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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 190 out of 8,753

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VAERS ID: 1780784 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: D.C.  
Vaccinated:2021-10-12
Onset:2021-10-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / UNK LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Dizziness, Fall, Pyrexia, Vertigo
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Accidents and injuries (narrow), Vestibular disorders (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Fever, chills, dizziness started about 6 hours after injection and still existing now 21 hrs later. I just fell down a few minutes ago due to vertigo.


VAERS ID: 1780785 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-10-12
Onset:2021-10-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 1 RA / IM

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

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

Write-up: Systemic: Fainting / Unresponsive-Mild, Additional Details: About 10 minutes after patient received shot he was sitting in a recovery chair and passed out. He was given a bottle of water and crackers as well as the NP from the Minute Clinic came over to check on him and he was okay by this time. At 30 minutes after the shot patient has been checked on and is doing well and will have a ride home with person he came with and will be followed up on tomorrow.


VAERS ID: 1780791 (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: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2590 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Confusional state, Dizziness, Injection site erythema, Injection site pain, Injection site swelling, Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Site: Pain at Injection Site-Mild, Site: Redness at Injection Site-Mild, Site: Swelling at Injection Site-Mild, Systemic: Confusion-Mild, Systemic: Dizziness / Lightheadness-Severe, Systemic: nausea-Severe, Systemic: Nausea-Severe, Systemic: Vomiting-Medium, Additional Details: ems was called upon patient''s request, ems has arrived and was able to help patient out and give ease and comfort to patient; patient declined to go to the hospital. pt was feeling a lot better and walked out of the pharmacy after 30 more minutes of observations after ems left


VAERS ID: 1780792 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: New York  
Vaccinated:2021-10-12
Onset:2021-10-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 061E21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Product storage error
SMQs:, Medication errors (narrow)

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

Write-up: Error: Improper Storage (temperature)-


VAERS ID: 1780793 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-10-11
Onset:2021-10-12
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 - / -

Administered by: Private       Purchased by: ?
Symptoms: Malaise, Nausea, Pain, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Malaise, achy, low grade fever, nausea


VAERS ID: 1780794 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-12
Onset:2021-10-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2590 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Fatigue, Lethargy
SMQs:, Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Dizziness / Lightheadness-Mild, Systemic: Exhaustion / Lethargy-Mild


VAERS ID: 1780798 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: New York  
Vaccinated:2021-10-10
Onset:2021-10-12
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Lymph node pain, Neck mass
SMQs:, Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Joint pain R wrist, soreness at injection site
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Two small seed size lumps in what appears to be my L posterior external juggular vein and soreness in my L lymph node near the superior armpit.


VAERS ID: 1780805 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-10-12
Onset:2021-10-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / 2 UN / IM

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

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

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


VAERS ID: 1780806 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-10-12
Onset:2021-10-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / 2 UN / IM

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

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

Write-up: Error: Wrong Dose of Vaccine - Too High.


VAERS ID: 1780809 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: California  
Vaccinated:2021-10-12
Onset:2021-10-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30130BA / 2 LA / IM

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

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

Write-up: Systemic: Dizziness / Lightheadness-Mild, Systemic: Fainting / Unresponsive-Mild, Systemic: Flushed / Sweating-Mild, Additional Details: PT WAS WAITING AFTER GIVEN THE PFIZER VACCINE AROUND 1750. HE WAS SNORING WHEN HE SUDDENLY FELL FORWARD AND WAS UNCONSCIOUS AND UNRESPONSIVE FOR ABOUT 30 SECONDS TO 1 MINUTE. WE FLIPPED HIM TO HIS BACK AND HE WOKE UP. 911 WAS CALLED. PT REPORTED OF HX OF FAINTING WHEN DEHYRATED AND DOES NOT EAT FOR A WHILE. LAST MEAL WAS AROUND NOON PER PT.


VAERS ID: 1780810 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-10-12
Onset:2021-10-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Product preparation error
SMQs:, Medication errors (narrow)

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

Write-up: Error: Diluent administered instead of vaccine.


VAERS ID: 1780811 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-10-12
Onset:2021-10-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301358A / 2 LA / IM

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

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

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


VAERS ID: 1780815 (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: 2021-10-13
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: 1780816 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Vermont  
Vaccinated:2021-10-12
Onset:2021-10-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 3 LA / IM

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

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

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


VAERS ID: 1780819 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-01-28
Onset:2021-10-12
   Days after vaccination:257
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL8982 / 2 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Dyspnoea, Fatigue, Feeling abnormal, Mobility decreased, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Dementia (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Tendinopathies and ligament disorders (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: Patient presents to the ER with 10 days with a fatigue and difficulty breathing. She has been vaccinated against Covid. She started to feel bad and she tells me she quarantine herself however her symptoms have gotten much worse over the last couple days. She tells me typically she can walk without any assistance however currently she is needing a wheelchair and was unable to get off the toilet herself here in the emergency department. SARS-CoV-2 positive on 10/12/21. Now with oxygen requirements.


VAERS ID: 1780822 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-11
Onset:2021-10-12
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Axillary pain, Extra dose administered, Lymphadenopathy, Pain in extremity
SMQs:, Tendinopathies and ligament disorders (broad), Medication errors (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: Daily probiotic Turmeric supplement for arthritic inflammation
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: I had no reaction to my first two Pfizer COVID vaccines in Dec 2020 and January 2021 other than a very sore arm (worse than other vaccines). I received my booster on October 11 2021 and had a very sore arm but also developed within 24 hours a very sore axilla area on the same side with swollen axillary lymph nodes in the same side. I am almost 48 hours out from the injection and the symptoms have not subsided. This did not occur with my first two doses and has never occurred with any other vaccine I have ever received.


VAERS ID: 1782211 (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: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 3 LA / IM

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

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

Write-up: Error: Incorrect Reconstitution-


VAERS ID: 1782212 (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: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 3 RA / IM

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

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

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


VAERS ID: 1782214 (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: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 3 RA / IM

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

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

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


VAERS ID: 1782220 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-12
Onset:2021-10-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017E21A / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Systemic: Dizziness / Lightheadness-Severe, Systemic: Nausea-Severe


VAERS ID: 1782223 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-10-12
Onset:2021-10-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / 3 RA / IM

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

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

Write-up: Error: Diluent Administered Instead of Vaccine-


VAERS ID: 1782224 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-10-12
Onset:2021-10-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / 3 RA / IM

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

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

Write-up: Error: Diluent Administered Instead of Vaccine-


VAERS ID: 1782230 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-10-12
Onset:2021-10-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30130BA / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Product storage error
SMQs:, Medication errors (narrow)

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

Write-up: Error: Improper Storage (temperature)-


VAERS ID: 1782233 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-10-12
Onset:2021-10-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / 3 UN / IM

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

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

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


VAERS ID: 1782234 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-10-12
Onset:2021-10-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30130BA / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Product storage error
SMQs:, Medication errors (narrow)

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

Write-up: Error: Improper Storage (temperature)-


VAERS ID: 1782239 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-12
Onset:2021-10-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2590 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Injury, Joint injury, Paraesthesia, Product administration error
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Hostility/aggression (broad), Arthritis (broad), Medication errors (narrow)

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

Write-up: Error: Shoulder Joint Injury (prolonged pain, tingling, etc.)-


VAERS ID: 1782240 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-10-11
Onset:2021-10-12
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / SYR

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

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

Write-up: Headache Nausea Tiredness


VAERS ID: 1782249 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-10-12
Onset:2021-10-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2590 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anaphylactic reaction, Anxiety, Chills, Dysphagia, Feeling cold, Throat tightness
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Anticholinergic syndrome (broad), Anaphylactic/anaphylactoid shock conditions (narrow), 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), Hypersensitivity (narrow), Hypoglycaemia (broad)

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

Write-up: Systemic: Allergic: Anaphylaxis-Medium, Systemic: Allergic: Difficulty Swallowing, Throat Tightness-Medium, Systemic: Chills-Mild, Additional Details: tightness started 30 minutes after reaction--pt received epi 3 minutes after reaction. Tightness gradually emerged, pt felt very cool. Sx subside after epipen given. Pulse read 98 bpm, pt has anxiety and started to feel anxious. Called 911--paramedic accessed. After assessment recommend to transport through ambulance but patient refused.


VAERS ID: 1782268 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-04-01
Onset:2021-10-12
   Days after vaccination:194
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 028A21A / 2 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013A21A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospitalization due to COVID in a fully vaccinated individual: Vaccinated on 4/1/21 and 3/7/21 with Moderna vaccine.


VAERS ID: 1782272 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-10-12
Onset:2021-10-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 062E21A / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Balance disorder, Chills, Gait disturbance, Headache, Insomnia, Pyrexia, Tremor
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Patient stated that last night she had chills, and shakes. Also stated she had headaches, insomnia, and high temp. Was also having trouble with balance and walking. Patient has taken Tylenol, Tylenol broke fever and fever is now down to 100.4. Still having headaches.


VAERS ID: 1782276 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-10-11
Onset:2021-10-12
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Gait disturbance, Tenderness
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Arthritis (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: Topiramate, Valtrex, Amlodipine, Cyclobinzaprine, Femhrt, Nurtec, Probiotic, Lysine, Advil, Calcium, turmeric, Miralax
Current Illness: no
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: I have a great pain in my left hip joint. I am having trouble walking and just sitting down the pain is still there. To touch the area hurts. I did not have this pain before the shot.


VAERS ID: 1782296 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-10-11
Onset:2021-10-12
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Headache, Neck pain, Pain
SMQs:, Arthritis (broad)

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

Write-up: Excruciating head ache from neck to the front of the head, pulsating throbbing pain, tiredness


VAERS ID: 1782313 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: New York  
Vaccinated:2021-10-11
Onset:2021-10-12
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Vaccination site vesicles
SMQs:, Hypersensitivity (narrow)

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

Write-up: PATIENT DEVELOPED A BLISTER NEXT TO VACCINATION SITE ON LEFT ARM. PATIENT APPLIED WARM COMPRESS TO SITE, NO PAIN . I TOLD PATIENT TO SEE DERMATOLOGIST. PATIENT MAKING APPT. AND WILL ADVISE AS TO OUTCOME.


VAERS ID: 1782315 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-10-11
Onset:2021-10-12
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 RA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Axillary pain, Oedema peripheral, Pain
SMQs:, Cardiac failure (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: Buspirone 7.5 2x/day Welburtrin XL
Current Illness:
Preexisting Conditions: Hyper mobile Ehlers Danlos syndrome, Raynauds syndrome, generalized anxiety disorder
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Swelling and soreness in right armpit. Aches and pains in whole body.


VAERS ID: 1782328 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-10-10
Onset:2021-10-12
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 2 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Axillary pain, Oedema peripheral, Skin warm, Tenderness
SMQs:, Cardiac failure (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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Birth control, multivitamin, fluticasone, claritin, thyroid
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None at this time. Did get looking at by a medical doctor.
CDC Split Type:

Write-up: After two days I noticed I had a large bulge in my right armpit. Warm to the touch. Tenderness and painful.


VAERS ID: 1782336 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-03-19
Onset:2021-10-12
   Days after vaccination:207
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

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

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

Write-up: Janssen on 3/19. Positive on 10/12


VAERS ID: 1782340 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-02-08
Onset:2021-10-12
   Days after vaccination:246
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

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

Write-up: Moderna on 1/12 and 2/8. Positive on 10/9


VAERS ID: 1782343 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: New York  
Vaccinated:2021-10-12
Onset:2021-10-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 2 LA / SYR

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

Write-up: Started with chills, felt like when my body was touched the pain radiated all over the area. That got worse turned into body aches headache and high fever.


VAERS ID: 1782345 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-02-07
Onset:2021-10-12
   Days after vaccination:247
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6198 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen (TYLENOL) 325 mg oral tablet amiodarone (CORDARONE) 200 mg oral tablet ANTIOX #8/OM3/DHA/EPA/LUT/ZEAX (PRESERVISION AREDS 2, OMEGA-3, ORAL) atorvastatin (LIPITOR) 40 mg oral tablet carboxymethylcellulo
Current Illness: ED ADMITTANCE 1/18/21 FOLLOWING FALL AND HEAD INJURY
Preexisting Conditions: Accelerated hypertension Aortic stenosis AICD (automatic cardioverter/defibrillator) present Asthma CAD (coronary artery disease) Deep vein thrombosis (DVT) Heart palpitations Hyperlipidemia, mild Hypothyroidism Macrocytic anemia Mitral regurgitation Non-sustained ventricular tachycardia Paroxysmal atrial fibrillation PONV (postoperative nausea and vomiting) RA (rheumatoid arthritis) Rhabdomyolysis STEMI (ST elevation myocardial infarction) Thyroid disorder
Allergies: Remeron [Mirtazapine] Lisinopril Zofran [Ondansetron Hcl (Pf)]
Diagnostic Lab Data: Positive COVID test 10/12/21.
CDC Split Type:

Write-up: Patient presents to the emergency department via EMS transport for evaluation of weakness following a fall


VAERS ID: 1782376 (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: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH N/A / 3 RA / IM

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

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

Write-up: Administration error mixed series vaccination mRNA vaccine Pfizer and Moderna


VAERS ID: 1782378 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-10-12
Onset:2021-10-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH N/A / 3 RA / IM

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

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

Write-up: Administration error mixed series vaccination mRNA vaccine Pfizer and Moderna


VAERS ID: 1782380 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-10-12
Onset:2021-10-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH N/A / 3 RA / IM

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

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

Write-up: Administration error mixed series vaccination mRNA vaccine Pfizer and Moderna


VAERS ID: 1782391 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-02-26
Onset:2021-10-12
   Days after vaccination:228
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER2613 / 2 UN / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6203 / 1 UN / IM
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME) / UNKNOWN MANUFACTURER FF2587 / 3 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, COVID-19 pneumonia, Chills, Cough, Diarrhoea, Dizziness, Dyspnoea, Exposure to SARS-CoV-2, Fall, Head injury, Malaise, Musculoskeletal pain, Nausea, Neck pain, Pyrexia, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Arthritis (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Benign Neoplasm Cecum, Dystrophy Corneal Endothelial, Hypertension, Hospital-Pneumonia Due To COVID-19. Benign Neoplasm Cecum, Dystrophy Corneal Endothelial, Hypertension, Essential Primary, Hyperlipidemia Mixed, Gastroesophageal Reflux Disease Without, Esophagitis, Polyp Colon, Dry Eye Syndrome Bilateral, Presence Of Intraocular Lens, Other Hereditary Corneal Dystrophies, Polyp Colon Adenomatous, Intraductal Carcinoma In Situ Of Left Breast.
Allergies: NKA
Diagnostic Lab Data: SARS Coronavirus 2, PCR Rapid, V Symptomatic DETECTED 10/13/2021
CDC Split Type:

Write-up: CHIEF COMPLAINT/REASON FOR VISIT Shortness of Breath HISTORY OF PRESENT ILLNESS This is a 79-year-old female. She has a previous medical history of hypertension, hyperlipidemia, she presents today due to shortness of breath. This evening, the patient ambulated to the bathroom and was feeling weak and dizzy and had a fall. She is not exactly sure how she fell, but did fall onto her bottom and she also thinks she hit her head. She did not lose consciousness. She does report buttock pain and neck pain after the fall. This is preceded by a week of her feeling sick. She has had symptoms of fevers, chills, nausea, diarrhea, and cough. She did have a recent known contact to another person with COVID-19. She is vaccinated. She received her booster dose on 10/02.


VAERS ID: 1782393 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: New York  
Vaccinated:2021-10-11
Onset:2021-10-12
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822809 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain, Abdominal pain upper, Arthralgia, Chest pain, Chills, Fatigue, Muscle spasms, Nausea, Pyrexia, Retching
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dystonia (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Chills, fever, chest pain, abdominal pain, stomach ache, fatigue, nausea, dry heaving and gagging, joint pain, muscle cramping, headache


VAERS ID: 1782397 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: New York  
Vaccinated:2021-10-12
Onset:2021-10-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 3 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Choking, Cough, Oropharyngeal pain, Palatal oedema, Pharyngeal erythema, Pharyngeal swelling, Throat irritation, Throat tightness
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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Asthma, mitral valve regurgitation, chronic back pain of unknown etiology
Allergies: None
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: I started feeling a scratchy/sore throat around 1h30min after taking the 3rd dose, which gradually worsened throughout the day. In the evening, the pain became very intense, and my throat felt swollen. I woke up at night feeling like my throat might close, but I was still able to breathe. I woke up at a different point choking on my own saliva, and coughing profusely as a consequence. Today upon waking up my throat was red and looked somewhat swollen; my uvula in particular looked somewhat edematous (perhaps the soft palate as well, but I could not tell).


VAERS ID: 1782438 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: West Virginia  
Vaccinated:2021-10-12
Onset:2021-10-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 3 LA / IM

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

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

Write-up: Patient received Moderna COVID-19 on 1/14/21 and 2/10/21 for their primary series of COVID-19 vaccines. Patient did not report what vaccine they received for their primary series and presented to receive a booster dose of the Pfizer-BioNTech COVID-19 vaccine. It was discovered when entering into the statewide system that the patient received Moderna for their primary series. Patient has not reported any ADRs as of the time of the report.


VAERS ID: 1782441 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-10-12
Onset:2021-10-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood pressure increased, Flushing, Hyperhidrosis, Nausea, Tachycardia
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (narrow), Hypersensitivity (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Adderall 20mg daily
Current Illness: none
Preexisting Conditions: none
Allergies: nkda
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Tachycardia HR 118, elevated BP 185/120, flushed face, sweating, nausea - Treated with Benadryl 25mg IM and Famotidine 20mg po, symptom duration 30 minutes


VAERS ID: 1782449 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: West Virginia  
Vaccinated:2021-10-12
Onset:2021-10-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 061E21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Body temperature increased, Feeling of body temperature change, Headache, Muscular weakness, Nausea, Pain
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Temperature of 99.9?F. Severe headache. Nausea. Lower half of body feels like its freezing and the top half feels like it is burning up. Every joint and body aches. Upper left arm muscles is weak.


VAERS ID: 1782454 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: New York  
Vaccinated:2021-10-12
Onset:2021-10-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dysgeusia, Pain
SMQs:, Taste and smell disorders (narrow)

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

Write-up: Metallic taste in mouth so bad that i cannot drink anything besides water as the taste is awful. Left side from arm to leg is hurting


VAERS ID: 1782462 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-10-12
Onset:2021-10-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal pain lower, Arthralgia, Chills, Diarrhoea, Fatigue, Headache, Injection site erythema, Injection site pain, Injection site swelling, Lymphadenopathy, Malaise, Myalgia, Nausea, Pain in extremity, Pyrexia, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Arthritis (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: injection site pain, tiredness, headache, muscle pain, chills, joint pain, fever, injection site swelling, injection site redness, nausea, feeling unwell, lymphadenopathy, diarrhea, vomiting, arm pain, fatigue, lower abdominal pain.


VAERS ID: 1782464 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-03-18
Onset:2021-10-12
   Days after vaccination:208
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0162-2 / 2 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8727 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Angiogram cerebral abnormal, Arteriogram carotid abnormal, Balance disorder, Blood electrolytes normal, COVID-19, Cerebral venous sinus thrombosis, Computerised tomogram head normal, Condition aggravated, Dizziness, Full blood count normal, Headache, SARS-CoV-2 test positive, Tinnitus
SMQs:, Anticholinergic syndrome (broad), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Guillain-Barre syndrome (broad), Central nervous system vascular disorders, not specified as haemorrhagic or ischaemic (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hearing impairment (narrow), Vestibular disorders (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Hospital Stroke Pulsatile Tinnitus Left Ear Thrombosis Venous Sinus Headache New COVID-19 Infection Non-Hospital Cholecystitis
Allergies: NKA
Diagnostic Lab Data: SARS CoV-2, PCR, Rapid, V Detected 10/12/2021
CDC Split Type:

Write-up: CHIEF COMPLAINT Headache HISTORY OF PRESENT ILLNESS: Patient is a 42 y.o. female with medical comorbidities significant for hyperlipidemia (not on medication), migraine with aura (takes sumatriptan), depression who presents with chief complaint of left-sided pulsatile headache and dizziness of 1 day duration. Yesterday she developed sudden onset tinnitus of the left ear and a pulsatile headache above and below the left ear. She states that these symptoms were very different than her migraine with aura, as it was not associated with photophobia, phonophobia, or nausea/vomiting. She took her sumatriptan after which her symptoms briefly improved but did not resolve. Also endorses associated dizziness which she describes as "feeling like you are on a boat and unsteady." Denies any recent fever, chills, or respiratory symptoms. She was concerned that she might be having a stroke, so she decided to present to the ED for further workup. Workup in the ED significant for PCR-positive COVID-19. Electrolytes and complete blood count within normal limits. CT head non-contrast without acute intracranial abnormality. CTA head/neck significant for nonocclusive thrombus in the left sigmoid venous sinus, but patent intracranial nd cervical carotid and vertebral circulations. She takes oral contraceptive pills and is a non-smoker. She has a longstanding history of migraine with aura for which she takes sumatriptan. Denies any known COVID-19 exposure or symtpoms. She did have a COVID-19 infection diagnosed in January of 2021, and received two doses of the Pfizer vaccine (March and April 2021).


VAERS ID: 1782470 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-10-11
Onset:2021-10-12
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Axillary pain, Chills, Extra dose administered, Fatigue, Headache, Injection site pain, Oedema peripheral, Pain
SMQs:, Cardiac failure (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), 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: Pfizer COVID-19 2nd dose, 4/10/2021, lymph node in armpit painfully swollen, soreness at injection site, more frequent menstruat
Other Medications: Bupropion Hcl X 300mg tablet Telmisartan 40 mg tablet Metoprolol Suc 12.5 mg tablet Symbicort (budesonide 160 mcg and formoterol fumarate dihydrate 4.5 mcg) inhalation aerosol
Current Illness: n/a
Preexisting Conditions: long COVID
Allergies: Penicillin, norethindrone, sulfa antibiotics, Saxenda
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Chills, body aches, headache, fatigue, lymph node in left armpit painfully swollen, soreness at injection site


VAERS ID: 1782481 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-10-11
Onset:2021-10-12
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EF8027 / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Chills, Dyspnoea, Headache, Myalgia, Oedema peripheral, Pain
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: levothyroxine 75 mcg.
Current Illness: none
Preexisting Conditions: Hypothyroid
Allergies: Codeine, IBU,Advil,Aspirin, diclofenac sodium, PCN
Diagnostic Lab Data: none
CDC Split Type:

Write-up: muscle pain, joint pain , severe headache, chills, right under arm swollen, even my teeth hurt and short of breath I took Tylenol every 6 hours and drank plenty of fluids and rested 24 hours


VAERS ID: 1782507 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Nevada  
Vaccinated:2021-10-10
Onset:2021-10-12
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Gait disturbance, Pain
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Arthritis (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: Carbomazepene
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Sore, throbbing pain in left knee. I had no activity prior to this event. 7pm..On phone..Simply sitting in chair and laying on bed. Symptoms grew so bad by 11pm could barely bend knee and almost impossible to walk.


VAERS ID: 1782522 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-10-08
Onset:2021-10-12
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Chest discomfort, Chest pain, Electrocardiogram ST segment elevation, Myocarditis, Pericarditis
SMQs:, Anaphylactic reaction (broad), Systemic lupus erythematosus (broad), Myocardial infarction (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies: Midazolam
Diagnostic Lab Data:
CDC Split Type:

Write-up: Myopericarditis requiring hospitalization. Chest pain symptoms started 4 days after patients COVID Pfizer booster. Initial vaccination series was 12/17/2020 and 1/8/2021. Patient''s substernal chest pressure, positional with improvement sitting forward as well as EKG changes showing diffuse ST elevations all support pericarditis. Chest pain improve with colchicine and ibuprofen.


VAERS ID: 1782532 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-10-11
Onset:2021-10-12
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 061F21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Burning sensation, Condition aggravated, Paraesthesia, Small fibre neuropathy
SMQs:, Peripheral neuropathy (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: yes, small fiber neuropathy after flu vaccine received in late October 2015 I was 47 at the time. Brand is unknown..got shot a
Other Medications: Flonase, Claritin, Vitamin C, B12, D, B complex, turmeric, echinacea, elderberry, milk thistle, probiotic
Current Illness: N/A
Preexisting Conditions: Small fiber neuropathy, which occurred 2 days after receiving a flu vaccine in October 2015.
Allergies: Flexerill
Diagnostic Lab Data: N/A as this is only day 3, post dose.
CDC Split Type:

Write-up: Experiencing intermittent mild burning and tingling in hands, feet, and forearms which is consistent with small fiber neuropathy, a clinically documented pre existing condition that I suffer from. However, the new symptoms have excabertared directly following my dose.


VAERS ID: 1782538 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-10-12
Onset:2021-10-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH PFIZER / 1 LA / IM

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

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

Write-up: WE OFFER PFIZER COVID-19 SERIES AND BOOSTERS. PATIENT STATED HE HAD NOT RECIEVED A COVID-19 VACCINATION YET AND FILLED OUT NECESSARY PAPERWORK. WHEN UPLOADING VACCINATION INFORMATION INTO IT WAS DICOVERED HE HAD BEEN GIVEN COVID-19 JANSSEN BY ANOTHER PROVIDER ON 6/7/21. WE ARE DOING OUR DUE DILIGENCE AND REPORTING THE VACCINE ERROR. NO ADVERSE REACTIONS/EVENTS WERE REPORTED BY PATIENT


VAERS ID: 1782544 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-10-11
Onset:2021-10-12
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: No adverse event, Pain, Vaccine positive rechallenge
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Body aches, fever followinfg 2nd Pfizer Covid-19 vaccine on March 2, 2021
Other Medications: Verapamil Omeprazole Fosinopril Atorvastatin Cranberry Vitamin D Probiotic
Current Illness: None
Preexisting Conditions: High Blood Pressure
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Body aches on day 1 after vaccine. I took aspirin 26 hours after receiving the vaccine. It seemed to ease the symptoms. No adverse event on day 2 following vaccine.


VAERS ID: 1782553 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2021-10-12
Onset:2021-10-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH WMT#824 / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Nervousness, Vertigo
SMQs:, Anticholinergic syndrome (broad), Vestibular 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: Fluoxetine, pantoprazole, celecoxib, aspirin 81 mg, Azo probiotic, D Manassas, Calcium, vitamin D
Current Illness: none
Preexisting Conditions: pollen allergies
Allergies: Gluten,
Diagnostic Lab Data:
CDC Split Type:

Write-up: Dizzy spell within 15 minutes of receiving shot, subsided and drove home; vertigo for next 6 hours. Better today but still feeling shaky.


VAERS ID: 1782571 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-01-23
Onset:2021-10-12
   Days after vaccination:262
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1685 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL8982 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Antigen COVID-19 test with a positive result.
CDC Split Type:

Write-up: Patient received the COVID-19 vaccine on 1/4/21 and 1/23/21, so was fully vaccinated when testing positive for COVID-19 on 10/12/21.


VAERS ID: 1782579 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-02-11
Onset:2021-10-12
   Days after vaccination:243
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1284 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Antigen COVID-19 test with a positive result.
CDC Split Type:

Write-up: Patient was vaccinated for COVID-19 on 1/21/21 and 2/11/21, so was fully vaccinated when testing positive for COVID-19 on 10/12/21.


VAERS ID: 1782588 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-04-29
Onset:2021-10-12
   Days after vaccination:166
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / N/A LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: Sofia Antigen COVID-19 test with a positive result.
CDC Split Type:

Write-up: Patient was vaccinated for COVID-19 on 4/29/21, so was fully vaccinated when testing positive for COVID-19 on 4/29/21.


VAERS ID: 1782591 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-10-11
Onset:2021-10-12
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Headache, Myalgia, Nausea, Pain, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Severe headache, severe muscle, joint, and body aches, nausea, fever as high as 102.8 , lasted about 12 or 13 hours


VAERS ID: 1782598 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-10-11
Onset:2021-10-12
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017F21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Axillary mass, Axillary pain
SMQs:

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

Write-up: Approximately 24 hours after receiving the vaccine. his left arm pit was sore. He woke up the next morning with a softball size lump under his left arm. Took some Tylenol and applied ice to the lump.


VAERS ID: 1782600 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-02-06
Onset:2021-10-12
   Days after vaccination:248
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1284 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9262 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: Antigen COVID-19 test with a positive result.
CDC Split Type:

Write-up: Patient was vaccinated for COVID-19 on 1/16/21 and 2/6/21, so was fully vaccinated when testing positive for COVID-19 on 10/12/21.


VAERS ID: 1782609 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-03-15
Onset:2021-10-12
   Days after vaccination:211
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6208 / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Antigen COVID-19 test with a positive result.
CDC Split Type:

Write-up: Patient was vaccinated for COVID-19 on 2/22/21 and 3/15/21, so was fully vaccinated when testing positive for COVID-19 on 10/12/21.


VAERS ID: 1782615 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-09-29
Onset:2021-10-12
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 3 UN / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Musculoskeletal stiffness, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Hypersensitivity (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: hives on neck, stiff neck


VAERS ID: 1782616 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Mississippi  
Vaccinated:2021-10-12
Onset:2021-10-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822809 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Feeling cold, Headache, Heart rate increased, Muscle spasms, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dystonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

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

Write-up: Sever cramps right after for 2 hours straight Slight headache around 7 Chills started at 8, have been awful since...its 9:38. Bodyaches right after and then Fever 100.7 at 9:20 Fever 100.9 at 9:38 Fever 101.2 at 9:58 Fever 101.3 at 10:08 Fever 101.8 at 10:18 Fever 101.5 at 10:28 Fever 101.8 at 10:37 Fever 102 at 10:44 - still freezing, so cold Heart beating fast Still 102 at 10:51 Fever 102.2 Still the same at 11:18 Fever 102.1 at 12:02 Fever 102.7 at 12:12 Fever 102.4 at 12:30 102.2 at 1:47 102 at 205 101.2 at 420 99.9 at 9:00am Severe headache, body aches Currently 11:46 am next day and the headache is moderate


VAERS ID: 1782628 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-12
Onset:2021-10-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822809 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Burning sensation, Interchange of vaccine products, Neuralgia
SMQs:, Peripheral neuropathy (narrow), Medication errors (broad)

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

Write-up: 49 yo female received 1st dose Pfizer vaccine on 8/12/21. When client arrived at vaccine site, client reported to Lead RN that 30 hours after receiving the Pfizer vaccine she experienced a severe burning sensation that she described as a "sun burn" as well as nerve pain in arms and legs lasting for several hours. Client stated the pain still continues to come back in waves, particularly burning in the palms of hands and soles of feet. Client followed up with PCP 2 weeks after receiving vaccine and PCP referred to Neurologist. Client received diagnostic testing with Neurologist and reported neurologist told her everything came back normal. Client took gabapentin one time to treat pain but did not continue due to severe dizziness. Client reported she experienced a similar burning sensation in March 2020 when she tested positive for COVID-19. Client has NKDA and no chronic health conditions. Client provided Dr. note advising she receives Janssen vaccine for 2nd dose. Lead nurse elevated request to vaccine RN supervisor. RN supervisor elevated request to MD. MD gave clearance for client to receive Janssen as 2nd dose with a 30 minute observation. Client received the Janssen COVID-19 vaccine (lot#1822809, expiration 03/07/22) in the L deltoid at approximately 1600. No adverse reaction observed during 30 minute observation. Advised client to follow up with PCP and reviewed ER precautions.


VAERS ID: 1782662 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-10-12
Onset:2021-10-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vit B, Calcium/mag/zinc, vit D, fish oil, tofacitinib, turmeric, valacyclovir
Current Illness: N/A
Preexisting Conditions: rheumatoid arthritis, psoriasis
Allergies: Chantix, amoxicillin, humira, sulfa
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Employee came in for covid booster. Currently giving only Pfizer boosters. After completing questions, Pfizer vaccine given. When given vaccination card, noted that previous doses were Moderna. Patient monitored for 15 minutes. No adverse effects noted.


VAERS ID: 1782673 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-03-08
Onset:2021-10-12
   Days after vaccination:218
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 04A21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Angiogram pulmonary abnormal, COVID-19, Cough, Dyspnoea, Hypoxia, Lung infiltration, Pneumonia, SARS-CoV-2 test positive, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Interstitial lung disease (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Asthma, DM, HTN, CAD, OSA
Allergies:
Diagnostic Lab Data: 10/12/21 - SARS-COV-2 PCR + 10/12/21 - CTA Chest - Bilateral lung infiltrates compatible with PNA
CDC Split Type:

Write-up: Presented to ED with progressive shortness of breath, wheezing, cough. Was noted to be hypoxic requiring low flow oxygen (4 L at time of report) to maintain saturations $g 90%.


VAERS ID: 1782676 (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: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2590 / 1 - / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Confusional state, Dizziness, Dyspnoea, Hallucination, Immediate post-injection reaction, Nausea, Pallor, Presyncope, Skin discolouration, Speech disorder, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (broad), Psychosis and psychotic disorders (narrow), 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), Hypersensitivity (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Multivitamins
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Vitals, oxygen levels blood. Blood sugar. Normal .
CDC Split Type:

Write-up: Immediate Extreme dizziness and confusion Faintness, nausea, vomiting, hallucinations, restricted breathing, pale and discolored. Unable to speak and not able to think straight. Called 911 parademics


VAERS ID: 1782681 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-10-12
Onset:2021-10-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Urine analysis, Urine leukocyte esterase positive, Vaccine positive rechallenge, White blood cells urine positive
SMQs:, Chronic kidney disease (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: on 3/1/2021 received the pfizer first dose and had a UTI the next day
Other Medications:
Current Illness:
Preexisting Conditions: Recurrent UTIs
Allergies:
Diagnostic Lab Data: Urinalysis showed leukocyte esterase and WBCs
CDC Split Type:

Write-up: UTI symptoms including dysuria and urgency within 12 hours. Treated for UTI the next day. Had identical issue on 3/1/2021 where she had the pfizer shot and had a UTI the next day on 3/2/2021


VAERS ID: 1782685 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-10-12
Onset:2021-10-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2590 / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Incorrect route of product administration
SMQs:, Drug abuse and dependence (broad), Medication errors (narrow)

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

Write-up: shot was injected in fat under arm instead of muscle


VAERS ID: 1782686 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-08-25
Onset:2021-10-12
   Days after vaccination:48
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Angiogram cerebral, Arteriogram carotid, Cerebral infarction, Cerebral venous thrombosis, Computerised tomogram head, Magnetic resonance imaging head, Superior sagittal sinus thrombosis
SMQs:, Ischaemic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Central nervous system vascular disorders, not specified as haemorrhagic or ischaemic (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: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: CTA head/neck 10/12/21 CT brain 10/12/21 MRI brain, MRA head and neck 10/12/21 CT brain 10/13/21
CDC Split Type:

Write-up: development of superior sagittal sinus thrombosis with right mid to posterior cortical vein thrombosis with associated venous infarction


VAERS ID: 1782718 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-10-12
Onset:2021-10-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009C21A / 2 RA / IM

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

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

Write-up: Patient attended clinic to receive second dose COVID-19 vaccination requesting Moderna. RN administered second dose Moderna and discovered patient had received first dose Pfizer COVID-19 vaccination afterwards.


VAERS ID: 1782753 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-10-12
Onset:2021-10-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301458A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
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: 1782759 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-12
Onset:2021-10-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Condition aggravated, Swollen tongue, Throat clearing
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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Pfizer Covid vaccine dose 1 & 2
Other Medications: Albuterol, Zyrtec, Benedryl, Pepcid, Antivert, Zofran, Deltasone,
Current Illness: asthma, previous reactions to Pfizer Covid d1 & 2
Preexisting Conditions: Asthma, Eczema
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient visited vaccine clinic today for third dose of COVID vaccine. Patient states has a history of respiratory issues related to asthma following COVID vaccine. Patient states followed medication regimen as ordered by their HCP before COVID vaccine today. Patient advised to remain in clinic at least 30 minutes after vaccination. Patient received third dose Pfizer Covid vaccine 0.3mL. At around 1000 patient states is having minor tongue swelling and states beginning to feel the need to clear her airways. Patient states she felt that way after receiving her second dose, but that it cleared. Urgent care was notified and patient was advised to schedule visit with Urgent care clinic. Patient transferred over to urgent care clinic and was discharged home after receiving Solumedrol IM and Rx for oral prednisone. .


VAERS ID: 1782760 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-10-12
Onset:2021-10-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 1 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? 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: Error: Wrong Vaccine Formulation (ex. different manufact. initial and booster)-


VAERS ID: 1782762 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-10-12
Onset:2021-10-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011F21A / 1 RA / IM

Administered by: Work       Purchased by: ?
Symptoms: Unevaluable 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: propranol 10 mg, Methimazole 10mg, and citalopram 20 mg
Current Illness: none
Preexisting Conditions: Hyperthyroidism, anxiety, and uterine leiomyoma
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: None


VAERS ID: 1782773 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-10-12
Onset:2021-10-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 061E21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Product storage error
SMQs:, Medication errors (narrow)

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

Write-up: Error: Improper Storage (temperature)-


VAERS ID: 1782779 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-10-12
Onset:2021-10-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 211A21A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Hyperhidrosis, Nausea, Paraesthesia, Peripheral swelling, Pyrexia, Tremor
SMQs:, Cardiac failure (broad), Acute pancreatitis (broad), Angioedema (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Several hours after receiving the vaccination, I experienced violent shaking/trembling as well as swelling of my limbs and tingling in lower extremities. Other symptoms included fever, sweats and nausea. Symptoms have not resolved completely at time of submission.


VAERS ID: 1782788 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-10-12
Onset:2021-10-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

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

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

Write-up: Joints ached and had to stay home from work also experience a fever for 12 hours


VAERS ID: 1782799 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-10-12
Onset:2021-10-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 212A21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal discomfort, Blood pressure decreased, Dizziness, Pyrexia, Sensitive skin
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Multi Vitamin, zyrtec, probiotics, magnesium/calcium supplement, apple cider vinger pill, hair/skin/nail vitamin
Current Illness: None
Preexisting Conditions: None
Allergies: Penicillin, Ceclor, erythromycin, orange juice
Diagnostic Lab Data: N/a
CDC Split Type:

Write-up: Blood pressure drop, dizziness, fever, skin sensitivity, light headed, upset stomach


VAERS ID: 1782806 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-04-24
Onset:2021-10-12
   Days after vaccination:171
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0150 / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal pain, Chills, Diarrhoea, Dyspnoea, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Noninfectious diarrhoea (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Abdominal pain, vomiting, SOB, chills, diariah


VAERS ID: 1782818 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-04-07
Onset:2021-10-12
   Days after vaccination:188
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER2613 / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0153 / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Malaise, Pain
SMQs:, Guillain-Barre syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Not feeling well, weakness and body aches


VAERS ID: 1782833 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-10-11
Onset:2021-10-12
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301358A / 3 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Diarrhoea, Dizziness, Extra dose administered, Myalgia, Nausea, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Pfizer 1st and 2nd shots, second shot on 3/17/21
Other Medications: Diovan, glipizide, metformin, thyroxine, metoprolol, atovastatin, fenofibrate
Current Illness:
Preexisting Conditions: post quad. bypass, diabetes, hypertension, hoshimotos,
Allergies: dilaudid, latex, seasonal allergies
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Pfizer booster rec''d. Dizziness, myalgias (all over), fever (highest 101.4), continued until Saturday 10/9/21, diarrhea, nausea. for two days 10/12 and 10/13/21.


VAERS ID: 1782837 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-03-13
Onset:2021-10-12
   Days after vaccination:213
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016M20A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040A21A / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Dyspnoea, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (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? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever and SOB


VAERS ID: 1782839 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-02-09
Onset:2021-10-12
   Days after vaccination:245
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK9231 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3247 / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Cough, Dyspnoea exertional, Hypoxia
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: amlodipine, triamterene/hydrochlorothiazide
Current Illness: none
Preexisting Conditions: chronic kidney disease hypertension
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient diagnosed with covid-19 on 9/30/2021 and sent by PCP''s office with hypoxia. Patient had cough and received monoclonal antibody infusion on 10/8/2021. Patient completed steroids on 10/9/2021 and had worsening SOB on exertion.


VAERS ID: 1782840 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-10-11
Onset:2021-10-12
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: Doxycycline. Tramadol
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient is experiencing numbness, tingling and a feeling of pins and needles in her feet, legs, arms and face.


VAERS ID: 1782848 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-01-28
Onset:2021-10-12
   Days after vaccination:257
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011L20A / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012M20A / 2 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Anticoagulant therapy, Asthenia, Atrial fibrillation, COVID-19, Cardiac telemetry abnormal, Cardiomegaly, Chest X-ray abnormal, Computerised tomogram thorax, Coronary artery disease, Cough, Dyspnoea, Hypoxia, Lung disorder, Lung infiltration, Pulmonary oedema, Respiratory tract congestion, SARS-CoV-2 test positive
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Interstitial lung disease (narrow), Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Other ischaemic heart disease (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Physical Exam Vitals & Measurements T: 98.7 ?F (Oral) HR: 69(Peripheral) HR: 80(Monitored) RR: 24 BP: 132/89 SpO2: 96% WT: 107 kg VITAL SIGN LAST CHARTED MINIMUM MAXIMUM Blood Pressure 132/89 (10/12 16:15) 132/89 (10/12 16:15) 140/114 (10/12 15:49) Heart Rate 69 (10/12 17:30) 15 (10/12 15:49) 95 (10/12 16:45) Respirations 24 (10/12 17:00) 18 (10/12 15:49) 28 (10/12 16:30) Temperature 98.7 (10/12 15:49) 98.7 (10/12 15:49) 98.7 (10/12 15:49) SpO2 96 (10/12 17:30) 84 (10/12 15:49) 98 (10/12 17:15) O2 Flow Rate 3 (10/12 16:19) 3 (10/12 16:19) 3 (10/12 16:19) Weight 107 (10/12 15:49) 107 (10/12 15:49) 107 (10/12 15:49) Progress Note 10/13/2021 he states that he''s feeling "a little better" today, noting less SOB. He''s back on 3L oxygen this morning (was up to 5L). Tolerating p.o., no N/V.- Continue dexamethasone, day 2 of 10 - Cannot do remdesivir due to renal function - Initial oxygen requirement 3 L; now up to 5 L - Repeat CXR today w/cardiomegaly, interstitial infiltrates and bibasilar airspace disease; appears more consistent with pulmonary edema - Give tocilizumab today (10/13) - CTA with concern for pulm edema, might be contributing to hypoxia -- $g Lasix 40mg IV daily (will have to watch renal function closely) - Wean O2 as tolerated Atrial fibrillation. - Currently NSR on monitor - Continued home Coreg - Stop Eliquis due to interaction with dexamethasone; switch to therapeutic Lovenox (renal dose) - Telemetry Coronary artery disease (CAD). - Continued home ASA, statin - Stable CKD, stage IV. - Currently appears at baseline renal function - Was scheduled to have initial appointment w/Nephrology today - May need inpatient consult, pending course - Avoid nephrotoxins as able Essential HTN. - Continued home Coreg, Norvasc, lisinopril - Initially held home Lasix, but started on IV 40mg on 10/13 - BP''s currently within acceptable range
CDC Split Type:

Write-up: Admited 10/12/2021. Arrived via POV from PCP office after c/o SOB x1 week. Test positive today. c/o generalized weakness. History of Present Illness 89yo man with multiple medical issues who presents with cough and congestion. He is vaccinated for COVID since March, 2021. His symptoms started roughly 1 week ago. He denies fevers and chills. No n/v. Reports significant weakness. He went to his PCP today and his pulse ox was 82% on RA and he tested positive for COVID. He was sent to the ED for further care. Here he underwent CTA PE protocol which showed no PE but he does have b/l airspace disease. He was hypoxic on his ABG and admission was requested. Review of Systems A complete point 10


VAERS ID: 1782855 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-12
Onset:2021-10-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 3 RA / IM

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

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

Write-up: Client who is an employee registered for 3rd dose of Moderna. Client went into the vaccine room to the Moderna table to receive her vaccine with her vac card that documented two previous Moderna Vaccines. The drawer in the room, LVN handed the vaccinator a Pfizer Vaccine. The vaccinator vaccinated client with Pfizer vaccine instead of the Moderna Vaccine. The client sustained no adverse reaction post vac. Unit supervisors and RN notified.


VAERS ID: 1782870 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-10-11
Onset:2021-10-12
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN JANSSEN/J&J / 1 LA / IM
FLU4: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE QUADRIVALENT) / SANOFI PASTEUR FLUZONE HD / 1 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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Not sure
Current Illness: Patient was previously experiencing a rash, totally unrelated to the vaccine
Preexisting Conditions: None that we are aware
Allergies: NKA
Diagnostic Lab Data: None that we know of.
CDC Split Type:

Write-up: The patient made an appt for the J&J vaccine (only vaccine we were giving on 10/11/21), but meant to make an appt for his Pfizer booster. He was inadvertently given a J&J vaccine instead of the Pfizer booster he was looking for. He did not have symptoms, but happened to have an appt with his physician for a rash (totally unrelated to the vaccines). The physician called the pharmacy and informed us of what happened. I talked to the patient. He feels fine, is just concerned about whether the J&J will work as a booster or if he should still get a Pfizer booster shot.


VAERS ID: 1782875 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-10-12
Onset:2021-10-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 023C21A / 1 LA / SYR

Administered by: Military       Purchased by: ?
Symptoms: Dyspnoea, Eye pruritus, Pruritus, Throat irritation, Throat tightness
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: itchy eyes during the first 15 minutes post vaccine. took 50mg benadryl - didnt help. itchy face, hands, and throat to follow with closing of throat of shortness of breath


VAERS ID: 1782877 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-10-10
Onset:2021-10-12
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / 1 RA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamins B,C,D
Current Illness: No
Preexisting Conditions: Patient was diagnosed with P.A.ND.A.S. At age 7
Allergies: No
Diagnostic Lab Data:
CDC Split Type:

Write-up: At appx. 8:00 am on 10/12/21 patient began to have diarrhea and continued having diarrhea all day long and stopping at approximately 9:30 pm. At appx 1:45 am on 10/13/21 Patient vomited alot. But no more vomiting after the one time.


VAERS ID: 1782889 (history)  
Form: Version 2.0  
Age: 92.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-10-12
Onset:2021-10-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO187 / 3 LA / IM

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

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

Write-up: The Vaccine was diluted with 1.4 ml instead of 1.8ml. Patient was called by provider and explained to call with any adverse reactions .


VAERS ID: 1782906 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-02-25
Onset:2021-10-12
   Days after vaccination:229
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9266 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7534 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal pain, Asthenia, Back pain, Blood creatinine increased, Blood lactic acid, Blood urea increased, COVID-19, Chest X-ray abnormal, Chills, Computerised tomogram head normal, Confusional state, Diarrhoea, Dyspnoea, Fall, Headache, Lung opacity, Mental status changes, Pain, Procalcitonin, Pyrexia, SARS-CoV-2 test positive, Urine analysis normal, Vomiting, Walking aid user
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Pseudomembranous colitis (broad), 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), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Noninfectious diarrhoea (narrow), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: Patient is a 73-year-old male with a past medical history of ESRD m/w/f, Crohn disease, neuropathy presents to the ED due to shortness of breath and altered mental status that started about a week ago. Upon arrival to the ED patient was originally confused and confusion resolved by the time I saw the patient and was able to provide history. Patient reports he recently tested positive of COVID-19 10/2/21 at urgent care and that his sister who care for him periodically also tested positive for COVID-19. Patient stats that he his vaccinated. Patient reports headache, fever, chills, shortness of breath, confusion, weakness and body ache, vomiting, diarrhea. Patient reports he ambulates with walker. Admitted to hospital 10/12/2021.Patient reports he ambulates with walking cane and he has had frequent fall, over the past 6 months he has fell twice without hitting his head, last fall was 2 months ago. Patient complains of back aching pain onset 2 months ago after fall, that radiates to the abdomen, intensity 7/10, no associated symptoms, alleviating factors include rest, aggregative factors include movement. Patient also has history of ESRD, and reports that his sister drove him to dialysis yesterday. Patient reports he lives by himself in an apartment and his sister comes over to assist him periodically. Patient denies chest pain, urine changes, loss of consciousness, dizziness, and any head trauma. ED course: Vital: WNL except BP 105/69 Lab: Creatinine 4.4, BUN 23.7, procalcitonin 8.64, lactic acid 2 UA wnl CXR: Chronic markings with right bibasilar opacity possibly representing focal infiltrate. CT head or brain without contrast: No acute findings BC pending cefepime, vancomycin. ESRD m/w/f Cataract crohn Anemia Neuropathy GERD


VAERS ID: 1782907 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-02-10
Onset:2021-10-12
   Days after vaccination:244
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / IM

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

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

Write-up: Patient tested positive for COVID 19 on 10/12/21. No vaccine lot information available on database.


VAERS ID: 1782910 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-10-12
Onset:2021-10-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-13
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: covid Vaccine was diluted with 1.4 ml instead of 1.8ml, at this time no adverse reaction. Provider called patient to let them know of the error and to call back if any reactions.


VAERS ID: 1782915 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-12
Onset:2021-10-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017F21A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: flu vaccine when she was an infant (history of hospitalization for a week or so)
Other Medications: N/A
Current Illness: No
Preexisting Conditions: No
Allergies: No allergies
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Within 5 minutes of administering the vaccine, patient became unconscious for 2-3 minutes and slowly became conscious and started responding to our questions.


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