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From the 11/12/2021 release of VAERS data:

Found 875,292 cases where Vaccine is COVID19 and Patient Did Not Die

Government Disclaimer on use of this data



Case Details (Reverse Sorted by Onset Date)

This is page 189 out of 8,753

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VAERS ID: 1778802 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-10-11
Onset:2021-10-12
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ASA, lipitor, prilosec, metformin, losartan, humalog, tresiba, breo ellipta, jardiance, trulicity, celxa
Current Illness: Not mentioned
Preexisting Conditions: hypertension, hyperlipdemia, diabetes mellitus, hyperthyroidism, graves disease
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt reports fever of 101 the day after vaccination. Pt advised to Proceed to PCP for evaluation


VAERS ID: 1778828 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-10-10
Onset:2021-10-12
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2590 / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache, Pyrexia, Sleep disorder, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Fainting the DAY AFTER receiving Pfizer Covid-19 vaccine shot #2.
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: The day after the shot, I developed a fever of 102.4. During the night, I developed a headache so bad I couldn''t sleep. When I got up to take Tylenol, I fainted on the bedroom floor.


VAERS ID: 1778880 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-10-12
Onset:2021-10-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045C21A / 1 LA / IM

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

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

Write-up: Patient was given a Moderna vaccine and was only 17


VAERS ID: 1778891 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-18
Onset:2021-10-12
   Days after vaccination:208
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Admitted to Hospital on Date of Adverse Event [recorded in VAERS] for treatment of Covid-19 Positive following completion of Covid Vaccine Series


VAERS ID: 1778927 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-10-12
Onset:2021-10-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 1 LA / IM

Administered by: Military       Purchased by: ?
Symptoms: Blood glucose, Dizziness, Nausea, Pruritus, Throat tightness
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: patient began to have itching all over starting 15 minutes after her vaccine. She then complained about having throat tightness and feeling faint and nauseous. 911 was called at that time for further evaluation.


VAERS ID: 1778946 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: D.C.  
Vaccinated:2021-10-11
Onset:2021-10-12
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chills, Hypoaesthesia, Nasal congestion, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre 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: Pt had similar reaction in 2007 after HPV vaccination
Other Medications: Biktarvy
Current Illness: Vaginal bleeding.
Preexisting Conditions: HIV, Pre-Diabetes
Allergies: none
Diagnostic Lab Data: Penidng.
CDC Split Type:

Write-up: She describes L side numbness on face, arm, leg. some tingling. Can moe the arm and has strength but very numb. Pt coming to urgent care for evaluation. NO fevers. some cold/ chills. + nasal congestion.


VAERS ID: 1778955 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-10-12
Onset:2021-10-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30155BA / 3 LA / 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: SYNTHROID, BONE DENSITY MED, INFLAMATION MED, TYLENOL
Current Illness: SHOULDER ISSUES
Preexisting Conditions: VERTIGO, HYPOTHROID, BONE DENSITY
Allergies: SULFA DRUGS
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: PT STARTED FEELING LIGHTHEADED. AFTER EATING AND HAVING SOME COFFEE SHE STATED SHE STARTED TO FEEL BETTER. PT LEFT THE CLINIC WITH HER SISTER.


VAERS ID: 1779005 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-10-12
Onset:2021-10-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822809 / 1 RA / SYR

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

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

Write-up: Broke out in hives on foot, neck, arm, and back


VAERS ID: 1779042 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-10-04
Onset:2021-10-12
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 049121A / 1 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site erythema, Injection site swelling, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: N/A
Diagnostic Lab Data:
CDC Split Type:

Write-up: PATIENT''S ARM HAS A RED, SWOLLEN, WELT-LIKE CIRCLE AROUND WHERE THE PATIENT RECEIVED THE VACCINE. THIS REACTION APPEARED A WEEK AFTER THE VACCINE WAS GIVEN.


VAERS ID: 1779099 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-10-11
Onset:2021-10-12
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30155BA / 3 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prilosec (40 Mg), Krill Oil (30 MG), Low-dose aspirin.
Current Illness: None
Preexisting Conditions: High Blood pressure, Overweight.
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Low grade headache, Injection site soreness, log grade body aches, moderate fatigue.


VAERS ID: 1779102 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-10-12
Onset:2021-10-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047C21A / 1 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Dysarthria, Fall, Mental disorder, Movement disorder, Tremor, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Dementia (broad), Akathisia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Zanafelx, atenolol, quetiapine, ibuprofen, aspirin, hydrocodone,
Current Illness: Left wrist fracture, High blood pressure, back pain, arthritis,
Preexisting Conditions: High blood pressure, back pain, arthritis,
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: about 5 minutes after having her first COVID vaccine. When she all of the sudden fell back and started shacking. Patient had altered mental status, slurred speech and was unable to move or respond to staff. EMS was called and patient was transported to hospital.


VAERS ID: 1779143 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-10-10
Onset:2021-10-12
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dysmenorrhoea, Heavy menstrual bleeding, Menstruation irregular
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Fertility 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: Duloxetine
Current Illness: N/A
Preexisting Conditions: HPV
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Early period after just having one two weeks prior. Heavy bleeding and cramping with large blood clots.


VAERS ID: 1779227 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-10-12
Onset:2021-10-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 212A21A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dyspnoea, Heart rate increased, Interchange of vaccine products, Sensory disturbance, Swollen tongue
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (narrow), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Medication errors (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: numbness in lips/throat/face with PFIZER #1, reaction with childhood vaccine- unsure what kind of vaccine and type of reaction
Other Medications: Benadryl 50mg PO QHS 1000-1500mg PO QD Sodium 250mg PO QD Magnesium MVI daily
Current Illness: None
Preexisting Conditions: Asthma Smoker Postural orthostatic tachycardia
Allergies: Rabbits- anaphylaxis Probable polyethylene glycol allergy
Diagnostic Lab Data: None
CDC Split Type:

Write-up: 12:30 patient reported difficulty breathing, elevated HR, legs feeling like jello, tongue feeling " bigger in the back" BP: 123/63. HR 106, SPO2 98 Lungs CTA, patient alert, oriented and conversing without difficulty 12:35 HR 97, SPO2 97 12:40 101/66, HR 97, SPO2 97 12:50 113/81, HR 94, SPO2 95, lungs CTA No visible airway swelling or edema Patient feelings better, able to take deep breath, requesting to leave


VAERS ID: 1779244 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-10-12
Onset:2021-10-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / 3 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Hypoaesthesia oral, Paraesthesia oral, Throat irritation
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad)

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

Write-up: Pt. Came to clinic on 10/12 for booster Pfizer vaccine. Pt. Has hx of anaphyalxis to allergy shots and was in 30 minute observation waiting area. About 10 minutes after receiving COVID vaccine, Pt. Approached writer and stated that she had numbness and tingling in her lips and her throat felt scratchy. Denied any SOB/chest pain. Vital Signs assessed @ 1347 w/ a HR of 72bpm, RR of 16bpm, pulse ox 98% on RA, and BP 150/90mmhg. 50mg of benadryl IM in R deltoid @ 1347. W/n 5 minutes of benadryl dose, pt.''s symptoms resolved. Repeat VS assessed at 1410 were HR 67bpm, RR 16bpm, BP 142/78mmHg, Pulse ox 99% RA. Pt. States symptoms are improving and throat is no longer scratchy. Continues to deny SOB. Pt. Monitored for 30 minutes after dose of benadryl. RN recommended pt all call for a ride home, pt declined.


VAERS ID: 1779246 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-10-12
Onset:2021-10-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822809 / 1 LA / IM

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

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

Write-up: After receiving the vaccine patient reported tingling in extremities, light headedness and sweatiness.


VAERS ID: 1779251 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-10-12
Onset:2021-10-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 019F21A / 3 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Dizziness, Feeling hot, Nausea, Throat tightness, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypersensitivity (broad)

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

Write-up: Client c/o n&v, light headed, tightening of her throat and feeling hot. IM Epi administered, paramedics called and client was transported to Hospital.


VAERS ID: 1779254 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-10-12
Onset:2021-10-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2590 / 3 AR / IM

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

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

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


VAERS ID: 1779261 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: California  
Vaccinated:2021-10-12
Onset:2021-10-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048C21A / 3 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Extra dose administered, Eye movement disorder, Posture abnormal, Pulse absent, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Dystonia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Medication errors (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none reported
Current Illness: family reports hx of reoccurring UTI''s and "memory loss"
Preexisting Conditions: cardiac, gerd, htn, dm
Allergies: pcn, codeine
Diagnostic Lab Data: pt had completed fasting lab work prior to having vaccines (moderna and flu)
CDC Split Type:

Write-up: Pt received 3rd dose Moderna and Flu Vaccine today. He waited the 15 min for observation time. Then, our vaccine RN directed pt and family to the bathroom down the hall from the vaccine clinic. Per his family member, she assisted the patient to the toilet for a bowel movement and he "slumped over and his eyes rolled back." The family yelled for help and a Rapid Response code was called overhead. The Rapid Response RN arrived and reported the patient was pulseless and unresponsive. The Rapid Response team assisted to the ground and called a Code Blue Response. The team reports conducting CPR for "8 min." Upon my arrival, the patient was laying supine on the ground, alert with a NRB o2 mask on. The patient was lifted onto a gurney and escorted to the ED with family. The family reports the patient?s memory has changed recently and has declined. He had an appointment with Urology today for reoccurring UTI?s. Upon my return to the vaccine clinic, the LVN that administered the two vaccines reported he came from the Lab and had NPO labs drawn.


VAERS ID: 1779271 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Mississippi  
Vaccinated:2021-10-12
Onset:2021-10-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2584 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: NO ADVERSE EVENTS REPOTED.


VAERS ID: 1779313 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-10-12
Onset:2021-10-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2590 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dysphagia, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad)

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

Write-up: Patient said he was experiencing difficulty swallowing about every 3 swallow and some facial tingling.


VAERS ID: 1779317 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-10-12
Onset:2021-10-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO187 / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: No adverse event, Product preparation 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: No Adverse reaction as of yet. - Dilution was supposed to be 1.8ml instead it was 1.4ml. Patient was called by provider to watch for any side effects.


VAERS ID: 1779334 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-10-12
Onset:2021-10-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO187 / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: No adverse event, Product preparation issue
SMQs:, Medication errors (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: No Adverse Reaction at this time. Vaccine was to be diluted with 1.8 ml and it was only diluted with 1.4ml, patient was made aware if he has any reaction to call the office.


VAERS ID: 1779339 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-10-12
Onset:2021-10-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8735 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dysphonia, Tongue pruritus
SMQs:, Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: unknown
Preexisting Conditions: seizures, low back pain, migraines, adjustment disorder, HTN DM 2
Allergies: Peaches, vicodin, metformin, empagliflozin
Diagnostic Lab Data:
CDC Split Type:

Write-up: 1041: Pt c/o itchy tongue 1042: Pt states that this is how her previous allergic rxn occur and next is that her throat will close. Pt walked to ED with nursing staff x2, with epipen. Pt able to walk, talk, and no issues with breathing at this time. 1046: Pt to ed, checked in and take to a room, pt able to walk and converse with staff. At this time, pt started to become hoarse in speech and state this is when she would administer an epipen if she was at home. Epipen administered. 1047: SBAR to ED staff. Pt now in ED care.


VAERS ID: 1779342 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-24
Onset:2021-10-12
   Days after vaccination:230
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: COVID-19, Headache, Nasal congestion, Pain, 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: fully vaccinated, covid positive with nasal congestion, bodyache, and headache


VAERS ID: 1779345 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-10-04
Onset:2021-10-12
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30155BA / 1 LA / IM

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

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

Write-up: Pt received Pfizer Covid 19, but was only 11YOA. Pt had no adverse event, just not approved for pt age at this time.


VAERS ID: 1779358 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-04-14
Onset:2021-10-12
   Days after vaccination:181
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038B21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? 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: none
CDC Split Type:

Write-up: no adverse events the only issue is vaccine given at a not recommended age, patient age at the time 17 yrs old and vaccine age recommended at 18 yrs old.


VAERS ID: 1779365 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Vermont  
Vaccinated:2021-10-12
Onset:2021-10-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 2 LA / IM

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

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

Write-up: Vision sift then passed out, for a few seconds, water @1212, ambulatory at 1219.


VAERS ID: 1779375 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-10-12
Onset:2021-10-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 2 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Feeling hot, Malaise, Nausea
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

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

Write-up: Pfizer-BioNTech COVID-19 Vaccine: About 10 minutes of sitting post her vaccine, she?not well.? Within 3 minutes of that statement she became nauseous and feeling hot. Code 10 (Employee/Visitor Event) was called. was given ice water and a cool cloth for her neck. is on chemo treatment and took one of her own Zofran pills. had no rash, itching or signs of angioedema. We encouraged to go with the ER personnel to the ER to be observed and treated if needed. She agreed.


VAERS ID: 1779379 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-10-11
Onset:2021-10-12
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30130BA / UNK RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Pain in extremity
SMQs:, Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Omeprazole, Finasteride, Pravastatin
Current Illness: Bladder Cancer
Preexisting Conditions: Hypertension, Hyperlipidemia, BPH
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Soreness in arm, treated with Tylenol. duration of adverse event approx. 36 hours


VAERS ID: 1779385 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-04-12
Onset:2021-10-12
   Days after vaccination:183
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038B21A / 2 LA / IM

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

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

Write-up: no adverse event, vaccine given at a not recommended age. patient 17yrs old when vaccine is recommended at 18yrs old.


VAERS ID: 1779393 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-10-11
Onset:2021-10-12
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / 3 AR / IM

Administered by: Public       Purchased by: ?
Symptoms: Blood glucose normal, Presyncope, Vertigo
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: PATIENT''S HUSBAND CALLED CLINIC TODAY, 10/12/2021 AT 12:50 AND STATED THAT HIS WIFE CAME TO MEDICAL CENTER YESTERDAY FOR HER PFIZER COVID BOOSTER SHOT. HE STATES THAT HE JUST WENT INTO THE KITCHEN WHERE HIS WIFE "ABOUT PASSED OUT". HE STATES HE SAT HER IN A CHAIR. HE REPORTS HER BLOOD PRESSURE IS 140/86, PULSE IS 119, AND HER BLOOD GLUCOSE IS 110. INSTRUCTED PATIENT''S HUSBAND TO EITHER CALL PATIENT''S PCP OR CALL 911 FOR EVALUATION. I CALLED PATIENT TO CHECK ON HER AT 1:40 AND NO ANSER, I LEFT VOICEMAIL THAT I WAS CHECKING ON HER STATUS. AT 2:41 PATIENT''S SPOUSE CALLED BACK AND STATES HE CALLED 911 AND PATIENT WAS TRANSPORTED TO MEDICAL CENTER ER IN IN A NDIFFERENT CITY. HE STATES THE DOCTOR HAS SAID HE THINKS THE PATIENT LIKELY HAS VERTIGO. PATIENT''S HUSBAND STATES HAS HAD VERTIGO IN THE PAST.


VAERS ID: 1779418 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-12
Onset:2021-10-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / 3 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Gait disturbance, Hypoaesthesia, Vision blurred
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Hypoglycaemia (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Benadryl
Current Illness:
Preexisting Conditions: Diabetes, Hypertension, heart disease, lymphedema
Allergies: penicillin, lantus, venofer, HCTZ
Diagnostic Lab Data:
CDC Split Type:

Write-up: NUMBNESS, BLURRY VISION, UNSTEADY GAIT


VAERS ID: 1779425 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-02-18
Onset:2021-10-12
   Days after vaccination:236
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / 2 UN / UN

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: Incruse Ellipta, Aldactone, Celexa, Lovenox, Tylenol, Neurontin, Coumadin, Albuterol, Lipitor, Miralax, Proventil
Current Illness: N/A
Preexisting Conditions: A Fib, CVA, HTN, COPD, Hypertriglyceridemia, Hypercholesteremia, Hypogonadism male, Dyslipidemia, anemia
Allergies: Bee Stings
Diagnostic Lab Data: Positive RT-PCR Test.
CDC Split Type:

Write-up: Tested positive for COVID-19 while fully vaccinated.


VAERS ID: 1779451 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-10-12
Onset:2021-10-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 076C21A / 1 RA / IM

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

Life Threatening? Yes
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: patient receive vaccine and in less than 30 minutes , start having seizure and passed out .
Current Illness: asthma
Preexisting Conditions:
Allergies: shellfish,almonds,straberry ,citrus,tomatoes,latex ,seosnal
Diagnostic Lab Data:
CDC Split Type:

Write-up: None stated.


VAERS ID: 1779454 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-02-25
Onset:2021-10-12
   Days after vaccination:229
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010A21A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003B21A / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Asymptomatic COVID-19, SARS-CoV-2 test negative, 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: Albuterol; Folic acid; Hdyroxychloroquine; Meloxicam; Methotrexate
Current Illness: none
Preexisting Conditions: rheumatoid arthritis; mild asthma; urge incontinence
Allergies: Sulfa'' cats
Diagnostic Lab Data:
CDC Split Type:

Write-up: states she is on traveling tour and was notified of exposure to covid on Friday 10/8. Pt completed at home pharmacy nasal swab/rapid test Sunday with Negative results and this morning Tuesday 10/21 (positive) Pt is not having any symtpoms


VAERS ID: 1779460 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-03-25
Onset:2021-10-12
   Days after vaccination:201
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020B21A / 2 UN / UN

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: Lisinopril, Simvastatin
Current Illness: N/A
Preexisting Conditions: HTN, Hyperlipemia
Allergies: NKA
Diagnostic Lab Data: Positive RT-PCR Test
CDC Split Type:

Write-up: Tested positive for COVID-19 while fully vaccinated.


VAERS ID: 1779463 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Hawaii  
Vaccinated:2021-10-12
Onset:2021-10-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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 developed itchy neck, ears, chest and arms, approx 30 min after vaccine, also received fluvaccine, history of allergies to latex, strawberries, banana morphine and shellfish, went to own office and took benedryl with no relief, patient escorted to ED for further eval


VAERS ID: 1779483 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-11
Onset:2021-10-12
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 3 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Diplopia, Dizziness, Eye pain, Strabismus, Vision blurred
SMQs:, Anticholinergic syndrome (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Ocular motility disorders (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: Levothyroxine 88mcg, aspirin 81mg, chinese medicinal herbs
Current Illness: None
Preexisting Conditions: Hashimoto''s hypothyroidism, heterozygous MTHFR
Allergies: Amoxicillin, gluten
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Sudden onset of double and blurred vision causing dizziness, unable to uncross eyes, lasting about 10 seconds. Mild to moderate right eye pain for about 20 mins following the event.


VAERS ID: 1779486 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-10-12
Onset:2021-10-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dysarthria, Hypoaesthesia, Hypoaesthesia oral, Pruritus
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Flu shot roughly 6 years ago
Other Medications: Ibuprofen 600 mg daily (roughly every other day)
Current Illness: none
Preexisting Conditions: asthma arthritis
Allergies: sulfa peanut intolerance dill - histamine reaction tree nut allergy
Diagnostic Lab Data:
CDC Split Type:

Write-up: Approximately 15 minutes after the injection (noon) my face started to become numb (I ''needed" to physically try to stretch my face by moving it) and itchy, my lips went numb and my speech became slurred. I immediately took 25 mg of Benadryl, at 12:10pm, my husband was with me and monitoring me continuously. By 12:30pm my symptoms started to level off and my speech became more clear. By 1pm I was able to rest and doze on and off for roughly two hours after which time the facial numbness was gone and my speech was clear and recovered. As I of this report my family is still monitoring me.


VAERS ID: 1779488 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-09-22
Onset:2021-10-12
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injected limb mobility decreased, Pain
SMQs:

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

Write-up: patient reports burning pain in armpit and collar bone area of left arm. He also reports limited range of motion due to the pain. It started 2 to 3 days after the vaccination and has stayed the same (neither increase or decreased in severity)


VAERS ID: 1779489 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-01-21
Onset:2021-10-12
   Days after vaccination:264
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9262 / 2 LA / IM

Administered by: Work       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: 10/12/21 SARS/COV-2, NAAT, positive
CDC Split Type:

Write-up: Breakthrough COVID


VAERS ID: 1779522 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-19
Onset:2021-10-12
   Days after vaccination:176
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Admitted to Hospital on Date of Adverse Event [recorded in VAERS] for treatment of Covid-19 Positive following completion of Covid Vaccine Series


VAERS ID: 1779526 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-10-11
Onset:2021-10-12
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Ear pain, Oropharyngeal pain, Pharyngeal swelling, Swollen tongue
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Diltiazem, Zyrtec, Prilosec, Singular
Current Illness: None
Preexisting Conditions: Asthma, Graves, Factor V, GERD
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Swollen, painful throat and swollen tongue. Ear pain.


VAERS ID: 1779529 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-10-12
Onset:2021-10-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050E21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Erythema, Feeling hot, Hypoaesthesia, Paraesthesia
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sexual dysfunction (broad)

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

Write-up: Numbness and tingling in both arms, face turned red (warm sensation to face)


VAERS ID: 1779530 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-15
Onset:2021-10-12
   Days after vaccination:211
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Admitted to Hospital on Date of Adverse Event [recorded in VAERS] for treatment of Covid-19 Positive following completion of Covid Vaccine Series


VAERS ID: 1779531 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-10-12
Onset:2021-10-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 3 LA / SC

Administered by: Public       Purchased by: ?
Symptoms: Abdominal pain upper, Dizziness, Heart rate increased, Nausea
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (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: lightheadedness and nausea age 73 with the second Covid 19 Pfizer vaccine on 2-25-21 about 45 minutes after receiving it (not re
Other Medications: Trazodone 75mg at bedtime, Metamucil fiber supplement 1Tablespoon in AM, Fluticasone nasal spray in the morning.
Current Illness: None
Preexisting Conditions: 3 years post chemotherapy and radiation for lympoma Chronic Insomnia Allergic Rhinitis
Allergies: rash associated with band-aid adhesive
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Within 2 minutes of receiving the shot, I felt lightheaded and had a rapid heart beat and moderate stomach pain. Reported to the doctor monitoring the immunization. Saw a paramedic about 5 minutes later where a blood pressure of 156/92 was obtained and a pulse of 92. Within another 10 minutes the pulse and blood pressure returned to normal and the lightheadedness resolved. The stomach pain resolved and mild nausea remained for another hour. No rash noted. No hives.


VAERS ID: 1779532 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: California  
Vaccinated:2021-10-12
Onset:2021-10-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822809 / 1 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Circumstance or information capable of leading to medication error, Interchange of vaccine products
SMQs:, Medication errors (narrow)

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

Write-up: Patient had received COVID19 vaccine and has today received Janssen vaccine. Patient also had moderna vaccine in immunization registry, but patient claims someone had used his identity to receive moderna.


VAERS ID: 1779556 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-23
Onset:2021-10-12
   Days after vaccination:172
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Admitted to Hospital on Date of Adverse Event [recorded in VAERS] for treatment of Covid-19 Positive following completion of Covid Vaccine Series


VAERS ID: 1779561 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-10-12
Onset:2021-10-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822809 / N/A LA / IM

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

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

Write-up: The patient was sitting on the medical exam chair and couple minutes after receiving the shot he told his mom that he feels light headed and moment after he blacked out and fell from the chair to the floor. He was out for couple seconds then opened his eyes but not responding much. We provided Epipen since we noticed he was kind of shaking. We called 911 and EMT showed up at our lab and took his vitals. His blood sugar was at 90, and blood pressure at 100/80. They recommended taking him to the ER to be evaluated for any possible head or neck injury from the fall. The mother said he had blacked out before at sight of blood.


VAERS ID: 1779579 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-21
Onset:2021-10-12
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 005C21A / 1 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Ear discomfort, Vertigo
SMQs:, Vestibular disorders (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: none
Current Illness: none
Preexisting Conditions: Pmhx of Multiple Sclerosis
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: bilateral ear fullness minutes after receiving the vaccine and associated vertigo. Vertigo resolved on meclizine


VAERS ID: 1779587 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: New York  
Vaccinated:2021-10-12
Onset:2021-10-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 3 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Extra dose administered, No adverse event
SMQs:, Medication errors (narrow)

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

Write-up: provided booster dose 1 day prior to approved 6 month wait period; client last 2nd dose 4/13/2021 and was scheduled for 10/13/2021 but came to clinic 1 day early( today 10/12/2021). waited 15 minutes after dose; left on own accord with no reported side effects.


VAERS ID: 1779588 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: North Dakota  
Vaccinated:2021-10-12
Onset:2021-10-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014F21A / 3 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: anastrozole, asmanex, atenolol, atorvastatin, cetrizine, fluticasone, gabapentin, metamucil, metrondazole, nortriptyline, restasis, topiramate, ventolin
Current Illness:
Preexisting Conditions: HLD, Asthma, Migraine, GERD, Rosacea, Environmental allergies, HTN, Fibromyalgia, DDD of Lubar sacral Spine, Abnormal patellar femoral alignment, Neuropathic pain right foot, osteoarthritis, invasive ductal carcinoma left breast
Allergies: naproxen/ naprosyn
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient is fully vaccinated with Pfizer as of 02/26/2021. Patient received Moderna Vaccine as a third dose in series by error on 10/12/2021 at 1523 in RDeltoid. No signs or symptoms were noted by patient at time of administration. Patient was monitored in office for 30 minutes and sent home with instructions on adverse reactions. VAERS system was shown to patient to submit. Patient will be monitored via telephone by Medical Center Staff for 3 following days. Patient made aware and had no complaints or concerns at the time.


VAERS ID: 1779592 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-12
Onset:2021-10-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthma, Chest discomfort, Condition aggravated, Cough
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Asthma, anemia, prone to blood clots, severe allergies
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Asthma attack. Chest tightening and cough. Using rescue inhaler and breathing treatment


VAERS ID: 1779597 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-10-10
Onset:2021-10-12
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Malaise, 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: atorvastatin hydrochlorothiazide sertraline
Current Illness: none
Preexisting Conditions: high blood pressure
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: second fever and malaise after recovery from side effects


VAERS ID: 1779598 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-10-12
Onset:2021-10-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822811 / 1 LA / IM

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

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

Write-up: After getting the shot patient started getting sweaty, we asked if he is ok he said yea he is fine just feeling little off. After minute or so he got up to grab a drink. We told him to take off the mask to make it easier to breath. After getting water from cooler he just fell down. Got him up he was responding saying he was dizzy. Just got him seated back after 30 minutes he walked out on his own. Offered to call ambulance he declined it. When he left he said he felt fine


VAERS ID: 1779608 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-10-12
Onset:2021-10-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood glucose normal, Dizziness, Dyspnoea, Fear, Hyperhidrosis, Incomplete course of vaccination, Loss of consciousness, Nausea, Speech disorder
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Acute central respiratory depression (broad), Psychosis and psychotic disorders (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Medication errors (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Multi-vitamin Fosteum
Current Illness: None
Preexisting Conditions: Aneurism on heart
Allergies: None known
Diagnostic Lab Data: None have been done yet
CDC Split Type:

Write-up: At first I felt fine, I was very hydrated and ready to get the shot. I sat down in a waiting area for about 2 minutes and still felt good-then within seconds I started having trouble breathing an felt nauseous. I couldn?t speak to well and then I started sweating and started to feel like I was going to loose consciousness. The pharmacy staff was with me by this time and they layed me on the floor. At this point passed out for a minute and don?t remember much but when I opened my eyes the paramedic team was with me. They sat me up and took my vitals. I started to feel better and was able to explain what happened. My blood pressure and sugar were good so I asked if I could just go home, monitor symptoms and follow up with my doctor. This is what I ended up doing . I have an appointment with my doctor but and I have have also called my cardiologist to understand what happened better. I do not intend to get a second dose as this was a very scary event for me.


VAERS ID: 1779609 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-11
Onset:2021-10-12
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011F21A / 7+ LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Diarrhoea, Dizziness, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Noninfectious diarrhoea (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: Excedrin Extra Strength [2 tablets by mouth daily] Reclast 5 mg/100 mL Intravenous Piggyback Requip 3 mg oral tablet [Take 1 tablet by mouth at bedtime] Ventolin HFA 90 mcg/actuation Inhalation HFA Aerosol Inhaler [2 PUFFS Q 4 HRS PRN F
Current Illness:
Preexisting Conditions: She has a history of hypertension, RLE, left knee pain, depression, and osteoporosis. Patient reported COVID-19 positive in January
Allergies: PCN
Diagnostic Lab Data:
CDC Split Type:

Write-up: Body-aches, dizziness, diarrhea, fever (no temp was relayed to front office staff or to triage nurse. patient was advised to use tylenol as needed for body aches and fever, patient advised to hydrate and to report to the ER if symptoms worsen.


VAERS ID: 1779618 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-10-12
Onset:2021-10-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30125BA / 1 RA / IM

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

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

Write-up: Patient was supposed to get a Flu shot but was confused and received the Pfizer COVID shot instead. She had received both of the Moderna Covid shots in Feb/March of 2021. No adverse events happened the patient just received an Pfizer shot.


VAERS ID: 1779622 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-10-12
Onset:2021-10-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 1 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Blood glucose normal, Chest discomfort, Dizziness, Dyspnoea, Electrocardiogram normal, Feeling hot, Flushing, Hypoaesthesia, Hypoaesthesia oral, Injection site hypoaesthesia, Injection site paraesthesia, Muscular weakness, Nausea, Paraesthesia, Paraesthesia oral, Presyncope, Productive cough, Throat irritation
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Hypoglycaemia (broad), Infective pneumonia (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: Patient did not disclose
Current Illness: Patient did not disclose, but reports history of COVID-19 Illness x 2, pleurisy, gastroparesis, anxiety, syncopal episodes, and hypoglycemia
Preexisting Conditions: Anxiety
Allergies: Flagyl, Codeine, NSAID''s
Diagnostic Lab Data: EMS reported BG = 78; BP = 140/90; P = 71; and O2 sats = 99%. EMT also reported normal EKG results.
CDC Split Type:

Write-up: Vaccination administered to L deltoid at 1250pm with no issues or complaints until 10 minutes later. Patient reported numbness and tingling to L arm, where injection was given, at 1255pm and then reported feeling slight SOB and mild chest tightness around 1305 pm. Requested assistance by LVN,, to monitor patient while NP was being retrieved for medical evaluation. NP presented where a presyncopal episode occurred with patient already reclined in chair; vitals were taken with O2 Sats ranging from 97% to 100% with pulse rate ranging between 67 to 71, RR at 14 - 18 breaths per minute. Breathing was noted to be non-labored. BP was attempted multiple times on LA by RN and LVN before obtaining 139/88 with larger cuff. NP offered to give patient epinephrine, but patient declined as she did not want to go to the hospital. Patient then ? lightheadedness, nausea and scratchy throat as well as facial flushing and feeling hot. Noted productive cough with clear and foamy sputum. Provided water; tolerated well with no emesis. OHN recommended that she contact her closest relative for pick up from TAO to rest. LVN remained with patient for direct observation while patient was allowed time to recover from her reported symptoms. LVN reported to OHN patient ? numbness and tingling around her lips and cheeks as well as weakness in her arms and legs when NP and OHN returned to check in on patient. Noted that patient was on phone with relative discussing pick up from work. Patient was offered epinephrine again by NP, but again declined. Provided stand-by assistance while patient stood up and ambulated slowly to the restroom and was allowed to proceed without direct observation. Patient was noted to be already standing upright when restroom door was opened for escort to sink. Patient reported feeling faint again and was then placed into a chair while EMS was contacted. Patient remained awake and responsive following commands appropriately during entire monitoring period.


VAERS ID: 1779626 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Montana  
Vaccinated:2021-10-12
Onset:2021-10-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 4 LA / IM

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

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

Write-up: Pt given a Pfizer booster 2 times within 5 days, in error. #3 Pfizer vaccine given 10/7/21, and 4th given 1012/21


VAERS ID: 1779633 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-10-12
Onset:2021-10-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Hypotension, Presyncope
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular disorders (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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: it was my first MMR when I was a small child, I had major swelling in the leg
Other Medications: Levothyroxine 50mcg each morning at 8AM, generic multivitamin, B-Complex, 25 mcg Vitamin D3
Current Illness:
Preexisting Conditions: Hypothyroidism, Severe food allergies (listed above)
Allergies: Food allergies: Peanuts, tree nuts, eggs, soy protein, soy flour, kiwi, nectarines, tuna fish
Diagnostic Lab Data: I was taken to a room with medical equipment (instead of the waiting room) and a nurse checked my blood pressure, heart rate and oxygen. heart rate and oxygen were normal, but my blood pressure was low at about 95/54. I suppose this would qualify as "Doctor or other healthcare profession office/clinic visit" below.
CDC Split Type:

Write-up: About 5 minutes after injection, I became lightheaded and nearly fainted. The lightheadedness cleared up about 30 minutes after injection.


VAERS ID: 1779657 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-10-12
Onset:2021-10-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 042B21A / 1 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Incorrect route of product administration, Injection site nerve damage, Injection site pain, Joint range of motion decreased
SMQs:, Drug abuse and dependence (broad), Extravasation events (injections, infusions and implants) (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Medication errors (narrow)

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

Write-up: The injection was VERY painful and (according to the nurse at the second injection) was given in the wrong part of the arm - the front-facing part of the arm rather than the side. It was also suggested that she hit a nerve because later that day and for several weeks after I would have pain in the upper muscle, moving horizontally around the muscle, not vertically up and down the arm. I''ve continued to have pain and movement of the arm has been impaired.


VAERS ID: 1779665 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-06-17
Onset:2021-10-12
   Days after vaccination:117
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Foetal disorder, Pregnancy
SMQs:, Foetal disorders (narrow), Normal pregnancy conditions and outcomes (narrow)

Life Threatening? No
Birth Defect? Yes
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: Nine
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Became pregnant July 15, 2021 and was diagnosed with fetal acrania on October 12, 2021. No previous history of fetal abnormalities.


VAERS ID: 1779672 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-10-10
Onset:2021-10-12
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Diplopia
SMQs:, Ocular motility disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Azithromycin
Diagnostic Lab Data: Requested MRI of the brain with and without constast and LP
CDC Split Type:

Write-up: At noon on 10/12/2021 patient developed double vision


VAERS ID: 1779674 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-10-12
Onset:2021-10-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 2 RA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Angina pectoris
SMQs:, Other ischaemic heart disease (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: Heart palpitations
Allergies: Ranitidine, protonix, amoxicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pain in my heart that keeps coming and going. Possibly Myocarditis.


VAERS ID: 1779675 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-10-11
Onset:2021-10-12
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Fatigue, Headache, Injection site pain, Pain, Paraesthesia, Pyrexia, Vision blurred
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Flu
Other Medications: Vitamin c,d,b,a Aspirin
Current Illness: None
Preexisting Conditions: Asthma Hypothyroidism
Allergies: Shellfish Flu shot
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever over 103, chills, bodyaches, crippling headache, extreme exhaustion , pain at injection site, tingling skin, blurred vision


VAERS ID: 1779683 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-10-12
Onset:2021-10-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204B21A / N/A LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypoaesthesia, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Sexual dysfunction (broad)

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

Write-up: Patient describes sporadic tingling in left arm and numbness in left hand since time of injection at around 12:00pm today.


VAERS ID: 1779684 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-10-12
Onset:2021-10-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: amlodipine 5 mg once daily,coreg 3.125 mg once daily,pepcid 40 mg once daily,protonix 40 mg once daily, valsartan 160 mg once daily
Current Illness: None.
Preexisting Conditions: HTN and hyperlipedemia
Allergies: Sulfa (rash), statins (muscle cramps)
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient given 0.3mL injection of Pfizer COVID-19 booster diluted with 0.8mL sodium chloride instead of the correct amount of 1.8mL diluent.


VAERS ID: 1779691 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-10-12
Onset:2021-10-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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 Effect, but given 2nd dose at 13 days as opposed to 21 days.


VAERS ID: 1779693 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-10-11
Onset:2021-10-12
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vit B; Vit D.
Current Illness: Hyperlipemia (controlled), HTN (Controlled), Hypothyroid (Controlled).
Preexisting Conditions: Previous MI, Previous Male Breast CA.
Allergies: NKA.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Chills, HA, Pain @ injection site, fatigue, runny nose.


VAERS ID: 1779696 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-04-15
Onset:2021-10-12
   Days after vaccination:180
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7534 / UNK LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6203 / UNK LA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Cough, Ear pain, Headache, Nasal congestion, Otitis media, Paranasal sinus discomfort, Respiratory tract congestion, Rhinorrhoea, SARS-CoV-2 test positive, Sinus pain, Tympanic membrane hyperaemia, X-ray abnormal
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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ? albuterol HFA (PROAIR HFA) 108 (90 Base) MCG/ACT inhaler Inhale 2 puffs into the lungs every 6 (six) hours as needed for Wheezing. 1 Inhaler 3 ? Biotin 300 MCG TABS Take by mouth. ? Calcium-Magnesium-Vitamin D 300-150-400 MG-MG-UNIT T
Current Illness:
Preexisting Conditions: Diabetes mellitus (CMS/HCC) ? Hypertension
Allergies: Bactrim, levaquin
Diagnostic Lab Data: 1. COVID-19 virus infection XR Chest 2Vw azithromycin (ZITHROMAX) 250 MG tablet methylPREDNISolone (MEDROL DOSPACK) 4 MG tablet 2. Cough IPOC SARS-CoV-2 Antigen IPOC SARS-CoV-2 Antigen XR Chest 2Vw albuterol HFA inhaler 2 puff benzonatate (TESSALON) 200 MG capsule 3. Right otitis media, unspecified otitis media type azithromycin (ZITHROMAX) 250 MG tablet 4. COVID-19 COVID+ Referral for EUA Covid Antibody Treatment
CDC Split Type:

Write-up: complaining of a mild headache, cough, nasal congestion and sinus pressure since Sunday morning. Also states that her ears hurt. She did watch her grandchild who is 13 years old and had the same signs and symptoms that she has and her grandchild''s Covid test was negative. Patient''s Covid test today is positive. Review of Symptoms: Review of Systems Constitutional: Negative for chills and fever. HENT: Positive for congestion, ear pain and sinus pressure. Negative for ear discharge, hearing loss and sore throat. Respiratory: Positive for cough. Negative for shortness of breath and wheezing. Cardiovascular: Negative for chest pain and palpitations. Gastrointestinal: Negative for abdominal pain, blood in stool, diarrhea, nausea and vomiting. Genitourinary: Negative for dysuria and urgency. Skin: Negative for rash. Neurological: Positive for headaches. Head: Normocephalic. Right Ear: Hearing normal. Tympanic membrane is injected. Left Ear: Hearing and tympanic membrane normal. Nose: Congestion and rhinorrhea present. No mucosal edema. Right Sinus: Maxillary sinus tenderness and frontal sinus tenderness present. Left Sinus: Maxillary sinus tenderness and frontal sinus tenderness present. Lungs clear and equal bilaterally, no respiratory distress, does have a cough


VAERS ID: 1779699 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-10-12
Onset:2021-10-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 2 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Hypoaesthesia, Hypoaesthesia oral, Paraesthesia, Paraesthesia oral, Swelling face, Swollen tongue
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Peripheral neuropathy (broad), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None reported
Current Illness: sinus infection the week prior. Tested negative for weekly covid tests.
Preexisting Conditions: Hypertension
Allergies: No known Food or drug allergies noted
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: 1725-began complaint of swelling, tingling and numbness in Left cheek, 1730- Bendryl administered, 1730 Vital Signs- Blood Pressure 205/105, Pulse 105, Pulse Ox 95%, Respirations 22/min, Auscultated lungs, no audible wheezing, lung sounds clear. 1741-began complaining of tongue tingling, numb and swelling. 1743- Epinephrine 0.3 mg IM Right quadricep administered. Refused further vital signs and didn''t want to take ambulance to hospital. 1802- Stat-EMS, ambulance arrived and offered treatment , patient refused. Stated she was going to get a ride from family and spending the night with family. Instructed patient that going to seek treatment in Emergency facility was best option, continued to refuse and ultimately stated she was staying with her mother.


VAERS ID: 1779701 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-10-12
Onset:2021-10-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 3 RA / IM

Administered by: Private       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: albuterol,calcium carbonate with vit D3,flonase,claritin
Current Illness: none
Preexisting Conditions: none
Allergies: NKDA
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Patient given 0.3 ml of vaccine diluted with 0.8 ml sodium chloride instead of correct amount of 1.8 ml sodium chloride.


VAERS ID: 1779703 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-12
Onset:2021-10-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301258A / 4 LA / IM

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

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

Write-up: None reported


VAERS ID: 1779880 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-10-12
Onset:2021-10-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 3 RA / IM

Administered by: Private       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: coreg 12.5 mg,lisinopril 20 mg,prilosec 20 mg,flomax 0.4 mg
Current Illness: none
Preexisting Conditions: HTN,hyperlipidemia
Allergies: statins-swelling
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Vaccine was incorrectly diluted with 0.8 ml of sodium chloride instead of the correct 1.8 ml amount.


VAERS ID: 1779882 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-12
Onset:2021-10-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30155B1 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Pharyngeal hypoaesthesia, Pharyngeal paraesthesia, Throat clearing
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad)

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

Write-up: Patient received 1st dose of Pfizer vaccine at about 15:15 and after about 15 minutes, she started complaining of tingling and numbness in her throat. Patient denied shortness of breath or trouble breathing. No rash, hives, dizziness or other symptoms. After 30 minutes patient continued to have symptoms and was clearing her throat. Patient brought to ED for evaluation.


VAERS ID: 1779906 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-10-08
Onset:2021-10-12
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039D21A / 2 LA / IM

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

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

Write-up: REDNESS AND ITCHING AT INJECTION SITE. NASAL CONGESTION


VAERS ID: 1779915 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-10-12
Onset:2021-10-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 18228110 / UNK RA / IM

Administered by: Work       Purchased by: ?
Symptoms: Hypoaesthesia, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Sexual dysfunction (broad)

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

Write-up: Complained of tinkling an numbness of the fingers and arm.


VAERS ID: 1779921 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Montana  
Vaccinated:2021-10-11
Onset:2021-10-12
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Feeling abnormal, Headache, Pain, Pain in extremity
SMQs:, Dementia (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: Emergency c, natural calm magnesium
Current Illness: None- on monthly period during vaccination
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Very sore arm. Extreme chills , body aches, headache, foggy brain.


VAERS ID: 1779925 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-10-12
Onset:2021-10-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Mother indicates patient not having any.
Preexisting Conditions: None
Allergies: Fish oil; Aspirin
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patients mother indicates redness on area of injection.


VAERS ID: 1779928 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-10-12
Onset:2021-10-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / SYR

Administered by: Military       Purchased by: ?
Symptoms: Anxiety, Autoscopy, Chest discomfort, Chest pain, Chills, Dizziness, Dyspnoea, Electrocardiogram normal, Fatigue, Feeling abnormal, Feeling hot, Head discomfort, Heart rate increased, Hypoaesthesia, Palpitations, Taste disorder, Throat irritation, Vision blurred
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Glaucoma (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypoglycaemia (broad), Dehydration (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lexapro
Current Illness: Diagnosed with panic disorder after being COVID positive in may of 2021
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: EKG
CDC Split Type:

Write-up: Body went numb 5min after. Heart rate jumped to 165, had a weird taste, transported to ER, burning chest, chest pressure, stabbing chest pain. Head had pressure, head went numb, felt like I was dying. No history of reaction to vaccines or injections. Heart palpitations. Feet would go numb, very fatigued, extremely dizzy, blurred vision. Only a EKG was done which returned normal. Chills/ very hot as if I have a heating blanket on. Feeing as if I had fiberglass in my throat. Some difficulty breathing. Feeling if an out of body experience as if everything was moving fast but slow at the same time. Pounding heart beat, numbness in stomach. Was discharged after EKG and told it was a anxiety attack.


VAERS ID: 1779933 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-10-12
Onset:2021-10-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8027 / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Immediate post-injection reaction, Injection site induration, Injection site swelling, Skin discolouration
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow)

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

Write-up: Patient''s arm immediately began to swell at the injection site. No bleeding but area became hard and puffed straight out. Slight discoloration developed. An ice pack was given and patient monitored for any other signs or symptoms for 30 minutes.


VAERS ID: 1779938 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-10-12
Onset:2021-10-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 1 LA / IM

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

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

Write-up: Patient given Pfizer vaccine around 6:28 pm , within one minute of vaccination patient fainted and lost consciousness while sitting in vaccination chair. Pharmacist arrived back to patient''s side within one minute and patient regained consciousness almost immediately. 911 was called and EMS arrived, BP assessed, taken to ambulance for assessment where BP recorded 80/33 and HR 40 bpm. Patient taken to Hospital


VAERS ID: 1780104 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-10-12
Onset:2021-10-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185-H / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Anxiety, Dissociation, Dizziness, Dysacusis, Dyspnoea, Fall, Feeling cold, Feeling hot, Hyperhidrosis, Loss of consciousness, Pallor
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), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Hearing impairment (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

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

Write-up: PT here for 1st dose of Pfizer, received at 1324. At 1328, PT stood from chair in observation area and then collapsed. PT presented with pallor, diaphoresis. VS at 1331 were: BP laying 98/62, HR 56, SPO2 95% RA. It is unclear whether PT lost consciousness completely; PT reports that he had felt anxious, SOB, and over-heated and that he had stood up to get the attention of nurses. He said that he knew he was going to pass out and tried to grab a chair, but missed it and fell to ground. PT reported that he doesn?t believe he hit his head or injured himself. PT was assisted to elevate legs, remained laying. At 1333, PT?s color had already begun to improve. PT accepted and consumed offered juice and water, ate a small snack. VS at this time: BP 116/68 laying, HR 58, SPO2 97%. Pulse at 1336 was 70. PT reported that he was anxious about the vaccination and had not had anything to eat all day aside from some nuts. At 1340, PT reported that he felt ?okay?. At 1341, PT was able to sit up on floor without assistance, reported that he was a little dizzy but ?not like before.? VS at this time: BP sitting 112/70, HR 69, SPO2 97% RA. PT?s head was assessed for any signs of injury, none noted. PT educated on vasovagal responses, safety, what to expect throughout day, and to report this incident when he presents for 2nd dose. PT continued with slight s/s, reporting at 1343 that he felt okay, but things were a ?little echo-y?. PT was sitting while drinking water and declined to lie back down. At 1346, PT reported that s/s and improved and was able to stand up from the floor without assistance in order to sit on chair. PT?s pallor and diaphoresis were resolved; although PT reports that he was feeling cold. PT put coats back on and reported that feeling was better. By 1349, PT stated ?I feel okay, maybe a little bit distant.? At 1403, PT was able to stand without difficulty, reported that he felt no changes from sitting position, denied dizziness, vision changes, hearing changes. VS at 1403: BP 116/70 standing, HR 78, SPO2 97%. PT reports that this is in line with his normal BP. PT walked short distance in facility, moved without difficulty or pain, full ROM and steady gait noted. PT reported that he felt ready to leave facility, that he will be monitored by family at home. PT exited facility at 1410.


VAERS ID: 1780107 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-04-12
Onset:2021-10-12
   Days after vaccination:183
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0150 / UNK LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6208 / UNK LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Aortic arteriosclerosis, Arteriosclerosis coronary artery, Atelectasis, Breath sounds abnormal, COVID-19 pneumonia, Cardiomegaly, Cerebral atrophy, Chest X-ray abnormal, Computerised tomogram head normal, Computerised tomogram thorax, Computerised tomogram thorax abnormal, Dysphagia, Dyspnoea, Facial paralysis, Feeding disorder, Feeling abnormal, General physical condition abnormal, Goitre, Infarction, Lung opacity, Mass
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Interstitial lung disease (narrow), Myocardial infarction (broad), Anticholinergic syndrome (broad), Dementia (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypothyroidism (broad), Hyperthyroidism (broad), Other ischaemic heart disease (narrow), Hearing impairment (broad), Respiratory failure (narrow), 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: ? aspirin EC EC tablet 81 mg, 81 mg, Oral, Daily, ? citalopram (CeleXA) tablet 20 mg, 20 mg, Oral, Daily, ? famotidine (PEPCID) tablet 20 mg, 20 mg, Oral, BID, ? fluconazole (DIFLUCAN) tablet 200 mg, 200 mg, Oral, Q24H,
Current Illness: None
Preexisting Conditions: Type 2 diabetes, GERD
Allergies: No known allergies
Diagnostic Lab Data: CT Head wo contrast: Brain Parenchyma: No acute intracranial hemorrhage, CT evidence of acute territorial infarct, mass, mass effect or midline shift. Patchy areas of white matter hypoattenuation are nonspecific but are most typical of chronic microvascular change. Ventricles/Extra-axial Spaces:No hydrocephalus or extra-axial fluid collection. There is generalized cerebral volume loss. Extracranial Structures:Visualized orbits are unremarkable. Paranasal sinuses and mastoids are clear. Calvarium is unremarkable. IMPRESSION: No acute CT abnormality. XR Chest: IMPRESSION: Mild infrahilar opacities bilaterally likely represent atelectasis. CT Angiogram Chest For PE IMPRESSION: 1. No pulmonary embolism or aortic dissection. 2. Bilateral groundglass infiltrates in a pattern most suggestive of Covid 19 pneumonitis though other forms of pneumonia are also in the differential diagnosis. 3. Cardiomegaly with coronary artery and aortic atherosclerotic calcification. 4. Multinodular enlargement of the thyroid consistent with goiter. Right lobe involved more than left
CDC Split Type:

Write-up: He has been feeling bad for about one week. States his shortness of breath has progressively gotten worse. He also complains of difficulty swallowing. He has been unable to eat for about two weeks. He says that water just runs out of his mouth when he takes a sip. General Appearance: Appears thin. Head: Normocephalic, atraumatic Eyes: PERRL, conjunctiva/corneas clear, EOM''s intact, sclera anicteric Ears: TMs not observed Nose: Patent without discharge Throat: No erythema or exudate Neck: Supple, without thyromegaly or masses. Trachea is midline. Back: Straight, no CVA tenderness Lungs: Decreased breath sounds Chest wall: No tenderness Heart: Regular rate and rhythm, S1 and S2 normal, no murmur, rub or gallop Abdomen: Soft, non-tender, non-distended, bowel sounds active all four quadrants, no masses, no organomegaly Extremities: Extremities normal, atraumatic, no cyanosis or edema Pulses: 2+ and symmetric all extremities Skin: Warm, dry, no rashes or lesions Lymph nodes: No adenopathy in the neck, axilla, or groin Neurologic: No focal deficits. CNII-XII intact. Speech is fluent. Conversation is coherent. Admitted to hospital, started on nasal O2 at 4lpm. MEDICATIONS GIVEN IN THE ER Medications Ampicillin/Sulbactam 3 gm/100 mL in NS (has no administration in time range) Azithromycin 500 mg/250 mL in D5W (has no administration in time range) fluconazole (DIFLUCAN) tablet 200 mg (has no administration in time range) iohexol (OMNIPAQUE) 300 MG/ML injection 60 mL (60 mLs Intravenous Given 10/12/21 1414)


VAERS ID: 1780115 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: California  
Vaccinated:2021-10-12
Onset:2021-10-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822809 / 2 LA / IM
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: No Allergies on File
Diagnostic Lab Data: None
CDC Split Type:

Write-up: LVN staff administered covid-19 vaccine on 10/12/21 at 1445 not knowing that pt already had J&J covid-19 vaccine on 3/12/21. Pt reported to the staff that he had received his first J&J covid-19 vaccine after the vaccine was administered by the staff. Pt was monitored by the staff and left the covid-19 vaccine clinic in a stable condition.


VAERS ID: 1780124 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-10-12
Onset:2021-10-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185-H / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Immunisation, No adverse event, Syringe issue
SMQs:, Medication errors (broad)

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

Write-up: administering vaccine punctured skin of left upper arm with needle, noted syringe did not contain any of the required dose of Pfizer vaccine and withdrew needle without engaging plunger. then administered confirmed dose of Pfizer vaccine in left deltoid. No adverse effects noted following dose administration.


VAERS ID: 1780129 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-10-12
Onset:2021-10-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Feeling hot, Hyperhidrosis, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Within 5 minutes after receiving 2nd Pfizer vaccine, patient started to become sweaty and light headed. Patient did not faint, but became unresponsive and mother had to help him sit in a chair. Gave patient water and took his temperature, since he was feeling warm/sweaty. Temperature was normal at 97.6. Inspected injection site and didn''t notice anything abnormal. After about 30 seconds to 1 minute, patient became responsive again, was speaking like normal, and drinking water. Patient has cerebral palsy and mother states he has seizure-like activity where he becomes unresponsive due to his condition. Used to have physical seizures and was on medication previously, but hasn''t had one in a long time so no longer taking seizure medication. Mom said these seizure-like episodes cannot be treated with medication, so they just help him through when they happen periodically. Patient did not have a reaction to first Pfizer vaccine, so mother and I think being nervous/excited triggered this episode and that it was unrelated to the actual vaccine. Patient and mother sat in pharmacy area for about 30 minutes before leaving.


VAERS ID: 1780136 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-10-12
Onset:2021-10-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017F21A / 1 LA / IM

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

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

Write-up: NO SYMPTOMS


VAERS ID: 1780138 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-04
Onset:2021-10-12
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Cough
SMQs:, Anaphylactic reaction (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: Cough


VAERS ID: 1780141 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-10-12
Onset:2021-10-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Head injury, 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), Accidents and injuries (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

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

Write-up: PATIENT RECEIVED PFIZER VACCINE DOSE 1. A FEW MINUTES AFTER RECEIVING HIS VACCINE, PATIENT PASSED OUT AND HIT HIS HEAD, HE THEN BEGAN TO HAVE WHAT LOOKED LIKE A MINOR SEIZURE FOR 5 TO 10 SECONDS. PATIENT REGAINED CONSCIOUSNESS AND PARAMEDICS ARRIVED TO TAKE HIM TO THE HOSPITAL.


VAERS ID: 1780146 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-10-12
Onset:2021-10-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 3 RA / IM

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

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

Write-up: PT CAME IN WITH NO VACCINE CARD AND ASKED TO GET PFIZER BOOSTER DOSE AND TECH TOOK A WARD FROM PT AND WE ADMINISTERED PFIZER SINCE PT WAS UNDER IMPRESSION THAT SHE HAD RECEIVED PFIZER IN THE PAST FROM DIFFERENT PLACE. IN FACT, WE DISCOVERED LATER ON THAT PT HAD RECEIVED MODERNA IN THE PAST FROM THE local HEALTH DEPARTMENT. SO SHE HAD 2 DOSES OF MODERNA BACK IN MARCH AND APRIL AND TODAY SHE GOT PFIZER FROM THE PHARMACY SO WE ARE REPORTING THIS AS AN ERROR TO VAERS.


VAERS ID: 1780154 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-10-10
Onset:2021-10-12
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2590 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Nodule, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

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

Write-up: Lump, swelling and redness in injection site.


VAERS ID: 1780312 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-10-10
Onset:2021-10-12
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2590 / 3 LA / IM

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

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

Write-up: swelling and redness


VAERS ID: 1780319 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-10-10
Onset:2021-10-12
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / UNK RA / IM

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

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

Write-up: Patient was given the Pfizer/Biotech Covid-19 Vaccine on 10/11/2021. It was discovered that the product was dispensed and administered on the 33rd day of being in the fridge. VAERS will be updated and filled with all pertinent information.


VAERS ID: 1780326 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: California  
Vaccinated:2021-10-11
Onset:2021-10-12
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0169 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Bell's palsy
SMQs:, Hearing impairment (broad)

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

Write-up: Bell''s palsy


VAERS ID: 1780331 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-10-12
Onset:2021-10-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Loss of consciousness, Pallor, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), 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: n/a
CDC Split Type:

Write-up: Patient experience vasovagal syncope. Patient briefly lost conscious for a few seconds and face was pale. EMT was requested and came. Patient was assessed by EMT; measured BP and HR. Patient was laid down on the floor and feet up on a stool. Patient recovered and stayed longer in the pharmacy until felt better. Patient left afterward without hospitalization.


VAERS ID: 1780337 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-10-12
Onset:2021-10-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / 3 LA / IM

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

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

Write-up: PATIENT RECEIVED PFIZER BOOSTER INSTEAD OF MODERNA


VAERS ID: 1780447 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-10-12
Onset:2021-10-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Dyspnoea, Fall, Head injury, Headache, Heart rate increased, Hypoaesthesia, Loss of consciousness, Paraesthesia, Throat tightness, Vision blurred
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Angioedema (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Glaucoma (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (broad), Hypoglycaemia (broad), Dehydration (broad), Sexual dysfunction (broad)

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

Write-up: almost immediately after the shot was given, my arm started to get tingly. i felt my arm gradually go numb, starting at my shoulder and going all the way down to my fingers. then my throat started getting tight and it became hard to breathe. i got light headed, my heart started beating really fast, and the next thing I am aware of I am laying on the floor. I passed out and fell out of the chair and hit my head on the way down so I woke back up with a headache. I have no idea how long I was out. They just gave me orange juice and had someone drive me home. two hours later my vision was still blurry and I am dizzy.


VAERS ID: 1780458 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-10-02
Onset:2021-10-12
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA UNKNOWN / 1 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Injection site erythema, Injection site nodule, Injection site pruritus, Injection site rash, Injection site urticaria
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: CITALOPRAM HBR 10 MG TABLET
Current Illness: None
Preexisting Conditions: None
Allergies: Amoxicillin, Bactrim
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Extreme itchy on and around the sight, hives, large red rash, large knot like bump beneath skin.


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