEM. WHEN GETTING BACK TO THE CLINIC, SUPERVISOR WAS CONSULTED THE PATIENT WAS CONTACTED. HE REPORTED HE DID NOT WORK AT WESTERN MEDICAL WHEN ASKED. WHEN ASKED IF HE HAD RECEIVED A J&J IN MARCH HE SAID YES. HE SAID HIS DOCTOR RECOMMENDED HE GET A PFIZER. THE PATIENT WOULD NOT SAY WHO HIS DOCTOR IS. PATIENT WAS INSTRUCTED TO NOT GET ANYMORE DOSES. UPON FURTHER REVIEW AS WELL THE PATIENT DID NOT ANSWER IF HE HAD RECEIVED A COVID VACCINE YET OR NOT - HE LEFT IT BLANK


VAERS ID: 1515694 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-01
Onset:2021-07-29
   Days after vaccination:178
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK UN / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK UN / SYR

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

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

Write-up: Patient is confirmed covid positive and is fully vaccinated.


VAERS ID: 1515700 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Unknown  
Vaccinated:2020-12-01
Onset:2021-07-29
   Days after vaccination:240
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK UN / SYR

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

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

Write-up: Patient is fully vaccinated and has tested positive for COVID 19


VAERS ID: 1515706 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-01-01
Onset:2021-07-29
   Days after vaccination:209
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK UN / SYR

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

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

Write-up: Patient is fully vaccinated and has tested positive for covid


VAERS ID: 1515727 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / N/A AR / IM

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

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

Write-up: Patient received the Janssen COVID vaccine ( lot #201A21A) at approximately 1850. At 1852, patient complained of feeling lightheaded, Paramedic walked the patient to the zero-gravity chair and placed the patient supine. Vital signs: blood pressure 104/72, O2 97%, pulse 56, respirations 16. PHN approached to assess the patient, noting no work of breathing. Patient denied shortness of breath, nausea or feeling sweaty. Patient was given water and started to drink it. Patient reported no allergies, taking medications, nor medical conditions. PHN offered patient Benadryl but patient refused. At 1853, patient reported symptoms had resolved. PHN encouraged patient to remain for 30min monitoring, to follow up with provider, and when to call 911. At 1903, patient continued to report no symptoms. VItal signs: blood pressure 108/76, pulse 64, respirations 16. Patient reported her blood pressure usually runs low around 110/70. At 1904, patient stood up, monitored closely by PHN and Paramedic. Patient continued to report no feelings of lightheadedness. Patient reported she wanted to leave despite recommended 30min monitoring after reporting symptoms. At 1905, patient left walking with steady gait.


VAERS ID: 1515730 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-28
Onset:2021-07-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030B21A / 1 LA / IM

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

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

Write-up: patient came by today and showed a red circular rash on her arm. no itching, no difficulty breathing. just warm to the touch. she was feeling fine otherwise


VAERS ID: 1515731 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034C214 / 1 LA / IM

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

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

Write-up: The patient was vaccinated on 7/29/2021 at around 2:45pm. Within 5 minutes of receiving the vaccine, the patient stated that he felt as though he "was going to faint" and started sweating profusely. 911 was immediately called. Continued patient monitoring until paramedics arrived. Patient''s pulse was monitored and blood pressure (reported by paramedics) was 90/60 mmHg. Patient refused to be transported to hospital. Patient was monitored at pharmacy until blood pressure normalized and patient was stable.


VAERS ID: 1515745 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Kansas  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 0361321 A / UNK LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest X-ray, Chest discomfort, Chest pain, Depressed level of consciousness, Differential white blood cell count normal, Disturbance in attention, Dysarthria, Dyspnoea, Electrocardiogram normal, Fatigue, Fibrin D dimer, Full blood count normal, Hypoaesthesia, Injection site pain, Metabolic function test, Myalgia, Nausea, Pain in extremity, Paraesthesia, Troponin I, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Depression (excl suicide and self injury) (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: sinus drainage for previous 10 days
Preexisting Conditions: none
Allergies: food allergies: legumes, chicken, peppers (seasoning)
Diagnostic Lab Data:
CDC Split Type:

Write-up: Four hours following the vac. I developed rapid onset of severe pain in my left arm which was the one I received the shot in. Thinking it was injection site pain (more severe than I''d experienced with any other vaccination) I took one 200mg ibuprofen. Within the next few minutes, the arm pain continued and upper chest pain and tightening started. The pain and tightness continued to worsen causing me to have trouble breathing. I began to feel nauseous and threw up a couple of times. At 8:40 I told my mom to take me to the emergency room because I continued to feel worse. We immediately left for the hospital and my arms and legs began to tingle and become numb. For the next 30 minutes my symptoms worsened and my speech began to slur. I was also having trouble concentrating and staying alert. About the time we met the ambulance along the highway the chest tightness was starting to subside. In the ambulance I received diphenhydramine and Toradol. I continued to improve on the way to the hospital and while in the emergency room. I was given more toradol and diphenhydramine in the emergency room. According to my release papers, I received the following lab tests: CBC with Differential reflex Manual Diff, Comprehesive Metabolic Panel, D-dimer, and Troponin I. I also received a standard EKG and an XP Chest 1 view AP. At approximately 11:30pm I was dismissed from the ER. The doctor explained that all tests and vitals were normal, he was unable to see any reason for the symptoms I experienced. That night and the next day I was extremely tired and all of my muscles were sore like I had done 2-a-day football practice without preconditioning.


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